Employers that cover abortion should consider adding Mifepristone to the outpatient formulary

March 8, 2024

Both CVS and Walgreens have announced that their retail stores will start dispensing mifepristone over the coming months. Most pharmacies already dispense the other pill used in medication abortion, misoprostol, since this is used for gastrointestinal disease as well as for abortions.

Most abortions performed in the United States are medication abortions using these two medications. The Food and Drug Administration (FDA) approves these medications for abortions up to ten weeks of gestation. Both medical and procedural abortions are safe, and have lower rates of complications than childbirth. Mifepristone historically was not dispensed in pharmacies because FDA rules required that the drug be dispensed in person by the abortion provider, but these requirements were eliminated in late 2021. Pharmacists must obtain special training to dispense mifepristone.

Abortion pills were prescribed over telemedicine during the pandemic, and these abortions appear as safe as medication abortions where the pregnant person goes to an abortion clinic to obtain medications. Research published in Nature Medicine last month followed over 4000 who were prescribed abortion medications through telemedicine and found levels of effectiveness and safety comparable to abortions associated with an in-person visit.

But few employers have chosen formularies that include mifepristone, so most members who choose to have a telemedicine medication abortion will have to pay out of pocket for medications. That hasn’t mattered much until now since few pharmacies have dispensed the medication.

Source: Long, et al KFF, 2/29/24 LINK

KFF reported last week that 40% of employers with over 200 employees that completed its annual health insurance survey weren’t sure if their health plans covered abortions. Of those who knew, 53% covered abortion in most or all circumstances, 30% covered in limited circumstances, and 17% did not cover under any circumstances. Evidence of Coverage documents are often silent on abortion coverage, in which case it is likely that procedures would be covered if a bill was submitted to the carrier. Many with insurance pay privately for abortions in any event. The KFF survey also showed that few employers (6% of all employers, and 19% of employers with over 5000 workers) provide travel benefits for abortions.

Implications for employers:

-        Employers that have chosen to provide benefits to cover abortions can instruct their pharmacy benefit manager to provide coverage for mifepristone in states where this is legally available.

-        Human Resources and carriers should be prepared to answer employee and member queries about abortion coverage.

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Monday: Out of pocket costs are high for diabetes drugs other than insulin