Abortion Providers Prepare for End of Mifepristone Telehealth as Legal Battle Continues
Montana providers say medication abortion through telehealth is critical in a state where some patients must drive hundreds of miles for clinic care
By Zoë Buhrmaster
Telehealth access to abortion and miscarriage management medication mifepristone is on the chopping block after a federal appeals court sought to roll back nationwide access to the drug on May 1. After pharmaceutical companies appealed the decision to the U.S. Supreme Court, the high court placed the ruling on hold until May 11.
In Montana, a sizeable state with few abortion care providers, telehealth access to mifepristone is critical, Helen Weems said. She’s one of the founders of All Families Healthcare in Whitefish, a family planning center that started offering mifepristone through telehealth appointments during the COVID-19 pandemic. They developed a telehealth system with rigorous screening and follow-up protocols, checking in on patients’ physical and emotional health, Weems said.
“The abortion care that we provide via telehealth is every bit as safe and thorough as the care we provide in person,” she said during a conference call with other national reproductive rights representatives Thursday afternoon.
Reproductive clinics are largely clustered on the western half of the state. At All Families Healthcare, Weems said they see people from all over, many who have to drive hours for an in-person appointment. That also includes patients who live on the Blackfeet Reservation. She recalled patients who would previously cancel appointments because they couldn’t drive over Marias Pass due to extreme winter conditions.
“Medication by mail has revolutionized access in Montana,” Weems said.
“If a woman is living, say, in Glendive, and she needs an in-office procedural abortion, she would need to drive seven hours and over 400 miles to a clinic in Helena,” she continued. “With telehealth abortion, we can mail abortion pills directly to her home.”
The Food and Drug Administration (FDA) first approved mifepristone as safe to use for medical termination of pregnancy over 20 years ago. After telehealth access was approved for the medication in 2020 and Roe v. Wade was overturned in 2022, use of the drug increased nationwide. It’s normally used in combination with misoprostol, another abortion medication.
Louisiana, a state that restricts abortions, sued the FDA last year arguing that telehealth access undermined their stringent statewide ban. After a district court judge put the case on hold, the state appealed the decision to the Fifth Circuit Court of Appeals. On May 1, the appeals court ruled in favor of Louisiana, bringing back the in-person requirement nationwide before the Supreme Court temporarily stayed the decision.
With the hold set to expire Monday, Justice Samuel Alito, who is assigned to the Fifth Circuit, could extend the stay temporarily or allow it to expire. If the stay is not renewed, telehealth access to mifepristone would end nationwide while the legal process continues.
Weems said that if that happens, the clinic will switch to an alternative method using only misoprostol using different dosing. Weems said the method is also safe and evidence-based.
“This is not the end of this fight,” Weems said. “Abortion care by mail will continue and that care will be safe and effective …We may lose mifepristone, but we have alternatives we’ll continue to mail. It seems the next target will be mailing of any abortion pills, and that will be devastating.”