Retail pharmacies filled less than 2% of prescriptions for the abortion pill mifepristone following a federal policy change, according to an April 13 study from the University of Southern California published in JAMA.
The U.S. Food and Drug Administration removed requirements in January 2023 that had forced patients to obtain mifepristone—the first drug used in medication abortions—in person at clinics or hospitals. The rule change allowed both in-store and mail-order pharmacies to dispense the drug when prescribed by certified providers, with expectations that this would increase access across the country.
Researchers found that since the update, about 2,700 mifepristone prescriptions are filled monthly, but nearly all are handled by mail-order pharmacies in states where abortion is legal and can be prescribed via telehealth. In these states—27 plus Washington, D.C.—less than 2% of pharmacy-dispensed mifepristone has been through brick-and-mortar locations. Most fills at physical stores were done by independent rather than chain pharmacies (92% compared to 8%).
"Our findings show how critically important mail-order pharmacy dispensing of mifepristone has been in the post-Dobbs era, with dispensing levels immediately rising sharply after the REMS change," said Christopher Scannell, first author and nonresident scholar at the USC Schaeffer Institute and senior research associate at USC Mann School of Pharmacy and Pharmaceutical Sciences.
Despite broader access through mail-order services—which offer privacy and convenience—gaps remain for patients who need quick access or lack internet or mailing addresses. Some may also prefer pharmacist counseling available only with in-person pickup. Major pharmacy chains have faced public pressure over their decisions: CVS and Walgreens plan to offer mifepristone where legal; Costco will not carry it; others have not clarified their stance.
In states where abortion is legal but telehealth restrictions exist (11 states), retail pharmacies play a larger role: about 61% of fills occur at these locations. The study also notes a shift toward more primary care physicians and advanced practice providers offering medication abortions via mail order since policy changes took effect. Researchers caution that some data may be affected if patients misrepresent their state residency to obtain prescriptions, suggesting future studies should examine shield laws’ impact on access.
