Everything you need to know about the abortion pill

A report that suggests the U.S. Supreme Court may soon overturn Roe v. Wade has raised the potential for widespread changes in access to reproductive health care.

The leaked draft of a majority opinion, reported by Politico and confirmed by the court as legitimate, would dismantle constitutional rights to abortion. Though the court has said that the opinion is not final, it has led many to question how such a ruling might impact them personally. Online searches for over-the-counter emergency contraceptives are surging. Some are rushing to get IUDs or stockpile Plan B.

>> RELATED: Next battle over access to abortion will focus on pills

So if the court does overturn Roe v. Wade, what does it mean for the abortion pill?

What is the abortion pill and how do you get it?

The majority of abortions in the U.S. are now what’s known as medication abortions, according to data from the Guttmacher Institute. Medication abortions refer to the use of the abortion pill, mifepristone, in combination with the more widely used drug misoprostol to end an early pregnancy. Both drugs are approved for use by the Food and Drug Administration and are considered safe and effective when used in accordance with the FDA-approved regimen up to 70 days after the first day of a woman’s last period.

Mifepristone is more tightly regulated by the FDA than many other drugs. It’s subject to what’s called a risk evaluation and mitigation strategy, or REMS, to ensure its continued benefit. But the REMS also means women can only be prescribed the drug by a certified health provider who has obtained a signed agreement from the patient. Until December 2021, the FDA also mandated that the drug must be administered in-person by a medical professional. That requirement, however, was lifted during the pandemic when the agency found that the abortion drug was still safe and effective when prescribed via telemedicine and self-administered. It can be mailed to a patient or picked up from a certified pharmacy. Only 40 out of more than 19,000 FDA-approved drugs must adhere to this certification requirement.

How does getting it differ from place to place in the U.S.?

The short answer: Even though mifepristone is federally approved, states can still block access to it.

Mifepristone is regulated at a federal level by the FDA, so it’s legal no matter where you live. But states are still able to make the pills difficult to access. This year as of February 22, 16 states have introduced legislation that would ban or restrict the use of abortion medication, according to the Guttmacher Institute. Some states already had such restrictions in place, or they restrict abortions to minors without parental consent.

For example, 32 states require clinicians who prescribe mifepristone to be physicians, which makes the pill harder to get in rural or underserved areas where it may be hard to find a physician to prescribe it. In Texas, medication abortions are banned after seven weeks of pregnancy and Indiana draws a hard line at 10 weeks.

Telehealth might in some cases offer an alternative when in-person access to the pill is limited, but despite the FDA lifting its in-person requirements, some states have sought to block virtual access to the pill, too. At present, 19 states still say the clinician providing a medication abortion must be physically present when the medication is administered. Three states (Arizona, Arkansas and Texas) go even further, banning the mailing of abortion pills to patients. An attempt to enact such bans in another three states (Montana, Oklahoma and South Dakota) has been blocked by courts for the time being.

This is important because studies show that almost nine out of 10 American women live in counties without an abortion clinic. In South Dakota, regulations that would have required patients to make four trips to a clinic in order to get the abortion drug is also being blocked by courts pending litigation.

Sites like Plan C can help connect people to abortion pills in states where it’s increasingly difficult.

What does it cost and is it covered by insurance?

In 2014, the average cost of a medication abortion was $535, according to a study published in the journal Women’s Health Issues. For the uninsured or those unable to front the high cost themselves, there are funds from non-profit organizations supporting abortion access available to help. But when it comes to insurance coverage, things get more complicated.

The Hyde Amendment has banned the use of federal funds for abortion for more than 40 years, unless the pregnancy is a result of rape or incest, or it is determined to endanger the woman’s life, according to the Kaiser Family Foundation. The law applies to medication abortions, too. But in 2019, the Government Accountability Office found that 14 state Medicaid programs weren’t even covering abortions in the cases specified under the Hyde Amendment.

Whether a private health insurance plan covers mifepristone is highly variable. Some plans cover abortion services but do not cover medication abortions. State laws can also affect whether or not insurance is allowed to pay for an abortion. Danco Laboratories, a pharmaceutical company that distributes the brand name mifepristone, offers information on its website about how coverage is handled by different insurers in each state. Plan C recommends reaching out directly to providers for the most accurate information.

What’s availability like globally?

The abortion pill is available in countries all over the world, but regulation is varied and dependent on the laws of that country.

According to the Center for Reproductive Rights, 24 countries ban abortion altogether, while 42 countries only allow it when it’s necessary to save the mother’s life.

Is the abortion pill safe?

Yes. Years of evidence show mifepristone is very safe when used in accordance with FDA guidance—in fact, it’s safer than Tylenol. The abortion pill sends fewer people to the hospital than Viagra does. Even when prescribed via telemedicine, mifepristone continues to maintain its record for both safety and efficacy, according to a study published in the journal Contraception.

When combined with misoprostol, mifepristone is effective 95% of the time in early pregnancies. A paper published in 2013 which reviewed abortion data for 45,000 women shows just 0.3% of patients who took the pill ended up hospitalized. The study’s authors concluded that abortion by pill is “highly effective and safe.”

Is Plan B an abortion pill?

Plan B, or by its generic name levonorgestrel, is not an abortion pill. It should not be used as an alternative to one. Plan B is a method of emergency contraception and isn’t for use in those already pregnant. Instead, it helps delay or prevent ovulation after unprotected sex or as a back-up when birth control fails.

What is a ‘DIY abortion pill’?

The abortion pill is mifepristone, but it’s used in combination with misoprostol. Mifepristone is highly regulated and only used for abortion. Misoprostol has other uses, such as reducing the risk of stomach ulcers caused by certain drugs. The drugs are used in combination together for maximum effectiveness — mifepristone blocks progesterone, a hormone that grows the uterine lining, while misoprostol causes the uterus to contract, which helps expel the fetus.

However, while misoprostol has many use cases, it comes with a warning label for pregnant women and those planning to become pregnant, which states that it can cause abortion. When mifepristone is not available, such as is the case in some states and some countries outside the U.S., misoprostol on its own can be a less-effective alternative option. The WHO has recommendations for misoprostol-induced abortions in locations where mifepristone is not available.