The legal effort to ban mail-order abortion drugs came just as the fledgling telemedicine industry was becoming more accepted and established as part of abortion care.
This week, Hey Jane, one of the virtual abortion providers with no physical location, started a deal with insurer Anthem Blue Cross Blue Shield. These include Empire Blue Cross in Connecticut, Blue Shield in New York, and Sana, which provides health insurance for small businesses nationwide. Hey Jane, he’s already accepted Aetna in eight of the nine states where Aetna operates.
Insurance companies rarely cover telemedicine abortions and most virtual clinics are cash only. Clinics are new and abortion coverage varies widely. The year before Roe v. Wade was overturned, just a third of abortion patients used insurance.some states need a private insurance company To cover abortion, others have banned it. Federal law prohibits the use of Medicaid for most abortions. 16 states Use state funds to cover them. But even plans that cover abortion usually don’t include these new telemedicine providers in their networks.
Health insurance companies tend to cover treatments that are widely accepted by clinicians and are cost-effective. Hey Jane’s insurance partnership is the latest sign that the healthcare industry sees virtual abortion clinics as a safe and in-demand option. It also tends to be cheaper than in-clinic procedures for both patients and insurance companies.
Will Young, CEO of Sana, said, “In abortion care, as in many other areas of health care, expanding the role of telemedicine will help make care more accessible and affordable. I think it’s a great way to get the price down.
Not all insurers are ready to cover this new way of offering abortions, said Gaby Santana, business director of Hey Jane. For example, some facilities require live video visits, but Hey Jane sees most of its patients through messages. Other insurers only contract with clinics that have a physical location, he told Hey Jane.
“Our goal is to make this as large and accessible as possible,” Santana said. “That’s why we want to bring in more states and more payers.”
Honeybee, the largest online pharmacy offering mail-in abortion pills, fills more than 10,000 prescriptions a month, new data shows telemedicine is rapidly increasing abortion rates. It says it’s compatible.
But these clinics can also get dragged down as soon as they start growing. The Fifth Circuit ruled last week that the Food and Drug Administration should ban telemedicine prescriptions and mail delivery of mifepristone. This is a temporary order while a Texas court considers whether to overturn the drug’s approval altogether. The Supreme Court ruled Friday that mifepristone will be available until midnight Wednesday, allowing time to consider the case.
US healthcare
The FDA will allow telemedicine abortions for the first time in 2020. This follows an emergency court decision early in the pandemic and after extensive data showed it was a safe and effective way to provide abortion drugs to patients. This policy has been made permanent in 2021.
According to Honeybee co-founder Jessica Nouhavandi, pharmacists must obtain a special certificate to dispense mifepristone and report data on each prescription. “We literally had to create protocols and train pharmacists,” she said. “Most people don’t even learn about this in school.”
Most of the emerging clinics only operate in a few states. They must have a licensed clinician in each state who sees patients. Some companies are funded by investors and funders to figure out how to build a profitable business. Few companies have lawyers on staff to help them navigate the legal challenges these days.
They form an informal network, have group chats about electronic medical records and legal questions, and help each other. A nonprofit called Plan C offers consulting, sometimes small grants, and a database of providers.
They started talking about what they would do if the FDA were prompted by a lawsuit to take mifepristone off the market. Many are prepared to offer only a second drug, misoprostol, which is effective when used alone to terminate a pregnancy but can have more side effects.
Dr. Rachna Kaul runs Maitri Wellness, New Jersey’s sole primary care practice. But she started offering telemedicine abortions during the pandemic, and now her office is in three states where she’s licensed. She mails dozens of pill packs a day. doing. She charges cash for patients who can afford the service and subsidizes the costs of those who cannot.
Adding services was easy, says Dr. Kaul Because she was self-employed, more for her than for many of her peers. “I didn’t have the money to begin with, so it all came out of my own pocket,” she said. “I could have had other jobs and made more money. This is a huge need.”
Juniper Midwives, run by two midwives on a daily basis in New York City hospitals and clinics, provides 175 medical abortions per month to women in six states. They are active at home and on the go.
Marisa Poverman, who founded Juniper with Jillian Barovick, said: “We are still in the grassroots stage, so this week felt a bit tenuous.
Juniper confirmed its first patient in August. Ms. Poberman used her WordPress to build the website and her husband took her headshot. They raised money from friends and family to get it off the ground and now have a grant from the state of New York. They accept cash only and use subsidies to subsidize prices or provide free care to patients who need it.
By contrast, Hey Jane is one of the most established providers, with $9.6 million in venture capital investment and 40 employees. Abortion on Demand and Aid Access operate in the most states. (Another chapter of Aid Access connects women with doctors and pharmacies abroad and operates in states where abortion is illegal.)
Carafem is another big business, offering telemedicine abortions in 16 states and also has several physical clinics. Chief Operating Officer Melissa Grant said the hardest part of the job was learning the rules that differ from state to state.
Insurance coverage questions reflect and often amplify these complexities. Health care providers are working hard to help patients understand what their insurance covers, Grant said, and are trying to convince more health insurance plans to work with the company.
“Not all plans cover abortion,” she said. “Add telemedicine on top of that, and unfortunately there are far more insurers who will deny care.”
Even with insurance, not all patients want to take advantage of it, says Stephanie Colantonio, a primary care physician who offers telemedicine abortions in California through Luna Flow Health. says Dr. “Some patients are nervous about privacy and security and prefer to pay out of their own pocket,” she said.
