Mail-order pharmacy dispensing of mifepristone for medication abortion after in-person clinical assessment

Daniel Grossman, Sarah Raifman, Natalie Morris, Andrea Arena, Lela Bachrach, Jessica Beaman, M. Antonia Biggs, Curtiss Hannum, Stephanie Ho, Eleanor B. Schwarz, Marji Gold

Research output: Contribution to journalArticlepeer-review

Abstract

Objective(s): To estimate the effectiveness, acceptability, and feasibility of medication abortion with mifepristone dispensed by a mail-order pharmacy after in-person clinical assessment. Study Design: This is an interim analysis of an ongoing prospective cohort study conducted at five sites. Clinicians assessed patients in clinic and, if they were eligible for medication abortion and ≤ 63 days’ gestation, electronically sent prescriptions for mifepristone 200 mg orally and misoprostol 800 mcg buccally to a mail-order pharmacy, which shipped medications for next-day delivery. Participants completed surveys three and 14 days after enrollment, and we abstracted medical chart data. Results: Between January 2020 and April 2021 we enrolled 240 participants and obtained clinical outcome information for 227 (94.6%); 3 reported not taking either medication. Of those with abortion outcome information (N = 224), 216 (96.4%) completed day-3 and 212 (94.6%) day-14 surveys. Of the 224 that took medications, none reported taking past 70 days’ gestation, and complete medication abortion occurred for 217 participants (96.9%, 95% CI 93.7%-98.7%). Most received medications within three days (82.1%, 95% CI 76.5%-86.9%). In the day-3 survey, 95.4% (95% CI 91.7%-97.8%) reported being very (88.4%) or somewhat (6.9%) satisfied with receiving medications by mail. In the day-14 survey, 89.6% (95% CI 84.7%-93.4%) said they would use the mail-order service again if needed. Eleven (4.9%, 95% CI 2.5%-8.6%) experienced adverse events; two were serious (one blood transfusion, one hospitalization), and none were related to mail-order pharmacy dispensing. Conclusions: Medication abortion with mail-order pharmacy dispensing of mifepristone appears effective, feasible, and acceptable to patients. Implications: The in-person dispensing requirement for mifepristone, codified in the drug's Risk Evaluation and Mitigation Strategy, should be removed.

Original languageEnglish (US)
JournalContraception
DOIs
StateAccepted/In press - 2021

Keywords

  • Mail-order
  • Medication abortion
  • Mifepristone
  • Pharmacy dispensing
  • REMS

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Fingerprint

Dive into the research topics of 'Mail-order pharmacy dispensing of mifepristone for medication abortion after in-person clinical assessment'. Together they form a unique fingerprint.

Cite this