What to know about mifepristone access after the Supreme Court ruling

The Supreme Court on Thursday upheld access to the abortion pill mifepristone. The ruling was a win for proponents of access to abortion, but laws surrounding access in states vary. 

The Food and Drug Administration approved mifepristone in 2000 for medication abortion. In 2016, it extended the time frame in which a pregnant woman can use the drug to terminate a pregnancy, from seven weeks’ gestation to 10. In 2021, it moved to permanently allow access to mifepristone prescriptions via telehealth and for the medication to be dispensed by pharmacists and mail-order pharmacies.

However, the right to access mifepristone doesn’t apply in every state.

“Access hasn’t changed from what it was before the decision. The issue is that access is still tough for a number of pregnant persons,” said Dr. Monica Saxena, an emergency medicine physician in Palo Alto, California.

How far into a pregnancy can you use mifepristone? 

Nearly two-thirds of abortions in the U.S. are medication abortions, according to a report by the Guttmacher Institute, a research organization that supports abortion access. Medication abortions consist of taking two pills: mifepristone followed a day or two later by misoprostol. 

Mifepristone is approved for use up to 10 weeks’ gestation, or 70 days. However, some doctors may prescribe it beyond that time frame, a practice called off-label use, said Dr. Reagan McDonald-Mosley, a practicing OB/GYN in Washington, D.C., and CEO of Power to Decide, an organization that supports access to abortion and contraception.  

“Off-label use is not uncommon in any medication,” McDonald-Mosley said. “The provider has made a decision based on evidence to provide that medication in a way that is different from what’s on the label.”

The American College of Obstetricians and Gynecologists’ recommendations for mifepristone say that while the FDA approves it for use up to 10 weeks of pregnancy, “evidence also exists to support safe and effective use with more advanced gestations.” In Sweden, for example, mifepristone is used up to 12 weeks’ gestation, according to Guttmacher. 

Do you need to see a doctor in person to get mifepristone?

As is true for all abortion access, that depends on where a person lives. According to Guttmacher, 14 states have near-total bans on abortion, which include medication abortions carried out within state lines, with in-person visits or without. 

In other states, laws about telehealth have muddied the waters when it comes to accessing mifepristone. 

Five states — Arizona, Nebraska, North Carolina, South Carolina and Wisconsin —  have laws that require in-person visits to get mifepristone, according to Guttmacher. In 15 states, the medication must be dispensed by physicians, rather than pharmacists or nurse practitioners. Two states, Arizona and North Carolina, have also banned sending abortion medication through the mail. 

Can you get mifepristone through telehealth?

In the first year after Roe v. Wade was overturned, telehealth providers handled 8% of all abortions, according to a report from the Society for Family Planning, a nonprofit organization dedicated to researching safe access to abortion care.

The medication is very safe for the vast majority of people to use at home, said Dr. Jamila Perritt, an OB/GYN and abortion provider in Washington, D.C., and president and CEO of Physicians for Reproductive Health.

“This medication is safe and it is effective, whether I give it to you or you self-source the pills online or access it through telehealth,” Perritt said. 

The FDA does include warnings about certain people for whom mifepristone might be dangerous, including those who have ectopic pregnancies, in which the egg implants outside the uterus, and those taking blood thinners.

As of December 2022, the FDA estimated that nearly 6 million women in the U.S. had used mifepristone. In 22 years of use, the agency recorded 32 deaths related to it, including its use in two ectopic pregnancies and several cases of sepsis. 

Can you get mifepristone in a state where abortion is illegal?

Almost all states with near-total abortion bans have exceptions for rape, incest or pregnancies that threaten the women’s lives. But navigating the legal framework can be tricky for both doctors and patients. 

“It is still legal to travel to get abortion care if that is something someone can navigate and chooses to do,” McDonald-Mosley said, noting that people who live in states with near-total bans are legally allowed to travel to states where abortion is legal to have abortions if they have the means. 

People also sometimes order the medication online, from places such as Plan C and AidAccess, which send pills by mail — but McDonald-Mosley said people should be aware of the legal ramifications they may face in their states. 

In some states where abortion is legal, so-called shield laws protect providers who prescribe abortion medications to pregnant women in states where the procedure is banned.

Although mifepristone is medically very safe, “there could be legal risks, which is important for people to know,” she said.