Lupin 2023

Rx finds itself between a rock and a hard place

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The dispensing of mifepristone, one of two medications used sequentially to terminate pregnancy, has emerged as a very thorny problem for Walgreens, one that will, in short order,

engulf other retail pharmacies across the country. The issue burst into prominence at the beginning of February when the attorneys general of 20 states wrote a letter to Walgreens Boots Alliance and other big pharmacy operators that asserted utilization of the mail to obtain and sell so-called abortion pills is a violation of federal and state law. (Kansas attorney general Kris Kobach subsequently sent a similar letter of his own.)

Walgreens’ initial response — that it would not dispense mifepristone in those states, including four where it is still legal (a position the company has since clarified) — set off a firestorm. Abortion rights advocates were quick to blast the move by the attorneys general.

“Elected officials targeting pharmacies and their ability to provide women with access to safe, effective and FDA-approved medication is dangerous and just unacceptable,” said White House press secretary Karine Jean-Pierre. “The administration will continue to stand by the FDA’s expert judgment in approving and regulating medications. And in the face of barriers to access and concerns about safety of patients, health care providers and pharmacists, we will continue to support access to this critical medication within the limits of the law.”

It didn’t take long for some critics to set their sights on Walgreens. California Gov. Gavin Newsom attacked the drug chain on Twitter, saying the state “won’t be doing business with @walgreens — or any other company that cowers to the extremists and puts women’s lives at risk. We’re done.”

After Newsom ordered California officials to review all dealings with Walgreens, the state decided not to renew a $54 million contract covering specialty medications for the prison population when it expires at the end of April. The move is clearly an overreaction by the governor of one state to the company’s commitment to obey the law in others. Newsom certainly wouldn’t want any of his counterparts to attempt to persuade businesses to disregard rules and regulations in California.

The uproar among abortion rights supporters over Walgreens’ announcement was also manifested by calls to boycott the drug chain, a movement supported by the likes of filmmaker Michael Moore that created considerable buzz on social media.

Amid all the sound and fury, Walgreens issued a statement clarifying its stance vis-a-vis pressure from the attorneys general, saying it intends to dispense mifepristone in any jurisdiction where it is legal to do so: “Once we are certified by the FDA, we will dispense this medication consistent with federal and state laws. Providing legally approved medications to patients is what pharmacies do, and is rooted in our commitment to the communities in which we operate.”

Retail pharmacy became the focal point of the abortion rights debate at the start of the year, when the Food and Drug Administration changed course and decided that, for the first time, mifepristone could be sold with a prescription at brick-and-mortar pharmacies. Prior to revision of the agency’s Risk Evaluation and Mitigation Strategy for the drug, mifepristone could only be obtained at clinics, physician practices and certified mail-service providers.

The question of where women can get mifepristone took on added significance in the wake of the Supreme Court’s 2022 ruling in Dobbs v. ­Jackson. The decision overturned Roe v. Wade, which since 1973 had guaranteed a right to abortion, leaving it to the states to regulate the practice.

Like other pharmacy operators, Walgreens is now awaiting FDA approval to dispense mifepristone, but securing such certification will not mollify antiabortion forces. Once they receive the green light from the agency, Walgreens and its peers — CVS Health, Walmart, Kroger, Albertsons, Rite Aid and Costco, all of which also received letters from the 20 state attorneys general — will have to decide how to proceed.

By making its intentions clear, Walgreens became a lighting rod for the industry, but other pharmacies are sure to find themselves in a similar position as soon as they indicate how they will handle the dispensing of the drug.

No matter what decision the companies make, they won’t be able to avoid controversy. The actions of Newsom, Moore and other abortion rights advocates are mirrored by those of the attorneys general and people in the antiabortion camp who call on consumers to shun pharmacies that carry mifepristone. That puts pharmacy operators between a rock and a hard place.

The industry can’t solve a societal rift of such magnitude and importance. Pharmacies can, however, adhere to their overriding purpose of providing convenient access to legal medications, along with expert advice about how best to use them. Walgreens has set a worthy precedent.

The abortion debate will ultimately have to be settled by government officials, legislators and members of the judiciary. In the meantime, let’s hope that Newsom and like-minded politicians avoid trying to penalize pharmacies that are there to help their constituents stay healthy.

Adheris Health

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