The FDA in 2000 approved use of mifepristone for abortions...

The FDA in 2000 approved use of mifepristone for abortions within the first 10 weeks of pregnancy. Credit: Associated Press/Soumyabrata Roy

ALBANY — New York would be the first state to allow pharmacists to dispense abortion drugs to women without a prescription under a state legislative proposal that would be another step in expanding access to abortion.

New York’s measure would allow a pharmacist to dispense abortion drugs on a “non-patient specific order” made by the state health commissioner. Under that standing order, a girl or woman would no longer need to get a prescription from a physician for the drugs.

A physician, certified nurse practitioner or licensed midwife would be able to identify pharmacies that could carry out a “nonspecific order of abortion medication” under the commissioner's order.

The bill also would allow registered nurses to dispense the drug regimen through the same “non-patient specific order.”

The proposal aims to increase access to abortion drugs, particularly in poorer communities where a woman is more likely to live near a pharmacy than a physician’s office. Allowing registered nurses to dispense the drug would expand access to the medication at health centers and on college campuses, the bill states.

“The idea came out of a conversation I had with doctors who specialized in abortion care,” said Assemb. Amy Paulin (D-Scarsdale), a sponsor of the bill. “I asked them, is this safe? Is it OK? They embraced the idea, and these were doctors who were actually prescribing medical abortions.”

The proposed measure seeks to use an existing provision in state Education Law governing medical professionals. Currently under this provision, registered nurses can execute “non-patient specific orders” to administer immunizations, anaphylaxis treatment, tests for tuberculosis, hepatitis and HIV, and to administer opioid overdose treatment.

CVS Health, which operates CVS pharmacies, declined comment. Walgreens, which is also one of the nation’s largest pharmacy chains, didn’t respond to a request for comment.

Recent state laws also allow pharmacists to administer immunizations for COVID-19, flu and the respiratory ailment known as RSV. The state recently passed a law allowing pharmacists to prescribe medical contraceptives, such as birth control pills, over the counter.

Under a non-patient specific order, “the ordering physician or nurse practitioner is not required to examine or have a treatment relationship with the recipient of the ordered tests or treatments,” according to state law.

“This practice exists in other countries,” Paulin said, citing India as one. “They get medical … [abortion pills] over the counter. They just pick it up. This provides much more access and you want these procedures done in a timely way. It also sends the message that this is as safe as it is.”

The drug is mifepristone. The FDA has approved its use since 2000 for abortions within the first 10 weeks of pregnancy, although some physicians have used it for up to 12 weeks without a threat to the woman’s health. The FDA provides instructions to use the drug safely and effectively, but also notes the medication can “very rarely” result in “serious and sometimes fatal infections and bleeding” after abortions.

Mifepristone is used over two days with the drug misoprostol, which expels tissue and is used in many other medical procedures. Together, the drugs are used in more than half of abortions nationwide.

There were 74,211 abortions statewide and 27,321 were medical procedures using the drug, according to state Department of Health statistics for 2019, the most recent year available. That year, there were 2,996 abortions in Nassau County and 1,137 were medical. There were 2,660 abortions in Suffolk County that year and 1,350 were medical, according to the records.

Under the bill, pharmacists would have to notify a patient’s physician of the procedure, unless the patient opts to block that. The bill also empowers pharmacists to refuse to dispense the drug based on their professional judgment, potential adverse effects and interactions and “other therapeutic complications [that] could endanger the health of the patient.”

The bill would require the pharmacists who participate to be trained and certified to counsel women seeking the medication.

The Pharmacists Society of the State of New York, a lobbying group, said the bill has “once again given New York the opportunity to cement its leadership on reproductive rights.” The group’s statement to Newsday noted pharmacists would, under the bill, dispense abortion medication without a doctor’s patient-specific prescription only to someone they “evaluate and approve to receive such medication.”

“Pharmacies are often more available to communities than reproductive health centers, and expert pharmacists provide quick and comprehensive pharmaceutical health care,” the group said. “While a reimbursement model must still be enacted to make the necessary screening and abortion medication care equitable for pharmacists, passing this legislation and signing it into law would set a new high bar for the value of reproductive health in New York … .”

But the state proposal is seen as “bad medicine” by groups that oppose abortion.

“New York is trying to put abortion pills in a vending machine,” said Katie Daniel, state policy director for Susan B. Anthony Pro-Life America in Washington, D.C., the organization that seeks to end abortion by supporting national leaders to office.

“It puts pharmacists in a terrible position,” Daniel said. “They are not trained to do screening … and it’s incredibly important that a woman or a girl seeking an abortion be screened to make sure whether or not they are a good candidate” for the drug.

The bill, if passed, likely would face court challenges, including whether it complies with FDA protocols.

“I don’t know if that is going to withstand scrutiny,” said Kirsten Moore of the Expanding Medication Abortion Access advocacy group based in Washington, D.C. “I know no other state has done this.”

Moore is also concerned pharmacists might not have the private space or the time to receive training and to counsel women seeking the abortion medication.

“There are independent pharmacies that might start to do this, but would a whole lot of pharmacies sign up for this? I doubt it,” Moore said. “I think this medication needs a little more hand-holding.”

The bill is active for the 2024 legislative session beginning in January. The bill was introduced in the Assembly in May, late in the session that ended in June. The bill was introduced in the Senate in October.

ALBANY — New York would be the first state to allow pharmacists to dispense abortion drugs to women without a prescription under a state legislative proposal that would be another step in expanding access to abortion.

New York’s measure would allow a pharmacist to dispense abortion drugs on a “non-patient specific order” made by the state health commissioner. Under that standing order, a girl or woman would no longer need to get a prescription from a physician for the drugs.

A physician, certified nurse practitioner or licensed midwife would be able to identify pharmacies that could carry out a “nonspecific order of abortion medication” under the commissioner's order.

The bill also would allow registered nurses to dispense the drug regimen through the same “non-patient specific order.”

WHAT TO KNOW

  • New York would be the first state to allow pharmacists to dispense abortion drugs to women without their own prescription under a state legislative proposal.
  • The bill would allow a pharmacist to dispense abortion drugs on a “non-patient specific order” made by the state health commissioner. 
  • The proposal aims to increase access to abortion drugs, particularly in poorer communities where a woman is more likely to live near a pharmacy than a physician’s office.

The proposal aims to increase access to abortion drugs, particularly in poorer communities where a woman is more likely to live near a pharmacy than a physician’s office. Allowing registered nurses to dispense the drug would expand access to the medication at health centers and on college campuses, the bill states.

“The idea came out of a conversation I had with doctors who specialized in abortion care,” said Assemb. Amy Paulin (D-Scarsdale), a sponsor of the bill. “I asked them, is this safe? Is it OK? They embraced the idea, and these were doctors who were actually prescribing medical abortions.”

The proposed measure seeks to use an existing provision in state Education Law governing medical professionals. Currently under this provision, registered nurses can execute “non-patient specific orders” to administer immunizations, anaphylaxis treatment, tests for tuberculosis, hepatitis and HIV, and to administer opioid overdose treatment.

CVS Health, which operates CVS pharmacies, declined comment. Walgreens, which is also one of the nation’s largest pharmacy chains, didn’t respond to a request for comment.

Recent state laws also allow pharmacists to administer immunizations for COVID-19, flu and the respiratory ailment known as RSV. The state recently passed a law allowing pharmacists to prescribe medical contraceptives, such as birth control pills, over the counter.

Under a non-patient specific order, “the ordering physician or nurse practitioner is not required to examine or have a treatment relationship with the recipient of the ordered tests or treatments,” according to state law.

“This practice exists in other countries,” Paulin said, citing India as one. “They get medical … [abortion pills] over the counter. They just pick it up. This provides much more access and you want these procedures done in a timely way. It also sends the message that this is as safe as it is.”

The drug is mifepristone. The FDA has approved its use since 2000 for abortions within the first 10 weeks of pregnancy, although some physicians have used it for up to 12 weeks without a threat to the woman’s health. The FDA provides instructions to use the drug safely and effectively, but also notes the medication can “very rarely” result in “serious and sometimes fatal infections and bleeding” after abortions.

Mifepristone is used over two days with the drug misoprostol, which expels tissue and is used in many other medical procedures. Together, the drugs are used in more than half of abortions nationwide.

There were 74,211 abortions statewide and 27,321 were medical procedures using the drug, according to state Department of Health statistics for 2019, the most recent year available. That year, there were 2,996 abortions in Nassau County and 1,137 were medical. There were 2,660 abortions in Suffolk County that year and 1,350 were medical, according to the records.

Under the bill, pharmacists would have to notify a patient’s physician of the procedure, unless the patient opts to block that. The bill also empowers pharmacists to refuse to dispense the drug based on their professional judgment, potential adverse effects and interactions and “other therapeutic complications [that] could endanger the health of the patient.”

The bill would require the pharmacists who participate to be trained and certified to counsel women seeking the medication.

The Pharmacists Society of the State of New York, a lobbying group, said the bill has “once again given New York the opportunity to cement its leadership on reproductive rights.” The group’s statement to Newsday noted pharmacists would, under the bill, dispense abortion medication without a doctor’s patient-specific prescription only to someone they “evaluate and approve to receive such medication.”

“Pharmacies are often more available to communities than reproductive health centers, and expert pharmacists provide quick and comprehensive pharmaceutical health care,” the group said. “While a reimbursement model must still be enacted to make the necessary screening and abortion medication care equitable for pharmacists, passing this legislation and signing it into law would set a new high bar for the value of reproductive health in New York … .”

But the state proposal is seen as “bad medicine” by groups that oppose abortion.

“New York is trying to put abortion pills in a vending machine,” said Katie Daniel, state policy director for Susan B. Anthony Pro-Life America in Washington, D.C., the organization that seeks to end abortion by supporting national leaders to office.

“It puts pharmacists in a terrible position,” Daniel said. “They are not trained to do screening … and it’s incredibly important that a woman or a girl seeking an abortion be screened to make sure whether or not they are a good candidate” for the drug.

The bill, if passed, likely would face court challenges, including whether it complies with FDA protocols.

“I don’t know if that is going to withstand scrutiny,” said Kirsten Moore of the Expanding Medication Abortion Access advocacy group based in Washington, D.C. “I know no other state has done this.”

Moore is also concerned pharmacists might not have the private space or the time to receive training and to counsel women seeking the abortion medication.

“There are independent pharmacies that might start to do this, but would a whole lot of pharmacies sign up for this? I doubt it,” Moore said. “I think this medication needs a little more hand-holding.”

The bill is active for the 2024 legislative session beginning in January. The bill was introduced in the Assembly in May, late in the session that ended in June. The bill was introduced in the Senate in October.

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