The U.S. Food and Drug Administration (FDA) will permit retail pharmacies to sell abortion pills in the United States for the first time, the agency indicated on Jan. 3.
Mifepristone is a drug that blocks the hormone progesterone, which is needed for a pregnancy to continue. The pill is used in combination with misoprostol to end a pregnancy at up to 10 weeks of gestation. Employers may or may not cover the two medications in their health plans.
There are a myriad of reasons why some employers choose to cover abortion in their health plans, such as to recruit and retain women, to ensure gender equity in their health benefits, or to support reproductive freedom.
However, most patients pay out of pocket for abortion, including patients with private health insurance, according to recent research published in Health Affairs. The most common reason reported for not using insurance to pay for abortion was that it was not covered. Eleven states restrict the type of abortion coverage that private health insurance plans can offer, and 26 states have laws that bar all plans participating in their state's health insurance exchange from covering abortion.
We gathered a batch of articles on the news from SHRM Online and other trusted news sources.
Employer Coverage
Abortion coverage, including abortion medication, is more common in health plans offered by self-insured employers because those plans are usually exempt from state laws. Fully insured plans, however, are subject to state laws.
In 2014, the Supreme Court ruled in favor of the retailer Hobby Lobby, stating that the federal government cannot require a company to provide coverage for contraception or abortion pills if the owner has a religious objection to it. That includes emergency contraceptives, like Ella and Plan B, as well as intrauterine devices (IUDs). This ruling was expanded by regulation in 2017, granting employers access to religious and moral exemptions to the contraceptive coverage mandate in the federal Affordable Care Act. The Supreme Court upheld these exemptions in 2020.
(SHRM Online, NPR and SHRM Online)
Expanding Abortion Access
The regulatory change will potentially expand abortion access as President Joe Biden's administration wrestles with how best to protect abortion rights after they were curtailed by the U.S. Supreme Court's decision to overturn the Roe v. Wade ruling last year, as well as the state abortion bans that followed.
Pharmacies now will be able to dispense the abortion medication directly to patients after receiving a prescription from a certified prescriber. In 2021, the FDA permanently removed restrictions on mail-order shipping of abortion medication and the ability to prescribe it through telehealth care.
(Reuters)
State Bans
Previously, patients could only get mifepristone from specially certified doctors or clinics or through a mail-order pharmacy. The medication is used in more than half of pregnancy terminations in the U.S., and it is becoming even more sought-after in the aftermath of last year's Supreme Court decision overturning the federal right to abortion.
In about half the states, abortion bans would make it illegal or very difficult for pharmacies to provide abortion pills. In states where abortion remains legal, pharmacies may face more customer demand for the medication. National chains could decide to offer the medication in those states while not providing it in their stores in restrictive states.
Legal Battle
The Alliance of Hippocratic Medicine, an anti-abortion group, filed a lawsuit against the FDA to overturn the agency's approval of abortion pills. The group argues that the FDA fast-tracked the approval of mifepristone and didn't adequately study the safety of it.
Major medical associations say that mifepristone is safe and effective, with the American Medical Association and the American College of Obstetricians and Gynecologists saying in a June letter to the FDA that the drug is a "safe, effective, and important component of treatment and management for early pregnancy loss."
(Axios)
Travel to Pharmacy
Patients in states with abortion bans will be able to cross state lines to pick up the drugs from a pharmacy. Patients in states allowing access to the abortion pills also are expected to use the new pharmacy option, including those without a stable home address, those without Internet access, and those who do not want a parent or partner to see the pills delivered by mail.
(Politico)
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