Clinics draw up backup plans as Supreme Court docket choice looms

US suppliers of abortion pills are scrambling to make backup plans as the Supreme Court decides whether to keep restrictions on key drug mifepristone.

Some personal clinics in New York, California and Kansas will offer mifepristone for now, but are preparing to offer an alternative abortion pill if a later decision essentially bans the drug. Several personal providers in Ohio could stop offering mifepristone altogether. A telemedicine provider plans to shut down for up to two weeks to adjust to new surgeries.

All of these efforts are aimed at maintaining access to the most common type of abortion in the US, even as a major litigation over mifepristone escalates.

Access to mifepristone is on the brink and could change quickly depending on what the country’s highest court rules as soon as next week. Judge Samuel Alito on Friday temporarily stayed lower court rulings restricting access to mifepristone to allow judges more time to consider the case.

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

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

Anna Moneymaker | Getty Images

The U.S. 5th Circuit Court of Circuit late Wednesday 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 in the mail, ordered abortion patients to see doctors again, and reduced the length of time the pill was taken to seven weeks of pregnancy, down from the previous 10 weeks.

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, which were the subject of a separate court decision issued last week, a federal judge in Washington said Thursday.

Some in-person abortion clinics in states where the procedure is legal told CNBC the surgeries will remain largely the same. But they also highlighted their contingency plans in case the court battle leads to stricter restrictions on the pill.

Trust Women, a clinic in Wichita, Kansas, will continue to offer mifepristone even after the restrictions go into effect, according to Zack Gingrich-Gaylord, the clinic’s communications director.

“We are not greatly affected by this ruling,” Gingrich-Gaylord told CNBC, citing the appeals court’s decision. “But we are still prepared to pivot if there are further restrictions. We have the alternate protocol ready.”

The clinic is poised to offer misoprostol as a standalone treatment if a later decision overrules the FDA’s approval of mifepristone, Gingrich-Gaylord said. The drug is typically used in the US in combination with mifepristone in abortion patients

Misoprostol alone is recommended worldwide as a safe and effective treatment for women wishing to terminate their pregnancy. The appeals court’s decision does not affect access to the drug.

Choices Women’s Medical Center in Queens, New York, and the University of California San Francisco Center for Pregnancy Options will also continue to offer mifepristone and have misoprostol-only therapy as a backup plan, hospital officials said.

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

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

Other clinics in states where abortion is legal can prescribe mifepristone outside of the first seven weeks of pregnancy, Hill said. She said this allows clinics to effectively circumvent a limitation in the appeals court order in a way that Ohio providers cannot.

“The regulation makes it particularly impractical for Ohio clinics to prescribe mifepristone, so they probably won’t do it.” We could be the only state in this strange situation,” Hill said.

She noted that some clinics may begin offering the misoprostol-only regimen once the restrictions take effect because it’s “actually a better option for most at this point”.

US-based telemedicine clinics may have to make more sudden changes than in-person providers due to mifepristone mail delivery restrictions.

Abortion Telemedicine will only offer misoprostol in states that allow it when restrictions go into effect Wednesday, according to provider founder Jayaram Brindala. The clinic looks after patients throughout the first trimester, i.e. the 13th week of pregnancy.

Just The Pill is also prepared to offer patients “the safe and effective pure misoprostol therapy when needed,” said Dr. Julie Amaon, the company’s medical director. Just The Pill supplies abortion drugs in Wyoming, Montana, Colorado and Minnesota.

Wisp, a company that offers telemedicine medical abortions in nine states, will also transition to offering only misoprostol when those restrictions are implemented, according to Monica Cepak, the company’s chief marketing officer.

But that change would require the company to close for up to two weeks starting Wednesday, she noted.

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

She emphasized the critical role of telemedicine in abortion care in the US, noting that the increasing demand for in-person services is making it difficult for patients to schedule appointments.

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

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