By Randall K. O’Bannon, Ph.D. NRL Director of Education & Research
Editor’s note. This appears in the February edition of National Right to Life News.
Please share this—and the entire 45 pages of the issue—with your pro-life family and friends.
What if a pharmacist could not only dispense abortion pills, as the Biden administration has recently made possible, but prescribe them? Pharmacists in the state of Washington, taking advantage of provision in state law allowing pharmacists to prescribe drugs, are completing a training program that will enable them to be certified to prescribe and deliver abortion pills to women in their state, says Patrick Adams in a January 22, 2024, report for National Public Radio (NPR).
The vision is not simply to expand abortion pill access in Washington State, but to serve as a model for other states.
Taking advantage of newer FDA rules
It was only about a year ago when the U.S. Food and Drug Administration (FDA), at the behest of the Biden administration, announced new regulations allowing for pharmacies to be certified to dispense mifepristone, the abortion pill.
Besides needing to have a designated person to fill out and manage all the paperwork, this person had to be familiar with the prescribing information, insure that prescriptions came from certified prescribers whose information was on file and confirm with the prescriber that the drug was appropriate for the patient
This essentially means that prescriber and pharmacist both have to make sure that the patient has been appropriately screened for various conditions or drug allergies, making sure they are within the appropriate gestational range (no more than ten weeks past a woman’s last menstrual period), and making sure that they do not have an ectopic pregnancy, which the drugs do not treat.
The pharmacist who is planning to ship these drugs to women’s homes has to track and record all shipments and guarantee their delivery within four calendar days.
Any patient deaths are to be reported back to the prescriber, who in turn is to report these to the distributor, who reports these to the FDA.
At one point, prescriptions were limited to doctors, but under regulations in place since 2016, these can be prescribed by any “certified healthcare provider.”
Under those terms, the drugs can be prescribed by any doctor, nurse, physician assistant, or any other healthcare provider –- such as a pharmacist.
So long as they meet the certification requirements, largely mirrored in the pharmacy certification conditions, they can receive certification and FDA permission to prescribe and distribute the drugs.
If there is a difference in the two certifications, it is that the prescriber has to certify that they personally have the ability to accurately date pregnancy, diagnose ectopic pregnancy, provide or refer for any necessary surgical intervention, and can assure patient access to medical facilities equipped for blood transfusion.
They also need to make sure the patient is fully briefed on mifepristone risks, has any questions answered, and signs appropriate agreements.
Abortion pill advocates have sought to interpret these very loosely. They claim these tasks can be accomplished without an in-person physical exam (or ultrasound) in a teleconference, or even a phone call, or a online questionnaire. As of January 2023, the FDA appears to be allowing if not endorsing that interpretation with its new protocol.
State of Washington takes advantage
Under the new regulations, it isn’t clear why any pharmacist in any state might not be able to qualify as a prescriber. But Washington state’s law explicitly authorizing pharmacists to prescribe medications certainly makes it easier.
More than forty years ago, Washington passed a law setting up “collaborative practice agreements,” or CPAs. These allowed licensed prescribers such as to physicians or nurse practitioners to delegate authority to a pharmacist to prescribe or administer certain drugs. This enabled the state to use pharmacists to provide some limited healthcare and boost immunization rates among underserved Native American communities in the state.
Don Downing is a pharmacy professor who was part of that program in the 1970s and served as a pharmacist medical provider on area reservations. This past spring, shortly after the Biden administration announced the new certification system, Downing and several of his colleagues set up the Pharmacy Abortion Access Project. This focused on training community pharmacists to screen chemical abortion patients, prescribe abortion pills, and dispense them from their stores.
Downing told NPR that most women live close to their community pharmacy and see their pharmacist twice as often as they do their primary physician. Being more familiar, Downing seems to feel, women may be more comfortable seeking abortion pills from their local pharmacist than their doctor. Pharmacists are also more accessible to patients, with drug stores being open in the evenings, on weekends and holidays, often available without need for any appointment.
Ten pharmacists are part of Downing’s first “class,” and he expects them to be prescribing abortion pills sometime in the next few weeks. No word on how Downing means to ensure that the FDA grants certification within that time frame. However, his training program includes not only instruction on how to screen patients remotely without ultrasound, pelvic exam, or bloodwork, but also how to implement the treatment regimen and handle follow-up care.
Downing believes Washington’s program can be a model for other states.
NPR’s Patrick Adams writes about a bill being considered in New York state that would grant pharmacists authority to prescribe abortion pills there. Researchers in San Diego, California recently published results of a pilot study claiming to show that pharmacists could safely and effectively prescribe abortion pills in that state.
NPR believes that there are already a few pharmacists in California who received advance practice certification and are legally allowed to prescribe the abortifacient pills.
Experts offer differing opinions
Naturally, like so many other propaganda pieces encouraged by the abortion establishment, the article wraps up with statements by industry “experts” that chemical abortions are “extremely effective and extremely effective.”
Pro-life doctors who challenged the FDA’s new laxer prescription criteria in Alliance for Hippocratic Medicine v. FDA, the case being heard by the Supreme Court in April this year, know better.
When the FDA expanded the prescriber pool to include non-physicians and dropped requirements for in-person visits, those doctors claimed this made misestimations of gestational age more likely, decreasing effectiveness and increasing the likelihood of complications.
They also believed this increased the risk of undetected ectopic pregnancies, which can prove deadly to the mother if they rupture.
This is in addition to the risks of hemorrhage, infection, and failure normally faced by users of the abortion pill.
If the Supreme Court rules in favor of pro-life doctors, it could mean that pharmacists in Washington and elsewhere will not be writing these prescriptions.