After Dobbs, ‘spike’ in medication abortion fulfillment requests via online-only pharmacy
Click Here to Manage Email Alerts
Key takeaways:
- An analysis of prescribing trends showed a sharp increase of fulfillment of medication abortion drugs after the Dobbs decision for a single online pharmacy.
- Virtual-only providers drove the increase.
Overall provision of medication abortion via a single online pharmacy was higher after the Dobbs v. Jackson decision, with much of the increase being driven by prescriptions from virtual-only providers, researchers reported.
Online pharmacies can offer a simple “one-stop-shop” solution for telehealth prescribers, who can count on the pharmacy to dispense and ship medication abortion wherever abortion is provided, researchers wrote in JAMA Network Open. Clinics can also use online pharmacies to fulfill medication abortion prescriptions, alleviating the burden of storing and dispensing. The FDA removed in-person and clinician-only dispensing requirements as part of the Risk Evaluation and Mitigation Strategy (REMS) attached to mifepristone during the COVID-19 public health emergency.
“These findings demonstrate the increasingly critical role online pharmacies play in direct-to-patient abortion care provision, and the strong linkages between virtual-only providers and online pharmacies,” Caila Brander, MSc, senior research manager at Ibis Reproductive Health in Cambridge, Massachusetts, told Healio.
Assessing clinic data
In a cross-sectional study, researchers analyzed deidentified medication abortion prescription fulfilment data from June 2021 through June 2023 from a single online pharmacy, which dispensed the combined regimen of mifepristone and misoprostol to patients by mail. The mean age of patients was 29 years. Researchers assessed patient age (grouped into six categories), state where the prescription was sent (grouped by abortion policy environment), medications prescribed, and the prescriber’s clinic care modality (in-person only, hybrid or virtual only).
“The online pharmacy only provided care to states where direct-to-patient abortion services were legally permitted,” the researchers wrote. “Therefore, there are no observations for states with abortion bans (most restrictive) in the dataset.”
Throughout the study period, the greatest volume of prescription requests came from states with most or very supportive policies and from prescribers at virtual-only platforms, according to the researchers.
Researchers observed that prescribers sent more prescriptions for medication abortion during the year after the Dobbs decision, increasing from a daily mean of 88.5 prescriptions in March 2022 to a daily mean of 201.5 prescriptions in March 2023. There were “fulfillment spikes” immediately after the leak of the Dobbs opinion on May 2, 2022, and again after the Dobbs decision on June 24, 2022.
“There was a noticeable spike in fulfillment in the week immediately following both the leak of the Dobbs v. Jackson decision and the decision itself,” the researchers wrote. “The week before the leak, the online pharmacy sent a mean of 84.4 medication abortion prescriptions per day. In the week after the Dobbs v. Jackson leak, this increased to 130.9 per day. Following the Dobbs v. Jackson decision, fulfillment rose to a mean of 169.6 prescriptions per day.”
In analyses stratified by prescriber care modality, virtual-only platforms were the biggest users of the online pharmacy; however, researchers observed an increase in prescription fulfillments from hybrid clinics 12 weeks after the Dobbs decision. In-person and telehealth-only platforms experienced large spikes in prescription fulfillment during the week immediately after the Dobbs decision.
Online pharmacies ‘a ready resource’
“The first clinical implication is that online pharmacies are a ready resource for providers who are interested in integrating medication abortion, whether in-person or via telehealth, into their cadre of services, but who might not want to stock the medications on-site,” Brander told Healio. “Second, there is literature showing that pharmacy dispensing is associated with safe use of medication, a reduction in health care costs, and potentially preventing adverse drug events. Barriers to medication abortion access, including the FDA’s remaining REMS restrictions — which restricts pharmacy dispensing — should be removed to allow for more people to get this care when they need it and as soon as they need it.”
Brander said because the study relied on prescription fulfillment records, the researchers were unable to assess patient demographics.
“Research exploring the characteristics of medication abortion patients receiving medications from online pharmacies could help identify who is benefiting from these services and who is not,” Brander told Healio. “Online pharmacies are also well equipped to provide other reproductive health products along with abortion medication, such as postabortion contraception or other sexual health products. Research could explore whether this impacts the quality of people’s abortion experiences.”
Importance of policy to decrease barriers
In a related editorial published in JAMA Network Open, Keemi Ereme, MD, MPH, a complex family planning fellow at the University of Washington, and Lauren Owens, MD, MPH, associate professor of obstetrics and gynecology at the University of Washington, noted that online pharmacies and telehealth access to medication abortion can help people seeking care avoid traveling long distances and facing protesters; however, legal intrusions continue to impact both telehealth and in-person care.
“Although improving access to online pharmacies is one step in improving access to medication abortion, there is much policy work to be done in decreasing barriers to this essential health care,” Ereme and Owens wrote.
Reference:
For more information:
Caila Brander, MSc, can be reached at cbrander@ibisreproductivehealth.org.