The Next Frontier in the Abortion Wars: Your Local CVS

“We want people to feel uncomfortable walking into a CVS that has a demonstration going on and to consider going to a different pharmacy,” said Caroline Smith, leader of the group Progressive Anti-Abortion Uprising. “We also want to put enough pressure on the companies to reverse this decision and not be certified to sell abortion pills.”

A Walgreens spokesman declined to comment on the protests. CVS did not respond to a request for comment.

The anti-abortion movement is targeting pharmacies as the pill has become the most popular method of terminating a pregnancy in the United States and a key way to access abortion in states where it is prohibited. .

The upcoming protests are just one piece of a larger strategy that, if successful, could further disrupt the national patchwork of abortion access.

As legislatures reconvene this month, many for the first time since then Roe v. Wade was overturned: Missouri and Kansas are among several states weighing bans on mail delivery and pharmacy dispensing of mifepristone, the first of two pills used to terminate pregnancy.

Members of the new House Republican majority will also introduce a bill Wednesday, first shared with POLITICO, that would expand pharmacists’ rights to refuse to fill prescriptions for the drug.

And conservative advocates are threatening legal action against pharmacies that choose to dispense the pill, as other pending lawsuits seek to ban its use nationwide.

“If Walgreens is to learn anything from our 50-plus years of anti-abortion activism, it’s that we won’t give up,” said Kristi Hamrick, vice president of policy for Students for Life of America. “They should be concerned about the kind of liability they’re going to face.”

Those conservative plans threaten to undercut what progressives call an already limited effort to expand abortion access and discourage patients from seeking the pills even if pharmacies choose to provide them.

Progressive lawmakers and abortion rights advocates initially applauded the FDA’s January announcement, saying it could make the drug more widely available, even as more states move to impose restrictions. They also expressed hope that the policy could reduce the stigma surrounding the use of the pills by treating them more like other prescription drugs.

But as details of the policy emerged, many on the left raised concerns that its impact would be limited for a number of reasons, including low pharmacy participation due to bureaucracy, the cost for patients and new state laws targeting pill distribution.

The FDA’s updated drug rules require pharmacies to get additional certification, and both the American Pharmacists Association and the National Community Pharmacists Association said it’s too early to tell how many pharmacists will jump through those hoops and take the risk. of being targeted by anti-abortion groups. . .

“The safety of pharmacy equipment is very important, and that’s something they will consider when deciding whether to certify or not,” said Ilisa Bernstein, interim CEO of the American Pharmacists Association. “In some communities, that may be more of a concern than in others, but it is a concern.”

Rachel Rebouché, an expert in reproductive health law and dean of Temple University’s Beasley School of Law, said she doesn’t think the certification process the FDA has outlined for pharmacies is “super onerous,” but the tracking and recordkeeping requirements can deter pharmacies that are” used to handling these types of restrictions to seek certification, especially small independent operations.

“It focuses a little bit on diversions — how are you going to monitor a controlled substance to make sure it’s not overprescribed, that people aren’t stockpiling, say, abortion medication,” Rebouché said.

Everyone involved in the manufacture, distribution and regulation of mifepristone is trying to “avoid a single database” of prescriber and patient records, said Ronna Hauser, senior vice president for policy and pharmacy affairs at the National Pharmacists Association. of the Community.

The possibility that some pharmacies could be deterred from dispensing the pills even in states where they remain legal has some medical groups and progressive advocates arguing that the FDA should have dropped all of its restrictions.

“The FDA could have taken the opportunity to greatly simplify the process,” said Ushma Upadhyay, a professor at the University of California, San Francisco School of Medicine and a researcher at the group Advancing New Standards in Reproductive Health. Medical abortion is extremely safe. Many studies have found rates of serious complications of less than half of one percent. And we know that pharmacies dispense other drugs with much greater risks without all these restrictions and certification requirements.”

Cost could prove another barrier to patients accessing the pills.

The average retail price of a mifepristone pill, the amount needed to start a medication abortion, is about $75, according to prescription drug price tracker GoodRx.

The main reason the pills won’t be available at all pharmacies, however, will likely be the growing number of state laws that dictate how patients can get them or ban them outright.

Pharmacies in 18 states are prohibited from dispensing the drugs because abortion is illegal in most circumstances or because patients can only get the pills directly from a doctor. More GOP-controlled states are expected to enact specific pill restrictions this year, including states where abortion is already banned.

“They’re trying to dissuade people from going online and taking pills and, in their minds, closing loopholes in their current law,” said Elizabeth Nash, who tracks state policy at the pro-Guttmacher Institute think tank. -abortion The FDA’s new policy on dispensing pills at pharmacies, he added, “put a spotlight on medication abortion just as these state legislatures are back in session.”

Some of those bills under consideration, in Texas and other states, focus on expanding federal laws that allow health care providers, including pharmacists, to opt out of providing services to which they have a moral or religious objection.

Rep. Buddy Carter (R-Ga.) plans to reintroduce a federal version Wednesday that prohibits employers or the government from penalizing any health care worker who refuses to fill a prescription for any drug he “believes in good faith can be used to cause an abortion.” .”

While it is not expected to pass the Democratic-controlled Senate, medical groups have raised concerns that the policy could exacerbate the already acute problem of denying patients prescription drugs for other purposes, from lupus to arthritis and the management of miscarriage, because they can also be used to terminate a pregnancy.

Even if they can’t enact new laws or block the new dispensary policy in court, anti-abortion forces say they will continue to work to reduce its impact, using the “death by 1,000 cuts” strategy in which they trusted for decades that eventually led to the elimination of abortion access in a quarter of the country.

“The idea that we’re going to stand by as long as there’s reckless distribution of abortion pills is very short-sighted,” Hamrick said. “We have a much smarter operation now than we did then Roe became Roe.”

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