Online mail-order pharmacies and brick-and-mortar retail pharmacies have the potential to dispense the abortion pill. Some more well-known pharmacies have even declared their intent to dispense the drug (mifepristone). Yet while online mail-order pharmacies are currently shipping the deadly drugs, it remains unclear whether any retail pharmacies have been certified to dispense the drugs.
FDA Approval History
The abortion pill, mifepristone (200mg), was approved by the Food and Drug Administration (FDA) in 2000 to be used in a regimen with a second drug called misoprostol. In 2011, the FDA made the decision to place the drug under its REMS safety system, but not before multiple women had died in association with use of the abortion pill regimen.
In April of 2021, under the auspices of the COVID-19 pandemic, the Biden Administration FDA temporarily enabled abortion pill distribution and expanded the REMS to limited mail-order pharmacy distribution. By December of 2021, the Biden FDA had further weakened the REMS by eliminating the in-person dispensing requirement and enabling the abortion pill to be permanently shipped by mail and ordered virtually, with little to no follow-up.
Those FDA modifications required “pharmacies that dispense the drug be certified” and a handful of mail-order pharmacies were allowed to dispense on behalf of prescribers.
Then, in January 2023, the FDA further gutted the REMS by announcing it would allow retail pharmacies to dispense the drug. It was at this time that the FDA officially published the certification process for pharmacies.
Mail Order Pharmacies
What are mail-order pharmacies?
A: They are online pharmacies which can mail abortion pills on behalf of approved prescribers.
Are mail-order pharmacies shipping abortion pills?
In a January of 2023 press release, Danco Laboratories, which oversees the U.S. manufacturing of the drug, named American Mail Order Pharmacy (AMOP) and Manifest Pharmacy as the two companies they use. As of the writing of this article, the generic manufacturer, GenBioPro, has named American Mail Order Pharmacy (AMOP) and Honeybee Health as its “currently Certified Pharmacies.”
Manifest Pharmacy (ManifestRX) is an online pharmacy headquartered in South Carolina (1018 S Batesville Rd, Greer, SC 29650), while appears to be operating as a DBA of Advanced Pharmacy Concepts, LLC (ACP). While ManifestRX does not publicly list the abortion pill mifepristone on its website, the Medication Abortion Pharmacy Advisory Group (MAPAG) website, (which boasts to have been formed by a number of associations including American Pharmacists Association (APhA), National Association of Boards of Pharmacy (NABP), The National Alliance of State Pharmacy Associations (NASPA), and claims to provide “reliable information on legality, certification, dispensing, and best practices for Medication Abortion”) does list the Manifest Pharmacy website as a “safe” online pharmacy for the drug.
In addition, a 2022 document entitled “Access Delivered,” published by the University of Washington and pro-abortion PlanC as “A Toolkit For Providers Offering Medication Abortion,” also lists the company as shipping on behalf of Danco. So does the website Birth Control Pharmacist (BCP), founded by Dr. Sally Rafie, a former pharmacist consultant for Planned Parenthood of the Pacific Southwest. She founded BCP with help from a grant by the pro-abortion Society for Family Planning (SFP).
HoneyBee Health is a California based mail-order pharmacy, which once claimed to be the first pharmacy to ship abortion pills for prescribers of the drug, even calling the move “a momentous achievement for Americans.” The pharmacy was founded in 2017 by Peter Wang and Dr. Jessica Nouhavandi, the latter of whom has referred to abortion safety regulations as “archaic.” (Read more here). “Honeybee can either bill the provider, who can then accept insurance from patients, or bill patients directly,” Access Delivered claimed in October of 2022.
Honeybee Health and Manifest Pharmacy are also among the names of “vendors” published by the Abortion Care Network (ACN).
What is a retail pharmacy?
A: A brick-and-mortar retail pharmacy which can only dispense the abortion pill with a prescription sent from an approved prescriber, once they complete the certification process.
Are retail pharmacies dispensing abortion pills?
A: This is unclear. The certification process is policed by the manufacturers of the drug, not the FDA, and all approvals are likely to be kept private.
In addition, a July update from Walgreens (see below) indicates that no retail pharmacies have been approved yet. This is possibly due to a pending decision in the Alliance for Hippocratic Medicine (AHM) v. Food and Drug Administration (FDA) court case, which could roll back more recent FDA REMS changes, potentially nullifying mail-order dispensing. This week, a Federal Court upheld the decision to roll back mail-order and pharmacy dispensing, but the decision is not in effect pending a review by the Supreme Court.
Until recently, abortion pills were only dispensed in person at abortion and Planned Parenthood facilities, a few physician offices, and hospitals. However, the January 2023 REMS expansion for pharmacy certification enabled brick and mortar retail pharmacies, like Walgreens or CVS, to dispense mifepristone (300) after a prescription is written by an approved prescriber. This is despite a survey authored by three consultants for Danco and the generic GenBioPro, which revealed that barely half of pharmacists (51%) understood the percentage of patients requiring blood transfusions, 53% understood the risks of taking mifepristone, and 53% understood minor consent laws for abortion. Just one-third (30%) understood adverse effects such as fevers and chills.
CVS Pharmacy: Spokesperson Amy Thibaut told multiple media outlets that CVS plans to become certified to dispense the abortion drug in their pharmacies, but as of January of this year could not provide details about when they expect to be able to offer the pills.
Rite Aid: The chain announced in January that it had plans to dispense the abortion pill at a limited number of its pharmacies. “We continue to evaluate the requirements for pharmacy certification, pharmacist training, and product availability as we determine the timing for dispensing mifepristone,” Rite Aid said in a statement. “We are committed to ensuring equitable access to customers prescribed this product.”
Walgreens: In January, Walgreens spokesperson Fraser Engerman said in a statement to the New York Times: “We intend to become a certified pharmacy under the program. We are working through the registration, necessary training of our pharmacists, as well as evaluating our pharmacy network in terms of where we normally dispense products that have extra F.D.A. requirements and will dispense these consistent with federal and state laws.”
In March of 2023, Walgreens published this statement: “We want to be very clear about what our position has always been: Walgreens plans to dispense Mifepristone in any jurisdiction where it is legally permissible to do so. Once we are certified by the FDA, we will dispense this medication consistent with federal and state laws. Providing legally approved medications to patients is what pharmacies do, and is rooted in our commitment to the communities in which we operate.”
An FAQ page updated in July of 2023 clarified that “No major retail pharmacy has received certification from the FDA to dispense mifepristone. Walgreens is currently seeking certification, so that it can dispense mifepristone. It never ‘stopped dispensing’ as it does not have the required authority to dispense in the first place.”
To date, Walmart, Costco, Kroger, Safeway and Health Mart have remained silent on any plans they may have to dispense abortion pills. The Florida Agency for Healthcare Administration has warned pharmacies such as Publix (Headquartered in Florida) and others against dispensing the drug. In addition, 19 attorneys general from various states previously sent a letter to retailers like Walmart, Kroger, and Costco encouraging them not to send abortion pills through the mail due to potential legal violations.