FDA Finalizes Rule Allowing Mail-Order Abortion Pills

The Food and Drug Administration on Tuesday finalized a rule change that allows women seeking abortion pills to get them through the mail, replacing a long-standing requirement that they pick up the medicine in person. 

The Biden administration implemented the change last year, announcing it would no longer enforce the dispensing rule. Tuesday’s action formally updates the drug’s labeling to allow women to get a prescription via telehealth consultation with a health professional, and then receive the pills through the mail, where permitted by law. 

Still, the rule change’s impact has been blunted by numerous state laws limiting abortion broadly and the pills specifically. Legal experts foresee years of court battles over access to the pills, as abortion-rights proponents bring test cases to challenge state restrictions. 

For more than 20 years, the FDA labeling had limited dispensing to doctor’s offices and clinics, due to safety concerns. During the COVID-19 pandemic, the FDA temporarily suspended the in-person requirement. The agency later said a new scientific review by agency staff supported easing access, concurring with numerous medical societies that had long said the restriction wasn’t necessary. 

Two drugmakers that make brand-name and generic versions of abortion pills requested the latest FDA label update. Agency rules require a company to file an application before modifying dispensing restrictions on drugs. 

Danco Laboratories, which sells branded Mifeprex (mifepristone), said in a statement the change “is critically important to expanding access to medication abortion services and will provide healthcare providers” another option for prescribing the drug. 

More than half of U.S. abortions are now done with pills rather than surgery, according to the Guttmacher Institute, a research group that supports abortion rights. 

The FDA in 2000 approved mifepristone to terminate pregnancies of up to 10 weeks when used with a second drug, misoprostol. Mifepristone is taken first to dilate the cervix and block the progesterone hormone, which is needed to sustain a pregnancy. Misoprostol is taken 24 to 48 hours later, causing the uterus to contract and expel pregnancy tissue. 

Bleeding is a common side effect, though serious complications are very rare. The FDA says more than 3.7 million U.S. women have used mifepristone since its approval. 

Several FDA-mandated safety requirements remain in effect, including training requirements to certify that prescribers can provide emergency care in the case of excessive bleeding. Pharmacies that dispense the pills also need a certification. 



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