Clinics draw up backup plans as Supreme Court ruling looms


US abortion pill suppliers are scrambling to come up with back-up plans as the Supreme Court decides whether to keep restrictions on the key drug, mifepristone.

Some in-person clinics in New York, California and Kansas will offer mifepristone for now, but are preparing to provide an alternative abortion pill if a later ruling essentially bans the drug. Several in-person providers in Ohio may stop offering mifepristone altogether. A telehealth provider plans to close for up to two weeks to move to new operations.

All of these efforts are aimed at preserving access to most common type of abortion in the United States, even as a broader legal battle over mifepristone intensifies.

Access to mifepristone is at stake and could quickly change depending on what the highest court in the land decides as early as next week. On Friday, Judge Samuel Alito temporarily suspended lower court rulings that placed limits on access to mifepristone so judges would have more time to consider the case.

But for now, telehealth and in-person clinics could be forced to deal with significant restrictions on the drug that could come into effect after Alito’s order expires Wednesday at 11:59 p.m. ET.

In this photo illustration, packages of mifepristone tablets are displayed at a family planning clinic on April 13, 2023 in Rockville, Maryland.

Anna Moneymaker | Getty Images

The 5th U.S. Circuit Court of Appeals on Wednesday night froze part of Judge Matthew Kacsmaryk’s order suspending the Food and Drug Administration’s approval of mifepristone. But the court temporarily blocked delivery of the pill by post, reimposed doctor visits on aborted patients and shortened the length of time patients can take the pill to week seven of pregnancy, down from 10 weeks. previous ones.

These restrictions will limit access to mifepristone even in states where abortion is legal. But the appeals court ruling does not restrict access to abortion pills in 17 states and Washington DC that were the subject of a separate court ruling last week, a federal judge told Thursday. Washington.

Some in-person abortion clinics in states where the procedure is legal told CNBC that operations will remain largely the same. But they also outlined their contingency plans should the court battle lead to tougher restrictions on the pill.

trust womena clinic in Wichita, Kansas will continue to offer mifepristone even if the restrictions go into effect, according to Zack Gingrich-Gaylord, the clinic’s communications director.

“We are not greatly affected by this decision,” Gingrich-Gaylord told CNBC, referring to the appeals court decision. “But we are always ready to pivot if there are more restrictions. We have the alternative protocol ready.”

The clinic is prepared to offer misoprostol as a stand-alone treatment if a subsequent decision rejects FDA approval of mifepristone, Gingrich-Gaylord said. The drug is typically used in combination with mifepristone for abortion patients in the United States.

Misoprostol alone is recognized worldwide as a safe and effective treatment for women wishing to terminate their pregnancies. The decision of the Court of Appeal does not affect access to the drug.

THE Choices Women’s Medical Center in Queens, New York, and the University of California San Francisco Pregnancy Options Center will also continue to offer mifepristone and implement misoprostol treatment alone as a back-up plan, according to clinic representatives.

But some in-person abortion clinics in Ohio may stop dispensing mifepristone altogether whether those restrictions go into effect, according to Jessie Hill, an attorney who represents several independent vendors in the state.

Hill, who is also a law professor at Case Western Reserve University, said Ohio law requires doctors to follow federal label guidelines when prescribing mifepristone. She noted that the law means clinics cannot prescribe a drug in a way that has not been approved by the federal government, which is known as “off-label” prescribing.

Other clinics in states where abortion is legal can prescribe off-label mifepristone beyond the first seven weeks of pregnancy, according to Hill. She said it allows clinics to effectively circumvent a restriction in the appeals court order in a way Ohio providers cannot.

“The order makes it particularly inconvenient for clinics in Ohio to prescribe mifepristone, so they probably won’t. We might be the only state in this weird situation,” Hill said.

She noted that some clinics may start offering misoprostol treatment alone as soon as the restrictions come into effect. because it’s “actually a better option for most at this point”.

U.S.-based telehealth clinics may need to make more sudden changes than in-person providers due to restricted courier delivery of mifepristone.

Abortion telemedicine will only offer misoprostol in states that allow it if the restrictions go into effect on Wednesday, according to the supplier’s founder, Jayaram Brindala. The clinic serves patients throughout the first trimester, which is 13 weeks of pregnancy.

just the pill is also ready to offer “the safe and effective misoprostol-only regimen to patients if needed,” said Dr. Julie Amaon, the company’s chief medical officer. Just The Pill provides abortion medication in Wyoming, Montana, Colorado and Minnesota.

Stranda company that offers medical abortions via telehealth in nine states will also switch to misoprostol only if those restrictions are put in place, according to Monica Cepak, the company’s chief marketing officer.

But the change would force the business to close for up to two weeks from Wednesday, she noted.

“At the moment we are in our status quo mode and will remain so until we hear further developments,” Cepak said.

She underscored the critical role of telehealth in abortion care in the United States, noting that the growing demand for in-person services makes difficult for patients to make an appointment.

“It can sometimes take 20 to 40 days. That’s too long for most people to wait,” she said. “Telehealth fills this gap.”

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