SRF025: Expanding Access to Medication Abortion through Pharmacy Dispensing of Mifepristone: Primary Care Perspectives from Illinois
Kayla Rasmussen, BS; Debra Stulberg, MD; Alischer Cottrill, BA; Elizabeth Janiak, ScD
Context: Medication abortion, using mifepristone and misoprostol, is a safe, effective, and increasingly popular method of pregnancy termination that has potential to expand abortion access via provision in primary care. However, mifepristone is regulated by the Food and Drug Administration through a strict Risk Evaluation and Mitigation Strategy (REMS) that prohibits pharmacy dispensing, requiring patients to access mifepristone from a medical provider. A current legal ruling allows mail dispensing during the COVID19 pandemic, but pharmacy dispensing is still not permitted. While there is no evidence that the REMS improves the safety of mifepristone, it does impose burdens on availability and accessibility. Given the ability of primary care providers (PCPs) to expand medication abortion access, especially in underserved areas, it is important to understand how the REMS affects their ability to provide. Objective: Assess PCP perspectives on how lifting the REMS to allow pharmacy dispensing of mifepristone would affect the provision of medication abortion in primary care. Human Subjects Review: Approved by the University of Chicago IRB. Design: Data were collected as part of a larger qualitative study on medication abortion in primary care. PCPs with experience or interest in providing medication abortion and their administrative colleagues were recruited through known professional contacts and snowball sampling. The final sample (n=19) consisted of 7 family medicine physicians, 7 APCs, and 5 administrative colleagues. Interviews were conducted by telephone using a semi-structured guide. Participants were asked how, if at all, removing the REMS to allow pharmacy dispensing of mifepristone would affect their ability to provide medication abortion. Interviews were recorded, transcribed, and dual-coded using ATLAS.ti. Discussions of pharmacy dispensing were analyzed to identify major themes. Setting: Illinois primary care. Results: PCPs expressed support for pharmacy dispensing due to its ability to help normalize medication abortion, reduce implementation barriers in primary care, and expand abortion access. Further challenges to address if the REMS restrictions are lifted include federal funding restrictions on abortion, concerns about unsupervised mifepristone use, and pharmacy cooperation. Conclusion: Removing the mifepristone REMS to allow pharmacy dispensing could facilitate provision in primary care and address disparities in abortion access.