FDA now allows pharmacies to sell abortion pills. NC law makes it complicated.
In an effort to make abortion pills more accessible, a new Food and Drug Administration regulation will allow retail pharmacies to dispense the medication for the first time. However, a state “informed consent” abortion law may prevent the change from improving access in North Carolina.
Mifepristone, which blocks the hormones needed for pregnancy development, is the first part of a two-pill regimen that ends a pregnancy within the first 10 weeks of gestation.
Until now, mifepristone could only be dispensed by licensed doctors and clinics and a handful of mail-order pharmacies. The FDA’s new guidance gives pharmacies the option to become certified to sell the drug to patients with a valid prescription.
But a provision in that state law requires that a doctor be in the room when a patient takes the first abortion pill. And that could complicate how the FDA’s new regulation works in North Carolina.
Jay Campbell, the executive director of the NC Pharmacy board, said the law doesn’t prevent pharmacies from becoming certified to dispense mifepristone. But it’s unclear whether the law would require patients to go back to their doctor’s office to be observed while taking the pill.
If that’s the case, the new regulations might not make the drug more accessible for patients in North Carolina, said Dr. Beverly Gray, a Duke OB-GYN.
“That would be really tough to navigate,” she said. “It’s just easier to directly administer in clinic rather than have a patient come back to watch them swallow a pill.”
The N.C. Medical Board, which regulates the medical profession, has not issued guidance to the state’s physicians on the issue and does not have immediate plans to, a spokesperson for the organization said. The state Attorney General’s Office is not authorized to give guidance to physicians, a spokesperson there said.
“I’ve had colleagues that are just very confused about what’s going on,” Gray said. “It’s just unclear whether this is good news for North Carolina.”
Gray said she fears the state’s complicated abortion laws could dissuade retail pharmacies from stocking mifepristone altogether in North Carolina.
Walgreens and CVS, two pharmacy giants that have publicly announced their intention to register to sell mifepristone, have not clarified in which states they will register to dispense the drug.
Pharmacies will likely be cautious when deciding whether to offer the pills in states with abortion restrictions in order to protect their licenses, the interim chief executive director of the American Pharmacists Association told The New York Times.
A CVS spokesperson told the N&O the company is reviewing the requirements to dispense in states that “do not restrict the dispensing of medications prescribed for elective termination of pregnancy.” A Walgreens spokesperson said the company is working to ensure they are in compliance with state laws.
Pharmacies have had a difficult time interpreting North Carolina’s abortion laws. Walmart recently rescinded a policy that limited access to misoprostol, another drug commonly used to manage abortions, after The News & Observer reported that the retail giant had misinterpreted state law.
It’s also not clear whether the loosened restrictions will allow pharmacies to sell mifepristone for anything other than an abortion. Mifepristone is recommended to manage miscarriages but is onerous to prescribe because of the heavy regulations placed on the medication, Gray said.
“It might open up opportunities for patients with miscarriages to more easily get the care that’s evidence-based,” she said.
Teddy Rosenbluth covers science and health care for The News & Observer in a position funded by Duke Health and the Burroughs Wellcome Fund. The N&O maintains full editorial control of the work.
This story was originally published January 9, 2023 at 5:30 AM with the headline "FDA now allows pharmacies to sell abortion pills. NC law makes it complicated.."
