Walgreens limits sale of abortion pills
Pharmacy chain stops mifepristone sales in four states where it’s legal
Walgreens will not distribute abortion pills in several states where abortion is legal, denying access to federally approved medications amid political and legal threats from the antiabortion movement and state Republican leaders.
The pharmacy chain’s decision to withhold sales of mifepristone in Alaska, Iowa, Kansas and Montana threatens to further squeeze access to abortion since the Supreme Court struck down Roe v. Wade, dramatically reducing the options for terminating a pregnancy in the United States.
Health-care companies have been forced into the role of health-care arbiters, balancing the job of dispensing approved medications against a thicket of issues, including legal risks and corporate reputation.
The Food and Drug Administration in early January said it would allow bricks-and-mortar drugstores to seek certification to fill prescriptions for mifepristone, part of an abortion drug combination that is now thought to account for more than half of abortions in the United States. Previously, the FDA only allowed the drugs to be dispensed directly by physicians and, beginning in the pandemic, through online pharmacies.
The FDA’S announcement immediately thrust chain pharmacies into the bull’s eye of antiabortion activists and Republican political leaders, who launched intense pressure campaigns.
Twenty Republican state attorneys general warned of legal action if the drugstore chain offered the medication in their states.
Walgreens responded by promising not to distribute the drug in their states, company spokesman Fraser Engerman said. The company, which saw the eruption of abortion protests this year at its annual shareholders meeting, appears to be taking the cautious approach, steering clear of potential gray areas.
“This is a very complex and in-flux area of the law and we are taking that into account as we seek certification to dispense mifepristone,” Engerman said in an email late Thursday, adding that Walgreens does not currently carry the drug. CVS, Rite Aid, Walmart and Costco did not comment on whether they would also deny access to abortion pills in some states where abortion is legal. CVS and Rite Aid previously said they planned to carry mifepristone. In a statement, Rite Aid said it is evaluating its response in relation to the rapidly shifting legal landscape.
“Rite Aid is monitoring the latest federal, state, legal and regulatory developments regarding mifepristone dispensing and we will continue to evaluate the company’s ability to dispense mifepristone in accordance with those developments,” the company said.
There are already some pharmacies that have completed the certification process to sell mifepristone and are carrying it, according to Abby Long, a representative for mifepristone manufacturer Danco Laboratories. She declined to say how many stores are certified or in which states, citing the sensitivity of the issue.
Mifepristone is the first part of a two-drug protocol that is now more common than surgical abortion. The pills, which are only available by prescription, can be taken at home and are transported easily, making them particularly appealing as access to reproductive health care diminishes in the United States. These qualities have also put them on the front line of the ongoing battle over abortion.
Karine Jean-pierre, a spokeswoman for President Biden, criticized the campaign that led to Walgreens response Friday. “Elected officials targeting pharmacies and their ability to provide women with safe, effective and Fda-approved medication is dangerous and just unacceptable,” Jean-pierre told reporters.
Some pharmacies may be waiting on the outcome of a lawsuit, filed in Texas by the conservative group Alliance Defending Freedom, which seeks to undo the drug’s 19-year-old approval. A decision from U.S. District Court Judge Matthew Kacsmaryk, an antiabortion Republican appointed by President Donald Trump, is expected soon.
Walgreens and other national pharmacy chains are in a risky position in terms of their corporate reputations, said Gary Sheffer, a professor of public relations at Boston University and a former chief communications officer at General Electric for 13 years.
“If you’re in the middle of providing abortion pills, inevitably that in this country right now is going to become a Gordian knot for your company,” he said.
Being perceived as caving to threats from Republican politicians could have a damaging effect inside the company, much as Disney suffered reputational damage among its own employees for a weak response to legislation in Florida restricting LGBTQ discussion, he said.
“They came to work for a company that provides health care to women, and then, in some cases the companies choose not to do that for political reasons or because of public pressure, this can create friction inside the company — the difference between the stated values of an organization and their actions,” he said.
Mom-and-pop pharmacies also are feeling the heat.
This sort of political pressure “really does put our members between a rock and a hard place, unfortunately,” said Ronna Hauser, senior vice president of the National Community Pharmacists Association, which represents independent drugstores.
That means the medications’ availability on drugstore shelves could vary widely based on local conditions, Hauser said.
“I think its going to come down to a very local situation where our members are small business owners in their communities,” Hauser said. “They know the prescribers, they know the patients. It’s going to be so variable from one area to the next.”
Abortion pills can be obtained through online pharmacies, which mail the medications directly to patients. Some states have tried to ban the mailing of abortion pills, but the Justice Department has said the U.S. Postal Service can deliver abortion pills to any state. The recent FDA decision expanding access via telehealth was meant to give women more ways to access the medications.
Walgreens is among the major pharmacies that have come under intense pressure from antiabortion activists. Its annual shareholder meeting in late January ended with an outburst by protesters from the podium. Days later, at a CVS Pharmacy in Pittsburgh, demonstrators on both sides of the debate tried to drown each other out with megaphones. On Feb. 14, another protest erupted at the Walgreens national headquarters in Deerfield, Ill., outside Chicago.
Abortion rights supporters are also engaging with pharmacies, and had been optimistic that they would opt to fill mifepristone prescriptions. The Ensuring Medication Abortion Access Project, an organization that seeks to improve how abortion medications are dispensed in the U.S., started contacting pharmacies in late 2021, said Kirsten Moore, the group’s director.
“What I was really pleasantly surprised to hear from most pharmacies was ‘ This is an FDAapproved drug and we have no problem carrying it,’ ” Moore said.
Her goal was to build a “coalition of the willing” among major pharmacies willing to carry the drug.
The major pharmacy chains face a legal and political calculus that differs widely from state to state. In Kansas, for example, the state Supreme Court has ruled that the right to an abortion is protected by the state constitution. In August, state voters rejected further restrictions on abortions. But existing state law requires abortion drugs be “administered by or in the same room as” the prescribing doctor, Kansas Attorney General Kris Kobach warned Walgreens in a letter.
The drugstore’s chief legal officer responded to Kobach by saying the company had no plans to either sell the drug in Kansas or ship it there. “If this approach changes, we will be sure to notify you,” wrote Walgreens global chief legal officer Danielle Gray.
A spokeswoman for Alaska Attorney General Treg Taylor said dispensing abortion pills outside of a doctor’s office is not legal in the state.
Abortion remains legal in Alaska, Montana and Iowa until at least the point of viability, around 22 to 24 weeks of pregnancy. Representatives for attorneys general in Montana and Iowa did not comment on the Walgreens news.
While Iowa’s Republican-led legislature could pass an abortion ban in the coming months, strict abortion restrictions would be much harder to pass in Alaska and Montana, where abortion is protected in the state constitution. Despite Republican attempts to ban abortion by mail, all three states allow doctors to prescribe abortion pills through telemedicine.