What if a pharmacist could not only dispense abortion pills, as the Biden administration recently made possible, but also prescribe them? Pharmacists in Washington state, taking advantage of a provision in state law that allows pharmacists to prescribe drugs, are completing a training program that will allow them to be certified to prescribe and dispense abortion pills to women in their state, says Patrick Adams in a report for National Public Radio (NPR) on 22 January 2024.
The vision is not simply to expand access to abortion pills in Washington State, but to serve as a model for other states.
Taking advantage of newer FDA regulations
It was only about a year ago that the U.S. Food and Drug Administration (FDA), at the behest of the Biden administration, announced new regulations allowing pharmacies to be certified to dispense mifepristone, the abortion pill.
In addition to having to have a designated person to fill out and manage all the paperwork, this person had to be familiar with the prescribing information, ensure that prescriptions came from certified prescribers whose information was on file, and confirm with the prescriber that the drug was appropriate for the patient.
This essentially means that both the prescriber and the pharmacist have to make sure that the patient has been properly screened for various conditions or drug allergies, that they are within the appropriate gestational range (no more than ten weeks after a woman’s last menstrual period), and that they do not have an ectopic pregnancy, which the drugs do not treat.
The pharmacist who plans to deliver these drugs to women’s homes must track and record all shipments and guarantee delivery within four calendar days.
Any patient deaths must be reported back to the prescriber, who must report them to the distributor, who must report them to the FDA.
At one point, prescriptions were limited to doctors, but under regulations in place since 2016, these can be prescribed by any “certified healthcare provider.”
Under those terms, the drugs can be prescribed by any doctor, nurse, physician assistant, or any other healthcare provider –- such as a pharmacist.
So long as they meet the certification requirements, largely mirrored in the pharmacy certification conditions, they can receive certification and FDA permission to prescribe and distribute the drugs.
If there is a difference in the two certifications, it is that the prescriber has to certify that they personally have the ability to accurately date pregnancy, diagnose ectopic pregnancy, provide or refer for any necessary surgical intervention, and can assure patient access to medical facilities equipped for blood transfusion.
They also need to make sure the patient is fully briefed on mifepristone risks, has any questions answered, and signs appropriate agreements.
Abortion pill advocates have sought to interpret these very loosely. They claim these tasks can be accomplished without an in-person physical exam (or ultrasound) in a teleconference, or even a phone call, or a online questionnaire. As of January 2023, the FDA appears to be allowing if not endorsing that interpretation with its new protocol.
State of Washington takes advantage
Under the new regulations, it isn’t clear why any pharmacist in any state might not be able to qualify as a prescriber. But Washington state’s law explicitly authorizing pharmacists to prescribe medications certainly makes it easier.
More than forty years ago, Washington passed a law setting up “collaborative practice agreements,” or CPAs. These allowed licensed prescribers such as to physicians or nurse practitioners to delegate authority to a pharmacist to prescribe or administer certain drugs. This enabled the state to use pharmacists to provide some limited healthcare and boost immunization rates among underserved Native American communities in the state.
Don Downing is a pharmacy professor who was part of that program in the 1970s and served as a pharmacist medical provider on area reservations. This past spring, shortly after the Biden administration announced the new certification system, Downing and several of his colleagues set up the Pharmacy Abortion Access Project. This focused on training community pharmacists to screen chemical abortion patients, prescribe abortion pills, and dispense them from their stores.
Downing told NPR that most women live close to their community pharmacy and see their pharmacist twice as often as they do their primary physician. Being more familiar, Downing seems to feel, women may be more comfortable seeking abortion pills from their local pharmacist than their doctor. Pharmacists are also more accessible to patients, with drug stores being open in the evenings, on weekends and holidays, often available without need for any appointment.
Ten pharmacists are part of Downing’s first “class,” and he expects them to be prescribing abortion pills sometime in the next few weeks. No word on how Downing means to ensure that the FDA grants certification within that time frame. However, his training program includes not only instruction on how to screen patients remotely without ultrasound, pelvic exam, or bloodwork, but also how to implement the treatment regimen and handle follow-up care.
Downing believes Washington’s program can be a model for other states.
NPR’s Patrick Adams writes about a bill being considered in New York state that would grant pharmacists authority to prescribe abortion pills there. Researchers in San Diego, California recently published results of a pilot study claiming to show that pharmacists could safely and effectively prescribe abortion pills in that state.
NPR believes that there are already a few pharmacists in California who received advance practice certification and are legally allowed to prescribe the abortifacient pills.
Experts offer differing opinions
Naturally, like so many other propaganda pieces encouraged by the abortion establishment, the article wraps up with statements by industry “experts” that chemical abortions are “extremely effective and extremely effective.”
Pro-life doctors who challenged the FDA’s new laxer prescription criteria in Alliance for Hippocratic Medicine v. FDA, the case being heard by the Supreme Court in April this year, know better.
When the FDA expanded the prescriber pool to include non-physicians and dropped requirements for in-person visits, those doctors claimed this made misestimations of gestational age more likely, decreasing effectiveness and increasing the likelihood of complications.
They also believed this increased the risk of undetected ectopic pregnancies, which can prove deadly to the mother if they rupture.
This is in addition to the risks of hemorrhage, infection, and failure normally faced by users of the abortion pill.
If the Supreme Court rules in favor of pro-life doctors, it could mean that pharmacists in Washington and elsewhere will not be writing these prescriptions.
Any patient deaths must be reported back to the prescriber, who must report them to the distributor, who must report them to the FDA.
Prescriptions were once restricted to doctors, but under regulations in place since 2016, they can be prescribed by any “certified health care provider”.
Under these rules, the drugs can be prescribed by any doctor, nurse, physician assistant or other healthcare provider – such as a pharmacist.
As long as they meet the certification requirements, which are largely mirrored in the pharmacy certification requirements, they can be certified and given permission by the FDA to prescribe and distribute the drugs.
If there is a difference between the two certificates, it is that the prescriber must certify that he or she is personally able to accurately date the pregnancy, diagnose ectopic pregnancy, carry out or refer for any necessary surgical intervention, and ensure that the patient has access to medical facilities equipped to carry out blood transfusions.
They must also ensure that the patient is fully informed of the risks of mifepristone, has all her questions answered and signs a consent form.
Abortion pill advocates have tried to interpret these very loosely. They claim that these tasks can be completed without an in-person physical exam (or ultrasound), in a teleconference or even a phone call, or through an online questionnaire. From January 2023, the FDA appears to be allowing, if not endorsing, this interpretation with its new protocol.
Washington state takes advantage
Under the new rules, it’s not clear why any pharmacist in any state can’t qualify as a prescriber. But Washington state’s law, which explicitly authorises pharmacists to prescribe, certainly makes it easier.
More than forty years ago, Washington passed a law creating “collaborative practice agreements” (CPAs). These allowed licensed prescribers, such as physicians or nurse practitioners, to delegate authority to a pharmacist to prescribe or administer certain medications. This enabled the state to use pharmacists to provide some limited health care and to increase immunisation rates in the state’s underserved Native American communities.
Don Downing is a pharmacy professor who was part of that programme in the 1970s and served as a pharmacist health care provider on area reservations. Last spring, shortly after the Biden administration announced the new certification system, Downing and several of his colleagues launched the Pharmacy Abortion Access Project. This focused on training community pharmacists to screen chemical abortion patients, prescribe abortion pills, and dispense them in their stores.
Downing told NPR that most women live close to their community pharmacy and visit their pharmacist twice as often as their GP. Because they are more familiar, Downing said, women may feel more comfortable getting abortion pills from their local pharmacist than from their doctor. Pharmacists are also more accessible to patients, with drugstores open in the evenings, on weekends and holidays, and often available without an appointment.
Ten pharmacists are part of Downing’s first ‘class’ and he expects them to start prescribing abortion pills in the next few weeks. No word on how Downing will ensure that the FDA grants certification within this time frame. But his training programme includes not only instruction on how to screen patients remotely without ultrasound, pelvic exams or blood tests, but also how to implement the treatment regimen and handle follow-up care.
Downing says Washington’s programme could be a model for other states.
NPR’s Patrick Adams writes about a bill being considered in New York state that would allow pharmacists to prescribe abortion pills. Researchers in San Diego, California, recently published the results of a pilot study that they say shows pharmacists can safely and effectively prescribe abortion pills in that state.
According to NPR, there are already a few pharmacists in California who have received advanced practice certification and are legally allowed to prescribe the abortion pills.
Experts disagree
Of course, like so much of the propaganda promoted by the abortion establishment, the article concludes with statements by industry “experts” that chemical abortions are “extremely effective and extremely efficient”.
Pro-life doctors who challenged the FDA’s new lax prescribing criteria in Alliance for Hippocratic Medicine v. FDA, the case heard by the Supreme Court in April this year, know better.
When the FDA expanded the pool of prescribers to include non-physicians and dropped the requirement for a face-to-face visit, these physicians claimed that this made it more likely that gestational age would be misjudged, reducing efficacy and increasing the likelihood of complications.
They also believed this increased the risk of undetected ectopic pregnancies, which can be fatal to the mother if they rupture.
This is in addition to the risks of haemorrhage, infection and failure that users of the abortion pill normally face.
If the Supreme Court rules in favour of pro-life doctors, it could mean that pharmacists in Washington and elsewhere will no longer write these prescriptions.
Daniel Miller is responsible for nearly all of National Right to Life News' political writing.
With the election of Donald Trump to the U.S. presidency, Daniel Miller developed a deep obsession with U.S. politics that has never let go of the political scientist. Whether it's the election of Joe Biden, the midterm elections in Congress, the abortion rights debate in the Supreme Court or the mudslinging in the primaries - Daniel Miller is happy to stay up late for you.
Daniel was born and raised in New York. After living in China, working for a news agency and another stint at a major news network, he now lives in Arizona with his two daughters.
