An emerging but fast-growing industry of abortion providers performs abortions only through telemedicine, with no brick-and-mortar clinics. A federal court ruling Wednesday that aims to ban the shipment of abortion pills could make it much more difficult for them to operate.
But for now, several of the more than a dozen virtual clinics — including Hey Jane, Juniper Midwifery, Pills by Post and Carafem — say they will continue to offer medication abortions, including mifepristone, the disputed pill, pending clarity from the Food and Drug Administration. Drug administration. Honeybee, which prescribes the most prescription drugs and is the largest mail-order pharmacy for abortion pills in the United States, said it would continue to ship the pills to the 24 states where it is allowed.
“As a licensed pharmacy, we adhere to FDA policies and regulations,” said Jessica Nouhavandi, co-founder and president of Honeybee. “And so until the FDA says something, which they haven’t already, we’ll just keep going.”
On Friday night, the Supreme Court issued a temporary stay, expiring at midnight Wednesday, leaving mifepristone, the first of two drugs commonly prescribed to induce abortion, widely available. Rulings in the lower courts, if they take effect, could severely limit the drug’s availability, including allowing it to be administered only to patients in a doctor’s office.
Virtual clinics employ specially licensed clinicians and serve women who are physically located in states where abortion is legal and have a mailing address there. They offer online consultations, via video or messages, and write prescriptions that are usually filled by a mail-order pharmacy. A visit generally costs $200 to $300, although some clinics offer discounts or free services to low-income patients.
Some of these providers offer same-day appointments and overnight delivery, and have clinicians on call if patients have questions during the process. Some also prescribe pills to women who are not pregnant but may need them in the future. They include Choix, Pills by Post, and Juniper Midwifery.
Virtual clinics started in 2020 and are responsible for a growing share of legal abortions. They accounted for 11 percent of all abortions in December, or 8,540, compared to 4 percent, or 3,610, in April, before Roe v. Wade was overturned, according to data released this week by WeCount, a research group that tracks nationwide counts of abortion procedures. collects and pill prescriptions.
The WeCount numbers do not include patients receiving medicated abortions via telehealth from clinics that also offer in-person abortions. They also do not include women who illegally order abortion pills from providers outside the United States. New data shows that enough abortion pills have been ordered from abroad to more than cover the decline in legal abortions in the United States.
The demand for virtual clinics has continued to grow. Honeybee is filling more than 10,000 abortion medication prescriptions per month this year, up several thousand from the end of last year. Since a federal judge in Texas last week issued a preliminary ruling invalidating the FDA’s approval of mifepristone, the pharmacy has had the largest number of abortion medication orders.
Several providers said they were not concerned about the legal risks of continuing to operate in light of the recent court rulings.
“We will continue to provide prescriptions for both mifepristone and misoprostol,” said Dr. Razel Remen, the owner of Pills by Post, which offers remote abortions in four states. “We feel we are bound by what the FDA says and not what the courts say.”
Abortion on Demand, the virtual clinic with the largest footprint, operating in 22 states and Washington, D.C., had said it would stop prescribing mifepristone by Monday, when the court’s ruling took effect. Following the Supreme Court stay, Dr. Jamie Phifer, the medical director of Abortion on Demand, said she was confident the clinic could continue to prescribe both pills in most states last Wednesday, but that the situation was rapidly changing. .
“We may elect to switch to miso only in other states pending more information next week,” said Dr. Phifer, referring to misoprostol, the second pill in the two pill regimen for medication abortion. It can be safely used alone, but with lower effectiveness and more side effects.
Most virtual clinics said they would still prescribe misoprostol if they couldn’t prescribe both pills. Some, such as Twentyeight Health and Wisp, indicated that there could be a break in service if they had to switch to the one-pill regimen. Several virtual clinics, including Choix and Forward Midwifery, said they were not yet sure how they would proceed next week due to the legal uncertainty.
In states where abortion remains legal, there are no risks to women who obtain and take the pills from these providers, said Farah Diaz-Tello, the legal director of the advocacy group If/When/How. The legal risks of potential FDA enforcement for the providers and the pharmacies are less clear, and they said they hope for more clarity next week.
The virtual abortion clinic industry is young: They were made possible during the pandemic when the FDA began allowing abortion providers to send pills without a visit to the clinic in an emergency. The FDA made the policy permanent in December 2021.
Since the Supreme Court’s Dobbs decision last June that ended nationwide abortion rights, California and New York have had the most abortions from virtual clinics, WeCount data shows. Prescriptions in half a dozen states more than tripled from last April to the end of the year.
A virtual clinic, Hey Jane, which started in 2021 and prescribes in eight states, has more than doubled monthly patients since Dobbs. To meet demand, it has increased its clinical staff fivefold over the past year and introduced a sliding salary scale. It’s also expanding to more states, starting with Maryland this month and focusing on states bordering those with restrictions.
There are several reasons for the rapid increase in orders from virtual clinics, say the people who run them. In some states where abortion is still legal, it can be difficult to get an appointment in person, as clinics have seen large numbers of patients arriving from states with a ban. The increased publicity for various abortion options since Dobbs has also made more women aware of virtual clinics, they say. Some patients also find virtual clinics more convenient and private.
“We can provide that care from the comfort of home in a very confidential way,” says Jillian Barovick, midwife and co-founder of Juniper Midwifery.
There are now competing rulings and lawsuits on medication abortion, which are expected to be resolved by the Supreme Court.
“We don’t know what the U.S. Supreme Court is going to do, we don’t know what the FDA is going to do,” said Mary Ziegler, a professor at the University of California Davis School of Law. “And I think we’re seeing a larger group of prescribers and other actors using that uncertainty to take a stand.”
Alicia Parlapiano contributed images.
