The most popular abortion method in the U.S. could vanish from the market, leaving providers scrambling to find alternatives after the end of Roe v. Wade.
A Texas judge is expected to rule soon on a case seeking to remove the Food and Drug Administration’s decades-old approval of mifepristone, one of two pills commonly used together to terminate a pregnancy. The anti-abortion group behind the suit is arguing the FDA fast-tracked the drug’s authorization and lacked sufficient evidence to make its final decision.
Research has shown that medication abortion is safe and effective. Mifepristone is approved for use in more than 80 countries, including Canada, Sweden and the U.K.
Losing access to the pill “really would be catastrophic,” said Hayley McMahon, a public health researcher and doctoral student at Emory Rollins School of Public Health.
Over the last 20 years, medication abortion has become increasingly popular in the U.S. The most recent data from the Centers for Disease Control and Prevention found that it accounted for more than half of all abortions in the country as of 2020. The number is likely higher now due to rule changes in recent years that have made it easier to prescribe via telemedicine and send to patients by mail.
Ahead of the ruling, abortion providers have started to make contingency plans. Telehealth clinics Honeybee Health and Abortion on Demand said they’ll stock up on misoprostol, the pill currently prescribed along with mifepristone to induce abortions, if the ruling doesn’t go their way. Misoprostol is approved for treating stomach ulcers, but studies have found that on its own can induce an abortion safely, though less reliably than the two-pill regimen. Together the two pills have a 95% success rate on average.
Aid Access and Choix are among the telehealth abortion services that allow people who aren’t yet pregnant to purchase mifepristone — which has a shelf life of about five years — to save for later use. They offer sliding-scale payments, but experts caution it still might not be an option for low-income people. Aid Access also could continue prescribing the pill and shipping it from overseas.
Major retail pharmacies Rite Aid Corp., Walgreens Boots Alliance Inc. and CVS Health Corp. have plans to sell it in locations where state law allows. CVS Chief Executive Officer Karen Lynch said in an interview that the company follows state and federal laws in distributing medication. Walgreens spokesperson Fraser Engerman wouldn’t comment on pending litigation. Rite Aide is monitoring the latest developments, spokesperson Terri Hickey said, and dispenses medication in accordance with state and federal laws.
Abortion providers have had to adapt to fast-changing rules in post-Roe v. Wade America, where lawsuits can alter state law from one week to the next. But the Texas abortion pill suit threatens to have lasting, national implications. Without FDA approval, the drug would be pulled from the U.S. market, with a potential years-long process to regain approval.
The looming ruling, which Greer Donley, a law professor at the University of Pittsburgh has called “unprecedented,” has left clinics with more questions than answers. They’re unclear on when they would have to comply and what it would mean for their current supply of mifepristone.
Clinics that see patients in person say they’ll try to shift as many people as they can to procedures. But that will likely mean fewer overall abortions because supply is limited and not everyone can afford the time and travel costs.
“You just can’t simply see as many patients in a day if they're all procedures versus the medication option,” Ashley Brink, the clinical director of Trust Women Wichita, said at a virtual roundtable on Feb. 9. The clinic, which is the closest option for millions of people living in border states to the south with near-total bans, told Bloomberg News last year that its already overloaded and has to turn patients away.
