PROVINCETOWN — Although medication abortions are legal for terminating pregnancies of up to 10 weeks in Massachusetts, access to the two-pill combination prescription is extremely limited on Cape Cod. That’s partly because doctors at only one health-care center, Health Imperatives in Hyannis, will write prescriptions for the medications.
But for patients on Outer Cape Cod, the access problem has been compounded by the fact that no pharmacies in the area would fill prescriptions for the two drugs. Thus, even for patients able to get prescriptions through telehealth appointments with Health Imperatives or with providers elsewhere, either a trip to Hyannis for the medications or a wait for them to arrive by mail was still required.
That changed on March 12, when CVS pharmacies in Massachusetts and Rhode Island began filling prescriptions for the pill that is taken first, mifepristone. CVS had already been filling prescriptions for the second drug, misoprostol, which in addition to aiding the abortion process is used for preventing ulcers.
The company, with stores in Provincetown and Orleans, is the only retail pharmacy on the Outer Cape to have expanded medication abortion access in this way.
“We have a long history of supporting and advancing women’s health, and we remain focused on meeting their unique health needs,” wrote CVS spokesperson Amy Thibault by email. “This includes providing access to safe, legal, and evidence-based reproductive health services, information, and FDA-approved products.”
Though the Outer Cape Health Services pharmacies in Provincetown and Wellfleet can fill other prescriptions written by non-OCHS providers, neither is currently certified to fill prescriptions for mifepristone. “We are certainly looking into this,” said the pharmacy director, Chris Casale.
“Outer Cape Health Services is investigating how it could administer mifepristone in compliance with federal and state laws,” added OCHS CEO Damian Archer in an emailed statement to the Independent.
The Stop & Shop pharmacy in Provincetown does not at fill mifepristone prescriptions. “We are continuing to evaluate this potential new offering and the associated training requirements for our pharmacists; however, a decision has not yet been made,” Stop & Shop spokesperson Stephanie Cuhna wrote by email.
Walgreens pharmacies also began dispensing mifepristone in some locations in Massachusetts during the first week in March. But Walgreens spokesperson Fraser Engerman would not say which stores would offer it.
A reporter contacted all nine Walgreens pharmacies on Cape Cod — including the one in Orleans — but none would confirm whether mifepristone was available at their stores.
State Sen. Julian Cyr of Truro told the Independent he thought the change at CVS would help solve the abortion medication access problem for people on the Outer Cape.
“Having mifepristone available at the Provincetown CVS will provide additional access for those previously driving to and from Hyannis, which is a two-hour round trip and a barrier,” he said. “This may very well meet most of the need out here.”
Mifepristone, which blocks the hormone progesterone from growing the interior lining of the uterus needed to sustain a pregnancy, has since 2000 been approved by the Food and Drug Administration to terminate pregnancies and manage miscarriages. In 2016, a revision extended a cap of the FDA-approved timeline for its use from 7 weeks of pregnancy to 10 weeks. The second pill, misoprostol, is typically taken 24 to 48 hours after mifepristone to help relax the cervix and induce the contractions that expel fetal tissue.
The two-drug regimen, which according to the Guttmacher Institute is used in over half of all abortions in the U.S., has an efficacy rate of about 95 percent, according to a 2023 New York Times review of 101 scientific studies that covered 124,000 abortions in 26 countries over 30 years.
The option for retail pharmacies to fill prescriptions for mifepristone came on the heels of a January 2023 regulatory change by the FDA. The agency removed a longstanding rule that patients could obtain mifepristone only in person from a certified health-care provider or from specialty mail-order pharmacies. The rule change also eased restrictions on distributing the medication by mail and prescribing it in telehealth appointments.
Retail pharmacies are now permitted to dispense mifepristone in person in states where abortion remains legal so long as they complete a pharmacy agreement form as part of a required FDA-administered certification process known as the Mifepristone Risk Evaluation and Mitigation Strategy Program.
Thibault confirmed the company’s certification and added that CVS plans over the coming weeks “to phase in other states where it is legally permissible for pharmacies to fill prescriptions for this medication.”
Retail pharmacists remain unable to write prescriptions for mifepristone, though some reproductive rights activists are pushing to grant them that authority. They also won’t mail mifepristone to patients. In February 2023, shortly after the FDA rule change, 20 attorneys general in states controlled by abortion opponents threatened CVS and Walgreens with legal action if the retail pharmacies were to do so.
While the move to make mifepristone available in retail pharmacies decreases wait time and increases privacy, potential barriers to access remain.
The Supreme Court began hearing oral arguments on March 26 in a challenge to the FDA approval of mifepristone brought by an anti-abortion coalition, the Alliance for Hippocratic Medicine (AHM). If the Supreme Court upholds the decision of the 5th U.S. Circuit Court of Appeals, which ruled in AHM’s favor last August, access to mifepristone could be severely rolled back.
During the hearing’s 90 minutes of arguments, justices across the political spectrum appeared skeptical of the legal standing of the plaintiffs to sue. But if the justices uphold the appeals court decision, pharmacies would likely have to cease dispensing mifepristone, even if abortion remains legal at the state level.
While Mass. Gov. Maura Healy last year issued an order to stockpile a supply of mifepristone, providers in Mass., including Health Imperatives, are preparing to adjust to potential changes if the long-term supply of mifepristone is threatened, as the Independent reported on Feb. 22.
