Explainer: Can Abortion Pills Get Around US State Bans?

June 24 (Reuters) – Following the U.S. Supreme Court’s June 24 ruling stripping away the national right to abortion that it had recognized nearly 50 years ago in its landmark Roe v. Wade, the demand for abortion pills, which can be prescribed through online telemedicine visits, is likely to increase. However, medical abortion won’t necessarily offer a way for most women to avoid the strict new abortion bans now expected to pass in conservative states, experts say.

WHAT IS A MEDICAL ABORTION?

In a medical abortion, the patient takes a drug called mifepristone, also known as RU-486, followed by a second drug called misoprostol, to end a pregnancy instead of undergoing a surgical procedure. More than half of abortions in the United States are medical abortions, according to the Guttmacher Institutean abortion rights research group.

HOW DOES THE FEDERAL GOVERNMENT REGULATE MEDICAL ABORTIONS?

The US Food and Drug Administration approved mifepristone in 2000, but until very recently, the FDA required patients to obtain it at a doctor’s office, clinic, or hospital. After easing those restrictions during the COVID-19 pandemic, the agency in December permanently removed the requirement that it had to be dispensed in person, allowing patients to see health care providers via telemedicine appointments and receive pills by mail. That increased access to abortion for patients who live in remote areas with no providers nearby and women who can’t take time off work or get to clinics for other reasons. The drugs are approved for use through the tenth week of pregnancy.

DO STATES RESTRICT MEDICAL ABORTION?

Yes. Medical abortions have become a target of anti-abortion activists and politicians. Indiana bans medical abortion at 10 weeks and Texas after seven weeks; other state medical abortion bans have been blocked by the courts.

Thirty-two states allow only physicians, and not other physicians such as nurse practitioners, to dispense abortion pills, according to the Guttmacher Institute. Nineteen states require the dispensing physician to be in the physical presence of the patient, effectively prohibiting telemedicine.

WHAT IS THE IMPACT OF THE SUPREME COURT RULING ON TELEMEDICINE ABORTION?

Before the Supreme Court ruling, 13 states had so-called “trigger laws” written to impose new abortion bans immediately or shortly after Roe v. Wade, and other states are expected to follow after Friday’s ruling in Dobbs v. Jackson Women’s Health. .

The Guttmacher Institute predicts that at least 26 states, including those with trigger laws, will pass new abortion laws. Such state laws have so far failed to distinguish between surgical and medical abortion, and are expected to ban medical abortion altogether. Some will ban abortions almost completely, while others will outlaw abortion altogether. six weeks or 15 weeks. read more

US Senator Tina Smith of Minnesota, a Democrat, introduced a bill on Thursday that would ensure telemedicine abortion is available in states where abortion remains legal before the Supreme Court ruling.

CAN A PATIENT IN A STATE WHERE MEDICAL ABORTION IS ILLEGAL GET PILLS FROM A PROVIDER OUT OF STATE WHERE IT IS LEGAL?

It depends. It is illegal for a medical professional to prescribe the pills via a telemedicine appointment to a woman in a state where they are illegal, legal experts say.

“The laws around telemedicine generally say that the patient’s location controls,” said Amanda Allen, senior counsel for the Lawyering Project, an organization that represents abortion providers. Doctors who prescribed abortion pills to a patient in a state where they are illegal could lose their licenses in that state or even face criminal charges, she said.

A woman who lives in a state where abortion is illegal could travel to a state where it is legal, have a telemedicine visit, and have the medication mailed to an address there.

“In some cases, that’s somewhat less onerous and expensive than traveling to a physical clinic in a neighboring state,” he said, noting that patients traveling to clinics in other states sometimes face weeks of waiting for appointments.

ARE THERE LAWSUITS CURRENTLY CHALLENGING STATE RESTRICTIONS ON MEDICAL ABORTION?

Yes. GenBioPro Inc, a company that sells mifepristone, has already challenged Mississippi’s restrictions on prescribing abortion pills via telemedicine, arguing that the FDA “overrides” them, meaning federal approval of the drug overrides any law state. There has been no ruling in that case, which is pending in federal court in Mississippi.

Similar challenges have been successful before. In 2014, a federal judge in Massachusetts struck down a state law that sought to regulate opioid drugs more strictly than federal law on the grounds that it was superseded.

US Attorney General Merrick Garland appeared to express support for that position in a statement on the June 24 Supreme Court ruling, saying that states “cannot ban mifepristone based on disagreement with FDA’s expert judgment on its safety and efficacy.

Mississippi has argued that FDA approval cannot override Supreme Court rulings that give states the authority to regulate abortions.

CAN PATIENTS GET ABORTION PILLS FROM OTHER COUNTRIES?

Yes. Women in states cracking down on telemedicine abortion are increasingly turning to ordering pills online from abroad.

While the practice is not legal, state authorities have said they have no effective way to control orders from foreign doctors and pharmacies.

(This story was reintroduced to change the reference from “medication abortion” to “medication abortion”)

Reporting from Brendan Pierson in New York and Nate Raymond in Boston; Edited by Alexia Garamfalvi and Aurora Ellis

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