The U.S. Food and Drug Administration's decision to allow retail pharmacies to dispense abortion pills means drug stores will have to make a decision of their own: Will they sell it?
It’s not a simple yes or no answer.
Before the Jan. 3 decision by the FDA, mifepristone could only be acquired from a doctor at a hospital or medical clinic. Now pharmacies can provide the medication with a prescription if they become certified under the FDA’s Risk Evaluation and Mitigation Strategy program – or REMS.
To get the certification, there are requirements such as ensuring prescribers are certified, proving pharmacies can receive the patient agreement forms by email and fax, and being able to ship the drug using a shipping service that provides tracking information.
In deciding whether to seek certification to sell the pill, pharmacies may weigh political and competitive considerations, too.
Mifepristone has been a source of conflict in the battle over abortion rights. In 2022, researchers from the Guttmacher Institute found that more than half of abortions in the U.S. are performed with pills. Mifepristone – available under the brand names Korlym and Mifeprex – is the initial pill used in the two-drug medication administered to end a pregnancy of 10 weeks or less.
Woonsocket-based CVS Health Corp. and Walgreens Co. – the nation’s two largest pharmacy chains – have already expressed their intentions to pursue the certification in states where it is legal, such as Rhode Island and Massachusetts.
Some independent pharmacies are still weighing the options.
Charles Agwunobi, the owner of AJ Pharmacy, which has locations in Providence and North Providence, says he will consider getting the certification based on the demand for it. So far, he hasn’t made a final decision.
Similarly, Matthew Olivier from Matt’s Local Pharmacy in Middletown says he is waiting for more information on the process.
Most of the certification requirements are already standard procedure in most pharmacies and the process is relatively straightforward, said Jeffrey Bratberg, clinical professor at the University of Rhode Island’s College of Pharmacy. He didn’t foresee certification being a substantial deterrent for independent drug stores.
“It's really applying for a certification and [specifying] all the things that are normal in a pharmacy, so I don't see this as a limitation,” Bratberg said. “But will they seek it out? I don't know.”
Ginger Lemay, president of the Rhode Island Pharmacists Association and clinical professor at URI’s College of Pharmacy, says the REMS program is in place for several medications that come with risks.
“The REMS program is specific to the drug,” Lemay said. “Because each drug in the REMS program carries its safety concern.”
Lemay says the association is ready to support its members and pharmacies and ensure they have access to updated information.
While CVS and Walgreens said they are planning to seek certification to dispense mifepristone under the program, it is unclear when the chains will start offering the pills. They didn’t offer further details.
The way Bratberg sees it, the decisions of CVS and Walgreens will make it difficult for other stores to avoid seeking certification.
“If I have three other pharmacies on the corner of the major intersection and I'm the one who doesn't carry this medication, I'm at a disadvantage,” Bratberg said. “Becoming certified to dispense mifepristone, I think is really just keeping up with everybody else on the other corners.”
Bratberg doesn’t think much of the political considerations, either.
“I see this medication as just a part of safe and effective health care. FDA has determined that,” he said. “The only medications we should not dispense are those that are either unsafe or not effective, and these medications are safe and effective and they're medications of public health importance.”
