You can now pick up your birth control and abortion pills at the same pharmacy. Under a regulatory change on Jan. 3 by the Food and Drug Administration, retail pharmacies (including major chains like CVS and Walgreens) can now offer Mifepristone, the first of two drugs required for medication abortion.
Previously there was an “in-person dispensing requirement,” which meant it had to be dispensed only by doctors or a few mail-order pharmacies. Now if drugstores agree to certain rules – such as obtaining certification from the FDA – they can provide it. But patients still need to obtain a prescription from their healthcare provider; mifepristone isn’t available for over-the-counter use.
Medication abortion is not an uncommon experience – the Guttmacher Institute estimates that in 2017, 39 percent of US abortions were medication abortions. That number has only increased: according to data from the Guttmacher Institute, medication abortion accounted for 53 percent of US abortions in 2020, making it the first year that pills became the country’s most-reported means of abortion. The Guttmacher Institute notes that the COVID-19 pandemic likely factored into this increase.
In a post-Roe world, easier access to medication abortion is a huge step toward connecting patients with time-sensitive medical care. “Today’s announcement means that people who live in states that have not banned medication abortion care may soon be able to walk into their neighborhood pharmacy and walk out with their medications in hand,” Kirsten Moore, director of Expanding Medication Abortion Access (EMAA) Project, said in a statement. “To be clear, today’s action doesn’t change the sparse landscape of abortion access post-Roe. Millions of people still live in states where abortion care is banned entirely. The kind of care you get shouldn’t depend on where you live, but that’s the reality anti-abortion politicians have created.”
While limitations remain, the FDA’s ruling is a win for accessibility in many respects. Ahead, find out more about medication abortions.
How Do Abortion Pills Work?
First approved by the FDA in 2000, mifepristone, known as Mifeprex, is ordered, prescribed, and dispensed by a qualified healthcare provider within 70 days – or 77 days, in some cases – of pregnancy. (Recent FDA decisions now means mifepristone specifically can be distributed via mail or pharmacy in states without limitations – more on that later.) Then, as approved by the FDA, a second pill, misoprostol, is taken 24 to 48 hours after taking Mifeprex in the location of your choice, meaning it can be administered at home.
How you qualify for a medication-abortion pill depends on where you live, but in terms of gestation, the FDA approved the medication through 70 days of gestation, and the medical community has since developed and supported use up to 77 days, says Colleen P. McNicholas, MD, the chief medical officer at Planned Parenthood of the St. Louis Region.
Dr. McNicholas says mifepristone stops a pregnancy from progressing by blocking progesterone, one of the hormones that holds the pregnancy to the uterus. Misoprostol then causes the uterus to contract, resulting in cramping and bleeding after one to four hours that expels pregnancy tissue. According to Planned Parenthood’s national website, a person may also feel the following side effects:
- Upset stomach and vomiting
- Diarrhea
- Mild fever
- Tiredness
- Heavy bleeding with large clots
- Dizziness
Nausea and slight bleeding may occur after taking mifepristone, although it’s uncommon. Expelling the pregnancy tissue usually lasts four to five hours or longer, and the cramping may persist for a few days. Planned Parenthood notes that if you don’t have any bleeding within 24 hours of taking misoprostol, you should call your doctor. You’ll have a followup appointment a week or two after the medication abortion, which Melissa Grant, COO of abortion and reproductive-health service provider Carafem, tells POPSUGAR can happen virtually (after checking in about symptoms, providers may ask you to take a home pregnancy test to confirm a negative test result).
How Effective Is the Abortion Pill?
According to Planned Parenthood, if you are eight weeks pregnant or less, a medication abortion works about 94 to 98 percent of the time. For people who are between 10 to 11 weeks pregnant, it’s about 87 percent effective. If the abortion doesn’t work, you may need additional medication or an in-clinic procedure. Complications from medication abortion are also rare but could include pregnancy tissue left in the uterus, infection, allergic reaction, blood clots in your uterus, and excessive bleeding. Call your doctor if you feel sick more than 24 hours after taking misoprostol.
Where Can You Get Abortion Pills?
Historically, these pills had to be acquired from a doctor’s office or a clinic, such as Planned Parenthood or Carafem. (Grant suggests using the National Abortion Federation to find a list of accredited providers across the country.) Some doctors would give mifepristone to you in their office and write a prescription for misoprostol to be picked up at a certified pharmacy, or they might have misoprostol at their disposal and send you home with it. Now with the January ruling, you can bring both of your prescriptions to your local drugstore or pharmacy chain like Walgreens or CVS (as long as they’re certified under the Mifepristone REMS Program). It should also be easier for many to get both sent via mail or through a mail-order pharmacy.
On Dec. 16, 2021, the FDA permanently lifted a requirement that mifepristone be dispensed in person by a healthcare professional, opening the doors for it to be sent by mail. The decision came after the agency said in April 2021 that it would temporarily stop enforcing the requirement – stated under the drug’s Risk Evaluation and Mitigation Strategy (REMS) guidelines – for the remainder of the COVID-19 pandemic.
The cost varies and also depends on several factors, such as the facility you go to, state law, tests you may need done before or after your medication abortion, and insurance coverage. However, Grant notes that the average cost nationwide for medication abortion through a private office is usually between $400 to $450. People who choose to purchase the pills virtually, she says, tend to pay a reduced cost.
Obstacles Remain For Medication Abortions
“It’s important that people have safe options that are respectful of their own personal needs, their own personal belief systems, if they decide that they want to have an abortion.”
While the FDA’s recent decisions are wins for abortion access, obstacles remain at the state level. On Dec. 2, for instance, Texas narrowed the window during which doctors are allowed to prescribe abortion pills from 10 weeks of pregnancy to seven weeks and specifically forbade doctors from sending abortion pills through the mail, according to the Texas Tribune – doing so is now a felony (although pregnant people are not considered liable). Additionally, laws in 19 states already prohibit medication abortions from taking place virtually because they require clinicians to be physically present when the medication is administered, according to the Guttmacher Institute. And as of Feb. 22, the Guttmacher Institute says that 16 state legislatures have introduced bans or restrictions on medication abortion. This includes seven states pursuing an outright ban on the use of abortion pills.
Both Grant and Dr. McNicholas stress that using mifepristone and misoprostol for medication abortion is safe and effective. “The additional barriers do nothing to make it safer and, if anything, actually delay appointments, increase costs, and create more stress and strife for the people in the situation,” Grant says.
Grant adds that untended pregnancies are often complicated by financial instability and inadequate access to healthcare. “It’s important that people have safe options that are respectful of their own personal needs, their own personal belief systems, if they decide that they want to have an abortion,” she says. “Whether you prefer to have your abortion at home with a pill, in the clinic with medication, in the clinic with a procedure and maybe an additional painkiller, these are all legal, safe options the patient themselves should be able to choose.”
– Additional reporting by Melanie Whyte