The potential for expanding provision of misoprostolonly abortions by nurse practitioners and pharmacists: a legal analysis

Objectives Recent lawsuits have challenged FDA approval and the continued availability of the medication mifepristone for abortion care in the US. Whatever the outcome of these efforts, misoprostol will remain available for off-label prescribing, and misoprostol alone can safely and effectively be used for medication abortion. We sought to determine the viability of strategies to increase access to misoprostol through a legal analysis. Methods To assess the various strategies, we conducted a state-by-state analysis of legislation, regulation, and case law to identify states in which access to a misoprostol-only regimen can be substantially increased via nurse practitioners or pharmacists. We also analyzed whether changes in practice, regulations, or law could expand the cadre of nurses and pharmacists providing abortions. Results Several states allow non-physicians to provide medication abortions and do not restrict that care to a mifepristone-based protocol. Our analysis found 20 states that could be viable targets for this strategy, nine of which we labeled priority states due to their proximity to jurisdictions with the most severe restrictions on abortion. For four of those states — Illinois, Minnesota, Colorado, and New Mexico — we also identified specific actions that could increase the prescribing of misoprostol by nurse practitioners and pharmacists. Conclusions Expanding patient access to misoprostol is possible, immediately and without legislative action, through changes in practice. This strategy holds promise for increasing access even in states where abortion is already legally protected and can normalize abortion care within more primary healthcare settings. Recent lawsuits have challenged FDA approval and the continued availability of the medication mifepristone for abortion care in the US. Whatever the outcome of these efforts, misoprostol will remain available for off-label prescribing, and misoprostol alone can safely and effectively be used for medication abortion. We sought to determine the viability of strategies to increase access to misoprostol through a legal analysis. To assess the various strategies, we conducted a state-by-state analysis of legislation, regulation, and case law to identify states in which access to a misoprostol-only regimen can be substantially increased via nurse practitioners or pharmacists. We also analyzed whether changes in practice, regulations, or law could expand the cadre of nurses and pharmacists providing abortions. Several states allow non-physicians to provide medication abortions and do not restrict that care to a mifepristone-based protocol. Our analysis found 20 states that could be viable targets for this strategy, nine of which we labeled priority states due to their proximity to jurisdictions with the most severe restrictions on abortion. For four of those states — Illinois, Minnesota, Colorado, and New Mexico — we also identified specific actions that could increase the prescribing of misoprostol by nurse practitioners and pharmacists. Expanding patient access to misoprostol is possible, immediately and without legislative action, through changes in practice. This strategy holds promise for increasing access even in states where abortion is already legally protected and can normalize abortion care within more primary healthcare settings.