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The FDA’s recent update allowing mail-order abortion pills could go a long way toward making abortions more accessible in Pennsylvania. It could also eventually make them less costly.
With the Federal Drug Administration’s December decision to permanently allow abortion pills by mail, patients around the country can now move through entire process virtually, with telehealth consultations followed by an order for medication to be shipped. That’s different from the old guidelines, which required picking up abortion pills in person from a specially-certified health care provider.
Abortion rights advocates say the policy shift can increase access to this type of early-term abortion, especially for people who face systemic barriers in getting to healthcare providers.
Antiabortion groups argue in-person physician prescriptions are important for spotting potential complications. A recent study in Canada compared the incidence of adverse effects before and after the pill was made available by mail, and found little to no difference.
The medication approved for mail order is called mifepristone. It’s the first of two in a series of pills that works to end pregnancies by blocking progesterone, a hormone key to uterus growth. Mifepristone, which is only authorized to terminate pregnancies up to 10 weeks’ gestation in the U.S., has endured controversy since it was approved in 2000.
In Philly, the FDA decision means abortion access is improving almost right away.
Planned Parenthood of Southeastern Pa. is prescribing mifepristone through telehealth appointments as of January, said Lindsey Mauldin, the nonprofit health care organization’s vice president for advocacy and public policy.
“This really opens up the door for providers to be able to provide this service to patients who might not be able to come into a health center or who are honestly scared to because of recent [COVID-19] spikes,” Mauldin told Billy Penn.
Not allowing mifeprestone to be mailed took away access to abortion for people have the hardest time accessing it, she said: “Folks who live in low income communities, folks from Black and Brown communities, and individuals from the LGBTQ+ community.”
Pennie health insurance won’t cover the pill
In the short term, the FDA decision doesn’t change much for Pennsylvania residents overall, said Pa. Department of Health spokesperson Maggi Barton.
Under state law, patients must receive a consultation from a certified abortion provider at least 24 hours before taking the pills and consent to them to via signature, but that can still happen virtually with an electronic signature.
“Pennsylvanians can continue to access the medication via telemedicine as they have done throughout the public health emergency,” Barton said. She added that Gov. Wolf, a longtime supporter of abortion access, supports the FDA policy change.
However, abortions — surgical or medication — are prohibited on insurance policies sold through the Pennie health care marketplace. Thanks to a 2013 Harrisburg law, insurance plans sold through the state-run marketplace will only cover abortions in the case of rape, incest, or life-threatening complicatons.
People with coverage through Pennie can still get abortions in Pa. — but they’ll have to pay out of pocket.
“[The law] does not prohibit an individual from purchasing supplemental abortion coverage off the exchange,” said Thaisa Jones, a spokesperson for the Pennsylvania Insurance Department.
It can be costly. Nationwide, a medication abortion averages about $500 without insurance. At Philadelphia-area Planned Parenthood locations, just the mifepristone costs $425, and there are additional costs: the required consultation, the recommended follow-up appointments, and potential lab work.
Mauldin, of Planned Parenthood, believes it’s possible the new FDA policy allowing mail-order could be a step toward lowering costs. “Opening up access in anyway, we’re able to do more work around making abortion medications more affordable and accessible,” she said
The battle continues in Harrisburg
Pennsylvania Medicaid does not currently cover abortions at all, which advocates are trying to change.
The Pa. Supreme Court is currently deliberating a suit brought by the Philadelphia-based Women’s Law Project to overturn the coverage ban. If argued successfully, the commonwealth could join 17 other states that do provide Medicaid coverage for pregnancy termination.
“In Pennsylvania, we have a pretty hostile legislature when it comes to sexual and reproductive health,” said Planned Parenthood VP Mauldin, citing recent bills that could limit abortion access if passed.
This November, state Sen Judy Ward of Blair County in Central Pa. sponsored an amendment to the state constitution that clarifies “there is no right to an abortion or abortion funding.”
That follows a bill passed this summer by the Pa. House that would impose fines for not burying or cremating fetal remains, which could translate into additional hurdles and costs for people who have abortions.
If approved by both chambers, most of this legislation would face challenges at the executive level. “Governor Wolf has vetoed three bills placed on his desk for signature,” said Barton, the health department spokesperson, “and [vows] to veto the rest.”