The future of access to the abortion pill in the U.S. may depend on where you live. Since the Supreme Court’s decision in June overturned national access to abortion, leaving the matter up to individual states, the nation has split: 27 states now allow abortion, while 13 states ban it, while the others either have temporary blocks on abortion bans, or gestational restrictions on when abortions can be performed.
Now, medication abortion—which makes up more than half of abortions performed in the U.S.—is under threat, even in Democratic states. In early April, a Texas district judge ruled that the U.S. Food and Drug Administration (FDA) approval of the abortion pill mifepristone should be suspended. The Supreme Court has stepped in to put a temporary hold on that ruling until midnight on Apr. 19.
For now, mifepristone is still an approved medication. But given the uncertainty of what the Supreme Court could decide, and the precariousness of the legal status of mifepristone, governors in states where abortion is legal are going on the offensive, taking steps to ensure that access to mifepristone continues for as long as possible. If the courts decide the drug is no longer FDA-approved, it’s unclear what will happen to the current supply of mifepristone already in clinics, hospitals, and reproductive health centers. There has never been a situation where a long-approved drug has its FDA approval questioned by the court system.
How Democratic states are responding
To protect against potential shortages, Massachusetts governor Maura Healey requested that the University of Massachusetts purchase 15,000 doses of the drug, which should be enough to treat patients for about a year. The state is committing $1 million to purchasing additional doses ordered by health care providers in Massachusetts.
In California, Gov. Gavin Newsom plans to purchase up to 2 million doses of misoprostol, another drug that’s FDA-approved, when used in combination with mifepristone, to induce abortion. While misoprostol is also FDA-approved to treat ulcers, it can be prescribed off-label to induce abortion without mifepristone, and it’s used on its own as an abortion medication in many countries around the world. The combination is approved in the U.S. because the two drugs together are slightly more effective and produce fewer side effects than misoprostol alone. California purchased the pills through its CalRx program, an initiative launched in 2019 designed to make prescription drugs more accessible and affordable through a network of state pharmacies to the state’s residents.
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New York governor Kathy Hochul has also instructed the state’s Department of Health to stockpile 150,000 doses of misoprostol, enough to treat patients in the state for five years. To further protect doctors who prescribe misoprostol off-label for abortion, Hochul also proposed legislation to require private insurers to cover misoprostol when it’s used for abortion, and to discourage higher malpractice rates for health-care professionals who prescribe the drug for that purpose. Since 1970, the right to abortion has been written into state law, but Hochul is working to make access easier, including allowing pharmacists to write prescriptions and permitting stockpiling if courts decide specific drugs for medical abortions are illegal.
If mifepristone is removed from the market as a result of the court battle, Hochul said the state would dedicate $20 million to provide other strategies for abortion care.
Gov. Jay Inslee of Washington recently announced that he had instructed the Department of Corrections in the state to purchase a three-year supply of mifepristone through its pharmacy, and the University of Washington has also bought 100,000 doses.
In other states where abortion is legal, officials are ensuring that access to the drug remains unencumbered. Gov. JB Pritzker of Illinois said in an emailed statement to TIME that “we have offered providers Medicaid advances for both mifepristone and misoprostol to ensure they have abortion medication available and can offer this gold standard healthcare as long as possible. As long as I am Governor, Illinois will do everything possible to keep abortion safe and legal.”
Depending on what the Supreme Court decides about mifepristone, these supplies of mifepristone and misoprostol could become a new battleground in the fight for abortion, as states where abortion remains legal enter new territory to defend reproductive rights.
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