Telehealth Services For Abortion Pills Prepare for Roe v. Wade Outcome

WASHINGTON — Telehealth service providers offering abortion pills by mail have been preparing for service changes that could occur by the end of the month if the U.S. Supreme Court overturns Roe v. Wade, a legal case which has protected abortion rights in the United States for nearly five decades.

“I think what will happen is patients from hostile states will have to travel… and then patients in states where abortion is legal may  shift their in-state care to telehealth. We are expecting to see more patients post-Roe,”  said Leah Coplon, director of Clinical Operations at Abortion on Demand, a telehealth service which legally operates in 22 states. 

A Supreme Court opinion draft, leaked by Politico on May 2, revealed that Roe v. Wade could be overturned.

Coplon said that if Roe v. Wade is overturned then the telehealth service might lose operations in some states if the states do not put laws in place to protect abortion access.

“Our particular model is that we practice in 22 states currently, and it’s all legal. We aren’t in any of the states that are hostile to abortion,” said Coplon.

“We may lose a state or two, as some states may become more hostile to abortion,” said Coplon.

In preparation for the Roe v. Wade outcome, the company has been developing resources on its website about places where abortion is expected to remain legal.

“We are hearing from patients who are thinking it’s going away tomorrow … there’s a lot of confusion,” said Coplon. 

The U.S. Food and Drug Administration approved the use of a drug called mifepristone in 2000 for early nonsurgical abortions through 70 days gestation.

The FDA revised a Mifepristone Risk Evaluation and Mitigation Strategy Program in 2019, which the FDA usually requires of manufacturers to ensure that the benefits of the drug or biological product outweigh the risks. 

The REMS Program allowed the medication to be dispensed in clinics, medical offices, and by hospitals, but required the medication to still be ordered, prescribed and dispensed by or under the supervision of a health care provider. 

“When the pandemic hit, given that [the FDA] had that research, they used an emergency act to say … it can actually be mailed to people,” said Coplon.

In April 2021, the FDA reviewed the REMS Program and revised their recommendations to lift the in-person dispensing requirement during the COVID-19 public health emergency.

By December 2021, the FDA permanently lifted the in-person dispensing requirement to permanently allow the medication to be dispensed through mail even beyond the COVID-19 pandemic.

“Right now, everyone who is getting [a medication abortion] you’re going to a clinic, or hospital, or you’re being sent it through the mail,” said Coplon.

Coplon said there is currently no way to receive the medication at a pharmacy, as those details are still being ironed out by the FDA regarding certification.

Coplon said the declaration of the COVID-19 pandemic has also allowed abortion pills to be dispensed by mail without needing an ultrasound or blood test, guidance which was made permanent in 2021.

Abortion on Demand works by allowing an individual to request the medication online through the company website, and get set up for an intake video appointment lasting about 20 minutes, with a physician who will gather their medical history, and give them information about the medication and side effects. 

If the patient is eligible, in most cases the pills are then mailed to the patient overnight.

One big concern, Coplon said, about living in a post-Roe world is that depending on how states respond a person could be criminalized for self-administering their own abortion. 

“[They] could be at risk of being charged with a crime, and that’s a terrifying aspect at this time,” said Coplon.

Mifepristone is typically distributed by abortion providers in combination with another abortion pill known as misoprostol, and data shows the combined regimens are effective and safe with a success rate over 95%, with continuing pregnancy rates of less than 2% and complication rates less than 1%.

“Mifepristone goes in and stops the pregnancy, and misoprostol causes the uterus to start contracting and expelling the pregnancy,”  said Evelyn Kieltyka, who serves as senior vice president of program services, executive office at Maine Family Planning, during a phone call with The Well News. 

Maine Family Planning operates out of 18 health centers in Maine which offer abortion services both in-person and through telehealth.

“We have been working with colleagues in the state to see what we can do to support other states with trigger laws,” said Kieltyka.

“There are 22 trigger states, and four to five on the bubble, [which means] they have laws moving through their legislature right now that would specifically ban abortions,” said Kieltyka.

Telehealth services offered through Abortion on Demand are not covered by any insurance and typically cost about $239-$289. 

The Family Planning Clinic of Maine, on the other hand, is able to offer Medicaid recipients in the state coverage for abortion services if they qualify. 

Kieltyka said prior to the pandemic medication abortions only accounted for about one in five patients, but now the clinic offers 80% of their abortions by medication and 20% through in-person services for non-medication abortions.

“Medication abortion is still really a big of share of what we do,” said Kieltyka.

“We are concerned about what we are calling tele-equity, and starting to dig into that data now to understand if there are areas where we are not seeing an uptick in telehealth and … whether there are disparities we need to pay attention to, like access to broadband.” 

Kieltyka said that Maine Family Planning was invited to develop a study in 2019 to investigate the safety of mailing pills for abortions.

She said the study contributed to the public health emergency flexibility that was made permanent in 2021 to allow for no-test abortions, or abortions which do not require an ultrasound or blood test. 

Maine currently has laws in place to protect license providers in the state and residents self-administering an abortion from criminalization. 

The Maine Family Planning clinic is keeping messaging on their website up-to-date about where abortion protections currently are, and where they will be expected to be maintained, even if Roe v. Wade is overturned by the Supreme Court later this month. 

“Maine has something to codify Roe v. Wade … for the moment, you can still get an abortion if you need one,” said Kieltyka.

Alexa can be reached at [email protected]