An anti-abortion group is celebrating Costco’s decision not to offer abortion pills in its pharmacies, but the battle to restrict access to the drug remains complex.
“This is undoubtedly a win for Costco shareholders,” remarked Michael Ross, an attorney for the Alliance Defending Freedom (ADF). He noted, “Retail pharmacies face risks when they try to operate like abortion clinics.”
In 2024, the ADF, alongside other anti-abortion organizations, reached out to major chains like Costco, Walmart, Kroger, Albertsons, and McKesson, urging them to resist the push to dispense Mifepristone.
However, many pharmacy chains are not swayed by these appeals.
CVS and Walgreens, two of the largest pharmacy retailers, continue to dispense abortion drugs where it is legal. Additionally, the majority of these medications across the U.S. are handled by mail-order pharmacies, which allows for distribution across state lines.
It’s worth noting that the Food and Drug Administration (FDA) has not made any changes regarding drug accessibility based on the Risk Assessment and Mitigation Strategy (REMS), a safety program aimed at monitoring adverse effects.
Experts in healthcare policy mentioned that for anti-abortion advocates to effectively limit mifepristone, modifying REMS is crucial—similar to actions taken a few years back, which were temporarily suspended during the COVID-19 pandemic.
Previously, during President Trump’s administration, REMS mandated that the drug be supplied directly at clinics. Those regulations were permanently altered in 2023, permitting certified pharmacies to distribute the drug without requiring in-person visits.
“I wish the original REM would be reinstated so we could better inform women about the effects of the pills,” commented Carol Tobias from the National Rights Commission. “But it’s not unexpected. We ultimately want to see the administration eliminate the pills altogether.”
Groups opposing abortion are also actively seeking legal action and petitions.
The FDA first approved Mifepristone back in 2000 for early pregnancy termination. While serious complications are rare, they can occur. Since its approval, five deaths linked to the drug have been reported among a million users.
Kirsten Moore, director of the EMAA Project, emphasized that focusing on retailers like Costco misses the broader issues. “The problem is not there,” she noted regarding the recent developments.
Pharmacies have access to a list of certified prescribers, allowing them to quickly verify requests. The time frame for patients to receive their prescriptions can sometimes be as little as 36 hours.
While anti-abortion groups continue to lobby retailers against distributing these drugs, some Democratic lawmakers are pushing for large pharmacy chains to start offering Mifepristone following the dismantling of Roe v. Wade in 2022.
During the COVID-19 pandemic, the FDA allowed Mifepristone to be dispensed by mail, which helped safeguard patients and providers from virus exposure. Honeybee Health became the first mail-order pharmacy to send these drugs directly to patients in 2020 after some restrictions were loosened.
Currently, twelve states have imposed complete abortion bans, with a few others implementing stricter regulations since Roe was overturned. Nonetheless, the number of medication-based abortions has risen, particularly via telehealth services.
Recent statistics show that in 2023, 63% of all abortions in the U.S. involved manufactured drugs, a rise from 53% in 2020, according to the Guttmacher Institute.
This increase is partly due to “abortion shield laws” in several states, which offer legal protection to providers and patients from civil and criminal cases arising in states with bans. There are 18 states, along with the District of Columbia, that fall under this protection, as explained by Rachel LeBauchet from Temple University’s Beasley Law School.
Anti-abortion activists have fought against these protections, but so far, they have not been successful.
Some lawmakers in Texas have introduced various bills aimed at limiting access to abortion drugs in the state, although one such bill recently failed.
Tobias from the National Rights Commission labeled their efforts to restrict mifepristone as both “necessary and critical,” but she expressed that progress hasn’t been fast enough.
James Bopp, an advisor to the National Rights Commission, conveyed hope that the Trump administration may reinstate the previous REM for Mifepristone. However, changes to REMS are not straightforward or quick.
Typically, pharmaceutical companies request alterations to REMS, but the FDA has the authority to approve or deny those requests based on whether current safeguards adequately protect consumers.
Earlier this year, HHS Director Robert F. Kennedy Jr. indicated he could support restricting access to abortion medications, while FDA commissioner Marty McCurry has committed to reviewing safety data regarding the drug.
As of now, the FDA, under the Department of Health and Human Services, has not initiated any changes to drug access.
A source familiar with the FDA’s REMS procedures mentioned that some individuals had high expectations for upcoming developments.
Meanwhile, a spokesperson for HHS stated that the FDA cannot comment on future actions regarding the drug.
Tobias reiterated her organization’s commitment to continue pressuring for changes. “We’re going to keep working on this,” she stated. “There’s no concrete plan at this moment, but we’re evaluating all options.”
