A Washington state-based nonprofit has launched a program training pharmacists to prescribe abortion medications via telehealth, a model that organizers hope other states will adopt to expand abortion access.

Abortion is broadly legal in Washington state up to the point of fetal viability, which is generally considered to be between 24 and 26 weeks of pregnancy. But Dr. Beth Rivin, president and CEO of nonprofit Uplift International, said there are still many individuals who face barriers to abortion access in Washington because of where they live, how much money they make and other factors. Those people can benefit most from having access to telehealth, Rivin said, and having pharmacists available helps increase that availability.

The nonprofit partnered with an online pharmacy called Honeybee Health to launch what they’re calling the Pharmacist Abortion Access Project. Ten pharmacists were recruited and trained to prescribe mifepristone and misoprostol, the standard U.S. Food and Drug Administration-approved medication abortion regimen, to patients in Washington up to 10 weeks’ gestation.

Rivin said the team created its training protocol with Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington. The program also has a list of clinics where patients can be referred if any in-person follow-up care is necessary, including ultrasounds, blood tests or other exams.

“If (patients) had questions, the platform allowed for messaging between the pharmacist and the individual, and patients were followed up with at one week and four to five weeks after prescriptions were written,” Rivin said.

Over the past two years, anti-abortion groups have increasingly called for more state legislation targeting abortion drugs, alleging telemedicine for abortion pills is dangerous to a pregnant person’s health. Research has repeatedly shown that telehealth prescriptions are just as safe as in-person treatment, with one recent study showing 99.7% of patients out of a sample of 6,000 did not experience any serious complications. Similarly, 97.7% didn’t need any form of additional follow-up care.

“Research confirms that medication abortion can be prescribed through telehealth just as safely as in person, and it confirms that pharmacists can specifically prescribe medication abortion,” Rivin told States Newsroom. “The training they undergo through (the project) mirrors the training that other providers receive.”

The Heritage Foundation, the conservative group behind a set of policies known as Project 2025, has gathered several examples of abortion pills given to pregnant women without their consent. Using those examples, the organization recommends states ban telemedicine and mail-order abortion pills and strengthen or enact laws targeting abortion coercion. There have also been calls to use a dormant federal law called the Comstock Act to ban abortion pills from being sent by mail altogether.

Proof of residency not required to obtain pills by mail  

By the end of the Washington pilot program, which took place between Oct. 31 and Nov. 26, 2024, the pharmacists successfully prescribed medication abortion to 43 people who were deemed eligible. To qualify, aside from the applicable medical protocol, the patient needed to be 18 or older and have a Washington address where the medication could be mailed. The recipient of the medication does not need to prove they are a Washington resident, but a valid Washington address must be provided. Washington has shield laws preventing states where abortion is illegal from investigating medical providers if a resident of that state obtains an abortion in Washington.

Following the success of the pilot, Uplift International said it plans to expand the program across Washington and explore pharmacists prescribing medication abortion in person from brick-and-mortar pharmacies.

Rivin said the hope is that the project paves the way for other states to implement the same model, especially as President-elect Donald Trump takes office and Republicans in Congress may eye more federal abortion restrictions.

“It is the first step toward mainstreaming pharmacists as prescribers of medication abortion in person,” Rivin said.

Don Downing, a clinical pharmacy professor emeritus at the University of Washington and co-director of the project, said Washington has one of the most progressive pharmacy laws in the country. State law has recognized pharmacists as health care providers since 1979, allowing them to prescribe many medications approved by the FDA.

Washington shares that progressive pharmacy law status with one of its border states, Idaho, where pharmacists can also prescribe medications for minor ailments such as cold sores and allergies, as well as drugs for treatment of illnesses such as flu and strep throat. Downing said Idaho’s pharmacy laws are actually even more progressive than Washington’s.

However, Idaho has an abortion policy that could hardly be more different. It is the only state in the Northwest with a near-total abortion ban, a civil enforcement law allowing family members to sue medical providers who perform an abortion, and a so-called “abortion trafficking” law making it a felony to take a minor to a state with legal abortion access without parental permission.

Ironically, Downing said the pilot team announced the project in Idaho during an annual pharmacy meeting held at a resort in Coeur d’Alene with pharmacists from Montana, Oregon, Washington, Idaho and Alaska.

“We presented the idea of pharmacists becoming much more involved in medication abortion access at that meeting, and it was surreal because Idaho at that time was just pouncing on women’s access to abortion,” Downing said.

Providing prescriptions via telehealth first was the priority, he said, because after conducting several listening sessions before launching the pilot, the consensus among women interviewed was that they preferred the privacy of an online experience.

“If you’re in a small town, if you go to the doctor’s office, you go to the school nurse, a pharmacy, there’s a good chance you’re going to see a neighbor, a relative, and someone is for sure going to ask you what you’re doing there today,” Downing said. “Women nationwide are increasingly saying, if I can get it online the same way we buy from Amazon, if I can do this without running into my aunt, so much the better.”