“In those states, there are still access concerns and those pharmacies are still stuck between a rock and the hard place, between state and federal law, in what they can do,” Dr. Bernstein said.
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Asked if pharmacies were prepared to be swept up in the polarized abortion debate, she said, “Each pharmacy is going to have to make their own determination based on the political, and also religious and ethical considerations.”
The steps for pharmacies to become certified to dispense mifepristone are not difficult, but they involve some administrative requirements that go beyond the process pharmacies use with most other medications, such as designating an employee to ensure compliance.
For chains like CVS and Walgreens, the most logistically intricate step might be the requirement that pharmacies keep confidential the names of the certified health providers who prescribe mifepristone to protect their privacy and safety.
To fulfill that requirement, a chain like CVS would not be able to list a doctor’s name in a companywide database, for example, and would have to keep that information restricted to the store that fills that doctor’s prescriptions, according to an official with Danco Laboratories, one of the two makers of mifepristone, who spoke on the condition of anonymity because of the company’s concerns about threats from abortion opponents.
Mifepristone, which blocks a hormone necessary for pregnancy development, is authorized by the F.D.A. to be taken in the first 10 weeks of pregnancy, although many clinics and telemedicine providers have begun offering it up to 12 or 13 weeks into pregnancy. This is a step they can legally take because most states allow physicians to use medical discretion to prescribe a drug for a particular “off label” use if there is scientific evidence that it is safe and effective for that use. The World Health Organization supports medication abortion through 12 weeks’ gestation, and studies suggest it is safe and effective during that time frame.
The second drug in the regimen, misoprostol, has never been as tightly restricted as mifepristone and is used for many different medical conditions. It is easily obtained at pharmacies through a typical prescription process. Misoprostol, which causes contractions that expel pregnancy tissue, is taken 24 to 48 hours after mifepristone.
Mifepristone is currently approved only for abortion. But it is also used in the treatment of some miscarriages, and there may be pressure for pharmacies to dispense it for that purpose as well. Recently, dozens of groups, including the American College of Obstetricians and Gynecologists and the American Medical Association, filed a citizen petition asking the F.D.A. to take action to make it easier for mifepristone to be used for miscarriages.