Almost a year after major pharmacy chains began waffling at the prospect of filling mifepristone prescriptions, Walgreens and CVS began dispensing the abortion pill in Nevada during the last few weeks.
The decision comes after a concentrated push by Sen. Catherine Cortez Masto (D-NV), who called on the chains to follow through with Food & Drug Administration (FDA) guidance updates finalized in 2023 allowing mifepristone to be dispensed and sold at pharmacies.
Now the most common means of terminating a pregnancy, mifepristone is the first of a two-pill drug regimen that patients can take within the first 10 weeks of pregnancy. The pro-abortion rights Guttmacher Institute estimates that medication is now used for more than half (54 percent) of all abortions.
Mifepristone is available in Nevada via mail or at clinics, but abortion advocates say the pharmacy option will make access similiar to patients visiting their regular doctor’s office (which often are not certified to stock the abortion pill), obtaining a prescription and then picking it up at their local pharmacy. The first pill cuts off nutrients to the baby inside the womb, while the second induces early labor.
There is a case before the U.S. Supreme Court asking justices to consider the legality of the drug itself and the FDA’s recent moves to expand its access.
And if the Supreme Court rules against the FDA, its impacts would be felt even in states that have legalized abortion — such as Nevada.
“It's not a red state-blue state thing,” said Rebecca Gill, a political science professor at UNLV. “There is no state law … that exempt[s] us from this.”
To dispense or not to dispense
In January 2023, the FDA issued a rule permitting pharmacies to dispense mifepristone at their physical locations to patients with a prescription, circumventing the need to return to a doctor’s office or rely on the mail to receive the time-sensitive drug. As part of the Biden administration’s effort to make abortion more accessible, the dispensing of mifepristone quickly became the latest battleground in a protracted war between the Democrat-led federal government and Republican-run states aiming to protect pre-born lives.
When drug wholesaler AmerisourceBergen and retail pharmacy chain Walgreens announced last March they would not move forward with dispensing the pill in states where they faced legal blowback from Republicans — given the need for a certification process from the FDA — Cortez Masto pounced.
In both public letters and private conversations, the senator made the case that the patchwork of state abortion laws should not preclude Nevadans, who are guaranteed the right to an abortion through 24 weeks of pregnancy, from being able to access prescribed mifepristone at pharmacies.
“I started with the fact that Nevada is a proud pro-choice state,” she said in a recent interview. “Nevada should not be penalized because other states wrongly have restricted a woman's access to abortion.”
After months of deliberation and then a certification process, Walgreens and CVS — which initially had been mum on their plans — announced this March that they would begin dispensing the abortion pill in pharmacies in select states. Nevada was not included in the initial rollout, and the recent expansion to the Silver State, first reported in The Nevada Independent, was not publicized.
Now, Nevada patients with a mifepristone prescription can pick the pill at either pharmacy. Without making any formal announcements, the companies each confirmed to The Nevada Independent that mifepristone is now available at their pharmacies in Nevada. CVS began dispensing the abortion pill in Nevada on March 19, and Walgreens followed suit on April 17.
Two independent pharmacies — A1C Pharmacy in Las Vegas and three locations of Renown Pharmacy in Reno — have also elected to begin dispensing mifepristone.
Jason Guinasso, the attorney for the Coalition for Parents and Children PAC, a Nevada group that sued to stop a pair of statewide abortion ballot questions, said he has concerns about patients receiving mifepristone in the mail and having complications. But he was accepting of the new pharmacy policy.
“If they're doing that under the supervision of their doctor and it’s dispensed through a pharmacy, then at least you've got some oversight,” Guinasso said.
Legal threats
The Supreme Court is expected to issue a ruling on the case brought by a group of doctors seeking to end the FDA’s approval of the drug.
The case has been working its way through the courts since 2023, when a group of conservative doctors filed a lawsuit challenging the FDA’s 2000 approval of the abortion pill and subsequent updates expanding how far into a pregnancy it can be used and means of access. The plaintiffs sued on the basis that the FDA’s approval process for the drug was improper.
In April 2023, a federal district court judge ruled in favor of the plaintiffs, temporarily ending the FDA’s approval of the drug and blocking its use. FDA approval — and ability to send the drug in the mail — was restored by an appeals court and the Supreme Court while the case continues to move through the courts.
In August 2023, a federal appeals court ruled that mifepristone is legal but that sending it in the mail is not, setting up the Supreme Court to make a final ruling.
Despite the fact that abortion is legal in Nevada, a Supreme Court ruling in favor of the plaintiffs would in effect eliminate mifepristone access in the state, including the new availability at drugstores.
If the justices affirm the appeals court’s ruling that mifepristone cannot be sent in the mail, then the fact that pharmacies can distribute it at their physical locations would become more significant, especially for rural Nevadans for whom multiple trips to a doctor’s office is impractical or who are unlikely to live anywhere near a clinic or practice that is certified to dispense abortion pills.
“This would put more pressure on those pharmacies to dispense, because they would be the only means of access,” Gill said.
And if the justices rule in favor of the FDA or throw out the case, then access to mifepristone will remain as is in the state.
The Abortion Pill (also known as “chemical abortion,” “medication abortion,” “medical abortion” and “the RU-486”) is a drug regimen used to kill the pre-born baby in the womb and expel him or her from the womb. It involves two drugs: mifepristone (Mifeprex), and misoprostol.
Mifepristone
(Mifeprex) This drug blocks the action of the hormone progesterone, which is naturally produced by the mother’s body to enable the mother to sustain and nourish the pregnancy. When RU-486 blocks progesterone, the lining of the mother’s uterus breaks down, cutting off blood and nourishment to the baby, who then dies inside the mother’s womb.
Misoprostol
Twenty-four to forty-eight hours later, the woman ingests another drug called Misoprostol (also called Cytotec), administered orally or vaginally, which causes contractions and bleeding to expel the baby from the womb. In short, misoprostol induces early labor.
This drug regimen has only been approved by the FDA for use up to the first 10 weeks of pregnancy.
• Do not take abortion pills without adequate medical supervision.
• Do not take herbal abortion pills or remedies. Do not take pills that do not come from a legitimate pharmacy or clinic.
• Talk to your doctor to make sure you are not at risk for an ectopic pregnancy before taking abortion pills, this could be life-threatening for the mother.
• Tell your doctor when the date of your last period was to make sure you are not too far along in your pregnancy for abortion pills.
• Tell your doctor if you have a history of bleeding or adrenal problems or if you are on long term steroid treatment.
• Seek immediate medical care if you have severe pain or bleeding, cannot keep down fluids, or are having pain.
The most common adverse effects associated with abortion pills are gastrointestinal upset (nausea, vomiting, diarrhea, stomach pain), pelvic cramping, and bleeding. Occasionally, dehydration and loss of electrolytes can occur if vomiting and diarrhea are severe. This can be treated with oral or intravenous fluids and nausea medications. Sometimes women have very heavy bleeding with a medication abortion and may require a blood transfusion or even a surgical procedure. Women with adrenal problems and those on long-term steroids may experience low blood pressure when taking RU-486.