Mail-order pharmacy-dispensed mifepristone is effective for medication abortion, according to a recent study published in JAMA Internal Medicine.1
Takeaways
- The study indicates a high efficacy rate of 97.8% for medication abortion with mifepristone dispensed through mail-order pharmacies, surpassing the rate reported on the label.
- A significant majority (91.3%) of participants reported being very satisfied with the mail-order dispensing process, emphasizing its acceptability among patients seeking abortion care.
- Mail-order pharmacy dispensing offers increased accessibility to medication abortion, particularly for individuals living outside metropolitan areas or in communities with limited access to reproductive healthcare services.
- No adverse events were directly linked to mail-order pharmacy dispensing, indicating that the process is safe for patients seeking medication abortion.
- The study suggests the potential for expanding pharmacy dispensing of mifepristone, highlighting the importance of efforts to enhance access to reproductive healthcare services.
Mifepristone and misoprostol have been proven safe and effective for medication abortion, with an increase from 53% to 63% of nonhospital medications being medication abortion in the United States between 2020 and 2023. During the COVID-19 pandemic, the in-person requirement for dispensing was rescinded, allowing patients to receive medication abortion through telehealth.
Research has indicated increased barriers when requiring in-person medication abortion, with many clinicians only able to see a small number of patients in-person to provide abortion services. Therefore, these barriers may be reduced by the option to receive medication by mail. However, there is little data about the efficacy of this method.
To determine the efficacy, acceptability, and feasibility of providing medication abortion by a mail-order pharmacy dispensing after an in-person eligibility assessment, investigators conducted a prospective cohort study. Patients were enrolled from 11 sites across 7 US states.
Eligibility criteria included seeking and being eligible for a medication abortion based on the FDA-approved mifepristone label, willing to receive mail-order medication, willing to use misoprostol based on the labelling, speaking English or Spanish, willing to be contacted by email or phone, and being at 63 days’ gestation or less.
Participants received instructions about medication use, and pregnancy termination was determined during follow-up. The initial prescription included mifepristone 200 mg and misoprostol 800 ug. Clinicians could also choose to prescribe patients with analgesics, antiemetics, antibiotics, contraceptives, and pregnancy tests.
Information about patients’ experiences with receiving the package, taking the medications, and having the abortion was collected through online surveys administered at days 3 and 14 after enrollment. Self-reported demographic information was also obtained through the surveys.
The efficacy and acceptability of medication abortion was reported as the primary outcome. Model feasibility and safety outcomes were reported as secondary outcomes.
There were 506 participants aged a median 27 years included in the final analysis. Of participants, 38.3% were Black, 27.9% White, 17.4% Hispanic, and 8.9% multiracial or other race. Day-3 survey data was obtained for 97% of participants and day-14 data for 94%.
Package retrieval within 3 days of enrollment was reported by 85.5% of participants, with 94.3% considering delivery time to be reasonable while 5.5% thought it was too long. Of participants, 97.4% reported the package was in good condition and 2.4% reported the package was damaged. Confidentiality was maintained for 98.2% of participants.
The mifepristone label noted a complete abortion rate of 97.4%. In participants, the rate was 97.8%, which was favorable when compared to the rate on the label. Of participants with a complete abortion, 5% had to take an additional misoprostol dose. Unsuccessful medication abortion was reported among 2.2% of participants.
Adverse events (AEs) included bleeding, nausea, pain, diarrhea, vomiting, and infection. Twenty-four AEs were reported, 17 of which required an emergency department visit and 3 were considered severe AEs.
No AEs were linked to mail-order pharmacy dispensing. Being very satisfied with mail-order dispensing was reported by 91.3% of participants and somewhat satisfied by 5.3%.
These results indicated efficacy and acceptability from mail-order pharmacy dispensing of medication abortion. Investigators concluded efforts are needed to expand pharmacy dispensing of mifepristone.
Based on this data, authors of a health care policy and law document stated, “Along with prescribing medications to be dispensed by mail, many US licensed primary care clinicians already offer safe and effective medication abortion using telehealth.”2
“Telehealth is especially important for individuals living outside metropolitan areas, in low-income communities, or where high-quality reproductive and maternity care services are lacking because of legislative reasons,” authors added.
References
- Grossman D, Raifman S, Morris N, et al. Mail-order pharmacy dispensing of mifepristone for medication abortion after in-person screening. JAMA Internal Medicine. 2024. doi:10.1001/jamainternmed.2024.1476
- Godfrey EM, Zhang Y, Stulberg DB. Primary care’s role in prescribing mail-order mifepristone. JAMA Internal Medicine. 2024. doi:10.1001/jamainternmed.2024.1448
