Public Health

Clinics make backup plans as Supreme Court decision looms

US abortion pill providers are scrambling to make backup plans as the Supreme Court decides whether to keep restrictions on the key drug mifepristone.

Some in-person clinics in New York, California and Kansas will offer mifepristone for now, but are preparing to provide an alternative abortion pill if a subsequent decision essentially bans the drug. Several in-person providers in Ohio could stop offering mifepristone altogether. One telehealth provider has plans to shut down for up to two weeks to pivot to new operations.

All of those efforts aim to preserve access to the most common type of abortion in the US, even as a larger legal fight over mifepristone escalates.

Access to mifepristone is hanging in the balance and could quickly change depending on what the nation’s highest court decides as early as next week. Justice Samuel Alito on Friday temporarily suspended lower court rulings that imposed limits on access to mifepristone so the justices have more time to review the case.

But for now, telehealth and in-person clinics may be forced to grapple with significant restrictions on the drug that could go into effect after Alito’s order expires on Wednesday at 11:59 pm ET.

In this photo illustration, packages of Mifepristone tablets are displayed at a family planning clinic on April 13, 2023 in Rockville, Maryland.

Anna Moneymaker | Getty Images

The 5th US Circuit Court of Appeals late Wednesday froze part of Judge Matthew Kacsmaryk’s order suspending the Food and Drug Administration’s approval of mifepristone. But the court temporarily blocked mail delivery of the pill, re-imposed doctor visits on abortion patients and shortened the length of time patients can take the pill to the seventh week of pregnancy, which is down from the previous 10 weeks.

Those restrictions will limit access to mifepristone even in states where abortion is legal. But the appeals court ruling does not restrict abortion pill access in 17 states and Washington DC that were subject to a separate court decision issued last week, a federal judge in Washington said Thursday.

Some in-person abortion clinics in states where the procedure is legal told CNBC that operations will remain largely the same. But they also highlighted their contingency plans if the court fight leads to tighter restrictions on the pill.

Trust Women, a clinic in Wichita, Kansas, will continue to offer mifepristone even if the restrictions go into effect, according to Zack Gingrich-Gaylord, the clinic’s communications director.

“We’re not very impacted by this ruling,” Gingrich-Gaylord told CNBC, referring to the appeals court decision. “But we are still ready to pivot if there are more restrictions. We have the alternate protocol ready.”

The clinic is prepared to offer misoprostol as a standalone treatment if a subsequent decision tosses out the FDA’s approval of mifepristone, Gingrich-Gaylord said. The drug is typically used in combination with mifepristone for abortion patients in the US

Misoprostol on its own is endorsed around the world as a safe and effective treatment for women who want to end their pregnancies. The appeals court decision does not affect access to the drug.

The Choices Women’s Medical Center in Queens, New York, and the University of California San Francisco Center for Pregnancy Options will similarly continue to offer mifepristone and have the misoprostol-only regimen in place as a backup plan, according to representatives from the clinics.

But some in-person abortion clinics in Ohio could stop dispensing mifepristone entirely if those restrictions go into effect, according to Jessie Hill, an attorney who represents several independent providers in the state.

Hill, who is also a law professor at Case Western Reserve University, said Ohio law requires doctors to follow federal label guidelines when prescribing mifepristone. She noted the law means clinics can’t prescribe a drug in a way that hasn’t been approved by the federal government, which is known as an “off-label” prescription.

Other clinics in states where abortion is legal can prescribe mifepristone off-label beyond the first seven weeks of pregnancy, according to Hill. She said that allows the clinics to effectively work around a restriction in the appeals court order in a way that Ohio providers can’t.

“The order makes it especially inconvenient for Ohio clinics to prescribe mifepristone, so they probably won’t. We might be the only state in this weird situation,” Hill said.

She noted that some clinics could start offering the misoprostol-only regimen as soon as the restrictions go into effect because it’s “actually a better option for most at this point.”

US-based telehealth clinics may have to make more sudden shifts than in-person providers due to the restriction on mail delivery of mifepristone.

Abortion Telemedicine will only offer misoprostol in states that allow it if the restrictions go into effect on Wednesday, according to the provider’s founder Jayaram Brindala. The clinic serves patients throughout the first trimester, which is 13 weeks into pregnancy.

Just The Pill is also prepared to offer “the safe and effective misoprostol-only regimen to patients if needed,” said Dr. Julie Amaon, the company’s medical director. Just The Pill delivers abortion medication in Wyoming, Montana, Colorado and Minnesota.

Wisp, a company that provides telehealth medication abortions in nine states, will also switch to providing only misoprostol if those restrictions are put in place, according to Monica Cepak, the company’s chief marketing officer.

But that change would require the company to close down for up to two weeks starting Wednesday, she noted.

“Right now, we’re in our status quo mode and will stay that way until we hear further developments,” Cepak said.

She emphasized telehealth’s critical role in abortion care in the US, noting that increasing demand for in-person services makes it difficult for patients to schedule appointments.

“It can sometimes take 20 to 40 days. That’s too long for most people to wait,” she said. “Telehealth fills that gap.”

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