Both drugsmifepristone and misoprostolare no longer covered by drug patents, and hence are available as
generic drugs. While the legality of abortion
varies by country, and access may be difficult even in countries where it is legal, some non-profits have provided medical abortion pills to women on a boat in international waters (
Women on Waves) or via shipment of pills directly to the patient.(
Women on Web and
Aid Access).
Telehealth access Telehealth includes access to medical services that the person can perform at home, without in-person visits to clinic or provider offices. People who have used telehealth report being satisfied with the access it provides to abortion services. However, those who might need the service the most (those who are incarcerated, unhoused, or live on low income) are often inhibited from accessing it. Public information on telehealth options in the United States of America is available on line. Some populations cannot directly access telehealth services but there are non-traditional means for people to obtain the medications through third party outlets.
Clinic-to-clinic access In this model, a provider communicates with a patient located at another site using clinic-to-clinic videoconferencing to provide medication abortion. This was introduced by
Planned Parenthood of the Heartland in Iowa to allow a patient at one health facility to communicate via secure video with a health provider at another facility. This model has expanded to other Planned Parenthoods in multiple states as well other clinics providing abortion care. The overall decrease in availability and delivery of crucial sexual health care, including safe abortions, amid the COVID-19 pandemic led to an increased incidence of complications and fatalities during pregnancy. Pregnant individuals requested access to medical abortion more than surgical abortion during the pandemic, and preferred the ability to perform medical abortions at home via telehealth services. Data suggest that the increased use of telemedicine for abortion services during this period were a result of COVID-19 fear, reduced travel ability, stay-at-home orders, greater concealment, and the solace of home-care. This data supported the safety and efficacy of telehealth abortion services, and demonstrated its increasing demand. However many pharmacies choose not to supply the drugs and no pharmacy is required by law to do so. This regulation was provisionally implemented in Dec 2021, and was finalized by the US
Food and Drug Administration (FDA) in January 2023. From 2011 until 2021, a woman was required to visit a
healthcare provider in-person (at a clinic or office) and receive mifepristone directly from the provider. The requirement to visit a clinic to receive the medication was removed by the FDA in December 2021, during the
COVID-19 pandemic. Under the new rules, the prescription may be obtained via telehealth (phone calls or video conferencing with a healthcare provider), and then filled at any certified pharmacy. At the same time the FDA removed the requirement for an in-person visit, they added a requirement that dispensing pharmacies be "certified", which requires the pharmacy to have special permission to dispense the medicationsa requirement the FDA imposes on only 40 medications out of more than 19,000 it manages. The second medication used in medical abortion, misoprostol, is most commonly used for treating
ulcers, and was never subject to the in-person dispensing constraints of mifepristone, and was always available from pharmacies with a prescription. The FDA does not authorize the use of mifepristone for medical abortion after 70 days, unlike most other countries, which authorize medical abortion into the second trimester and even the third trimester. Some states have passed laws that prohibit providers from examining the woman via phone or video conferencing, and instead require the woman to make an in-person visit to the provider to get the prescription. In most states, abortion medications may be sent from a pharmacy to the patient via mail, but certain states have passed laws making that illegal, and requiring the medications to be obtained from a pharmacy or provider in-person. Interest in abortion medications in the United States reached record highs in 2022, after the
Supreme Court of the United States draft ''
Dobbs v. Jackson Women's Health Organization'' ruling that would overturn 1973's
Roe v. Wade decision was leaked online. Interest was higher in states with more restrictions on access to abortion. In response to abortion restrictions imposed by some states after the Dobbs legal decision, several organizations that provide telehealth services related to medical abortion, such as
Plan C and
Hey Jane, saw an increase in inquiries and usage. In March 2023, Governor
Mark Gordon of Wyoming signed a bill outlawing the use of abortion pills in the state, making it the first US state to separately ban medical abortions from a ban on all abortion services. The new legislation, which went into effect in July 2023, criminalizes the "prescription, dispensation, distribution, sale, or use of any drug" for the purpose of obtaining or performing an abortion. Those who violate the law, excluding the pregnant woman, may be charged with a misdemeanor and could face a $9,000 fine and up to six months in jail. Fourteen other states have enacted blanket abortion bans that include medical abortions, however, and fifteen states already limit access to these medications. Abortion seekers do travel between states to seek care, often with significant difficulty. In March 2024, some major pharmacy chains, such as
CVS and
Walgreens, received certification from the FDA to dispense mifepristone and they plan to make it available for sale in states where it is legal. While legally allowed to dispense, most pharmacies choose not to supply. This does not violate US law. In December 2024, the state of Texas filed a
civil suit against a physician based in New York, alleging that the physician prescribed abortion drugs to a Texas resident. New York has a
shield law that allows a prescriber who is sued to countersue in this type of situation. The legal status of interstate telemedicine, in particular, writing prescriptions, is an emerging area of law in the United States.
Direct-to-patient access The direct-to-patient model allows for medication abortion to be provided without an in-person clinic visit. Instead of an in-person clinic visit, the patient receives counseling and instruction from the abortion provider via videoconference. The patient can be at any location, including their home. The medications necessary for the abortion are mailed directly to the patient. This is a model, called TelAbortion or no-test medication abortion (formerly no-touch medication abortion), being piloted and studied by Gynuity Health Projects, with special approval from the US
Food and Drug Administration (FDA). This model has been shown to be safe, effective, efficient, and satisfactory. Complete abortion can be confirmed via telephone-based assessment. Reasons why people might choose this option include the need for low-cost care, inability to travel, unhealth relationship status. ==Society and culture==