Virtual Clinics Have Been a Fast-Growing Method of Abortion. That Could Change.

A nascent but rapidly growing industry of abortion providers manages abortions exclusively through telemedicine, without physical clinics. Wednesday’s federal court ruling aimed at banning the mailing of abortion pills could make the abortion pills run more difficult.

But for now, some of the more than a dozen virtual clinics, including Hey Jane, Juniper Midwifery, Pills by Post and Carafem, are awaiting clarification from the food media so they can take the controversial pill, mifepristone. It says it will continue to offer medical abortions, including. and drug administration. Filling most of those prescriptions, Honeybee, the largest mail-order abortion drug pharmacy in the United States, said it will continue to mail the drug to the 24 states where it is allowed.

Honeybee co-founder and president Jessica Nouhavandi said: “So we will continue to do business as usual until the FDA announces something else.”

On Friday night, the Supreme Court ruled that a temporary moratorium on mifepristone, the first of two drugs commonly prescribed to induce abortion, would expire at midnight Wednesday to make it widely available. has been issued. If the lower court ruling becomes effective, it could severely limit the drug’s availability, such as only allowing it to be administered to patients in clinics.

Virtual clinics use specially licensed clinicians to serve women who are physically in a state where abortion is legal and have a mailing address there. It offers online consultations via video and messaging, and writes prescriptions typically filled by mail-order pharmacies. A single visit typically costs her $200 to $300, although some clinics offer discounted or free services to low-income patients.

Some of these providers also offer same-day appointments and overnight deliveries, with a clinician on call if the patient has any questions during the process. Some people prescribe pills for. They include Choix, Pills by Post and Juniper Midwifery.

Virtual clinics will launch in 2020, increasing legal abortion rates. Data released this week by WeCount, a research group that tracks the number of abortion procedures nationwide, showed that all in December, up from 4% (3,610) in April before Roe v. Wade was overturned. 11% of abortions (8,540). and pill prescription.

WeCount figures do not include patients undergoing medical abortions via telemedicine from clinics that also offer in-person abortions. It also does not include women who illegally order abortion pills from providers outside the United States. More abortion pills are being ordered from abroad than cover the decline in legal abortions in the United States, according to new data.

Demand for virtual clinics continues to accelerate. Bees are processing more than 10,000 abortion drug prescriptions this year, up by the thousands from late last year. Pharmacies have had the largest number of orders for abortion pills since it was lifted.

Some of the providers said they were not concerned about the legal risks of continuing their business in the face of recent court rulings.

“We will continue to offer prescriptions for both mifepristone and misoprostol,” said Dr. Razel Remen, owner of Pills by Post, which offers telemedicine abortions in four states. . “We feel bound by what the FDA says, not what the court says.”

Abortion on Demand, the largest virtual clinic operating in 22 states and Washington, DC, said it would stop prescribing mifepristone by Monday, when the court’s ruling takes effect. After the Supreme Court visit, Jamie Phifer, M.D., medical director of Abortion on Demand, said he was confident clinics in most states would be able to continue prescribing both pills after Wednesday, but the situation has changed. He said it was changing rapidly.

Referring to misoprostol, the second pill in a two-pill regimen for medical abortion, Dr. Pfeiffer said, “Other states have opted to switch to miso alone until we have more information next week. it is possible,” he said. It can be used safely on its own, but has a low efficacy rate and many side effects.

Most virtual clinics say they will prescribe misoprostol even if they can’t prescribe both pills. Others, like Twentyeight Health and Wisp, have indicated that they may suspend their services if they need to switch to a one-tablet regimen. A few more virtual clinics, including Choix and Forward Midwifery, said they weren’t yet sure how to proceed next week due to legal uncertainty.

In states where abortion is legal, there is no risk for women who obtain and take the pill from these providers, said Farah Diaz-Tello, legal director of the advocacy group If/When/How. The legal risks from possible FDA enforcement against providers and pharmacies are less clear and we hope to have more clarity next week.

The virtual abortion clinic industry is still in its infancy. During the pandemic, virtual abortion clinics became possible when the FDA began allowing pills to be mailed to abortion providers without visiting a clinic in an emergency. FDA has made the policy permanent in December 2021.

California and New York have had the highest numbers of virtual clinic abortions since the Dobbs ruling last June, when the Supreme Court suspended nationwide abortion rights, according to WeCount data. Prescriptions in half a dozen states he more than tripled from April last year to the end of the year.

Hey Jane, one virtual clinic that launched in 2021 and is prescribing in eight states, has more than doubled its monthly patient numbers since Dobbs. To meet demand, the company increased its clinical staff to five times his size last year and introduced a sliding pay scale. It’s also expanding to more states, starting with Maryland this month, with a focus on states bordering the restricted states.

Virtual clinic operators say there are several reasons for the surge in orders from virtual clinics. In some states where abortion is still legal, it can be difficult to get an in-person appointment. The clinic is seeing a surge in patients traveling from states where it is banned. Since Dobbs, more women have become aware of virtual clinics, they say, as the variety of options for getting an abortion has been touted. Some patients find virtual clinics more convenient and more private.

Juniper Midwifery co-founder and midwife Jillian Barovick said:

There are currently competing judgments and lawsuits over medical abortion that the Supreme Court is expected to resolve.

“We don’t know what the U.S. Supreme Court is going to do, or what the FDA is going to do,” said Mary Ziegler, a professor at the University of California, Davis School of Law. I think people and others are using that uncertainty to take a stand.”

Graphics provided by Alicia Parlapiano.