Mail-order dispensing of mifepristone effective for medication abortion

Key takeaways:

• Data show medication abortion was dispensed safely and quickly via mail-order pharmacies.
• There were few adverse events reported and none were related to mail-order pharmacy dispensing.

Mail-order pharmacy dispensing of mifepristone after an in-person assessment for eligibility was effective and acceptable for people seeking medication abortion, researchers reported.

The data add to a growing body of literature demonstrating medication abortion can be provided safely and effectively using models of care that do not involve a clinician dispensing mifepristone in person, Daniel Grossman, MD, professor in the department of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, and colleagues wrote in JAMA Internal Medicine.

“The model of care we examined in this study, where patients are evaluated in person for eligibility for medication abortion and then have the pills dispensed through a mail-order pharmacy, is particularly relevant for primary care clinicians,” Grossman told Healio. “Medication abortion is easy to provide, but since primary care clinicians may see a small number of patients seeking abortion, it is challenging for them to stock the mifepristone in their offices. Being able to prescribe the medication to be dispensed by a mail-order or brick-and-mortar pharmacy makes it much easier for primary care clinicians to offer this service.”

Access to mail-order mifepristone

For the prospective study, researchers analyzed data from 506 women who visited one of 11 clinics, including five abortion clinics and six primary care sites, in California, Colorado, Delaware, Georgia, New York, Pennsylvania and Rhode Island from January 2020 to May 2022. Services were provided by physicians and advanced practice clinicians specializing in family medicine, internal medicine, obstetrics and gynecology or pediatrics. The median age of participants was 27 years and 38.3% were Black, 17.4% Hispanic, 27.9% white and 8.9% multiracial. Eligible participants sought medication abortion at 63 or fewer days’ gestation and were willing to take misoprostol. After an in-person screening to assess eligibility for medication abortion, mifepristone and misoprostol were prescribed using a mail-order pharmacy. Participants received standard follow-up care with the clinic.

The primary outcomes were effectiveness and acceptability of medication abortion dispensed by mail-order pharmacy, evaluated as the proportion of abortions that were complete with medication only within the 6-week study follow-up period. Patient acceptability was measured by the proportion of patients who reported that they were satisfied or very satisfied with the medication abortion, and by the proportion of those who reported they would use the mail-order service again if they needed another abortion.

Eighty-five percent of women received medications within 3 days. Complete abortion occurred after medication use for 97.8% of cases. There were 24 adverse events (4.7%) related to medication abortion symptoms. Three participants experienced serious adverse events that required hospitalization, with one requiring a blood transfusion; however, there were no adverse events related to mail-order dispensing, according to the researchers.

Ninety percent of participants reported they would use mail-order dispensing again for abortion care and 91.2% reported satisfaction with the medication abortion.

Data support recent FDA decision

Researchers noted that the clinical sites that agreed to participate in the study had at least one motivated clinician and a supportive administrative environment and were typically located in states with relatively few abortion restrictions. Patients who agreed to participate in the study were open to mail-order dispensing, and this option may not be acceptable or feasible for all patients. The study also was not powered to precisely estimate safety outcomes and researchers added that satisfaction with services may be overestimated due to social desirability bias.

“This paper adds to the large body of evidence demonstrating that mifepristone for medication abortion can be safely dispensed using pharmacies, including mail-order pharmacies,” Grossman told Healio. “Last year, FDA issued guidance allowing certified pharmacies to dispense mifepristone, but so far few pharmacies have started stocking the drug.”

As Healio previously reported, FDA finalized changes to its dispensing requirements for mifepristone in 2023 to allow certified pharmacies to provide the abortifacient to patients. In March, CVS and Walgreens announced they would start dispensing mifepristone in states where abortion is legal.

Grossman said more research is needed to monitor which pharmacies are stocking and dispensing mifepristone, as well as the research on the safety and effectiveness of over-the-counter access to mifepristone and misoprostol.

Reference:

• CVS and Walgreens plan to start dispensing abortion pill mifepristone soon. Available at: https://apnews.com/article/cvs-walgreens-mifepristone-abortion-adaa5f92afa0f7b8ed5801e976932380. Accessed: May 10, 2023.

For more information:

Daniel Grossman, MD, can be reached at daniel.grossman@ucsf.edu; X (Twitter): @DrDGrossman.