{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T02:12:06Z","timestamp":1776132726315,"version":"3.50.1"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"Importance<\/jats:title>Before 2021, the US Food and Drug Administration required mifepristone to be dispensed in person, limiting access to medication abortion.<\/jats:p><\/jats:sec>Objective<\/jats:title>To estimate the effectiveness, acceptability, and feasibility of dispensing mifepristone for medication abortion using a mail-order pharmacy.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This prospective cohort study was conducted from January 2020 to May 2022 and included 11 clinics in 7 states (5 abortion clinics and 6 primary care sites, 4 of which were new to abortion provision). Eligible participants were seeking medication abortion at 63 or fewer days\u2019 gestation, spoke English or Spanish, were age 15 years or older, and were willing to take misoprostol buccally. After assessing eligibility for medication abortion through an in-person screening, mifepristone and misoprostol were prescribed using a mail-order pharmacy. Patients had standard follow-up care with the clinic. Clinical information was collected from medical records. Consenting participants completed online surveys about their experiences 3 and 14 days after enrolling. A total of 540 participants were enrolled; 10 withdrew or did not take medication. Data were analyzed from August 2022 to December 2023.<\/jats:p><\/jats:sec>Intervention<\/jats:title>Mifepristone, 200 mg, and misoprostol, 800 \u00b5g, prescribed to a mail-order pharmacy and mailed to participants instead of dispensed in person.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Proportion of patients with a complete abortion with medications only, reporting satisfaction with the medication abortion, and reporting timely delivery of medications.<\/jats:p><\/jats:sec>Results<\/jats:title>Clinical outcome information was obtained and analyzed for 510 abortions (96.2%) among 506 participants (median [IQR] age, 27 [23-31] years; 506 [100%] female; 194 [38.3%] Black, 88 [17.4%] Hispanic, 141 [27.9%] White, and 45 [8.9%] multiracial\/other individuals). Of these, 436 participants (85.5%; 95% CI, 82.2%-88.4%) received medications within 3 days. Complete abortion occurred after medication use in 499 cases (97.8%; 95% CI, 96.2%-98.9%). There were 24 adverse events (4.7%) for which care was sought for medication abortion symptoms; 3 patients (0.6%; 95% CI, 0.1%-1.7%) experienced serious adverse events requiring hospitalization (1 with blood transfusion); however, no adverse events were associated with mail-order dispensing. Of 477 participants, 431 (90.4%; 95% CI, 87.3%-92.9%) indicated that they would use mail-order dispensing again for abortion care, and 435 participants (91.2%; 95% CI, 88.3%-93.6%) reported satisfaction with the medication abortion. Findings were similar to those of other published studies of medication abortion with in-person dispensing.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The findings of this cohort study indicate that mail-order pharmacy dispensing of mifepristone for medication abortion was effective, acceptable to patients, and feasible, with a low prevalence of serious adverse events. This care model should be expanded to improve access to medication abortion services.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2024.1476","type":"journal-article","created":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T15:01:31Z","timestamp":1715612491000},"page":"873","source":"Crossref","is-referenced-by-count":10,"title":["Mail-Order Pharmacy Dispensing of Mifepristone for Medication Abortion After In-Person Screening"],"prefix":"10.1001","volume":"184","author":[{"given":"Daniel","family":"Grossman","sequence":"first","affiliation":[{"name":"Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Raifman","sequence":"additional","affiliation":[{"name":"Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Morris","sequence":"additional","affiliation":[{"name":"Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Arena","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Brown University, Pawtucket, Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lela","family":"Bachrach","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, San Francisco"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Beaman","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. Antonia","family":"Biggs","sequence":"additional","affiliation":[{"name":"Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Collins","sequence":"additional","affiliation":[{"name":"Allegheny Reproductive Health Center, Pittsburgh, Philadelphia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Curtiss","family":"Hannum","sequence":"additional","affiliation":[{"name":"Delaware County Women\u2019s Center, Chester, Philadelphia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Ho","sequence":"additional","affiliation":[{"name":"Highland Hospital, Alameda Health System, Oakland, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan 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Information about Mifepristone for Medical Termination of Pregnancy Through Ten Weeks Gestation. Published January 3, 2023. Accessed January 5, 2023. https:\/\/www.fda.gov\/drugs\/postmarket-drug-safety-information-patients-and-providers\/information-about-mifepristone-medical-termination-pregnancy-through-ten-weeks-gestation"},{"key":"ioi240027r16","unstructured":"Grossman? D. Feasibility and Acceptability of Dispensing Mifepristone Via Mail Order Pharmacy. Completed June 30, 2023. Accessed April 8, 2024. https:\/\/www.clinicaltrials.gov\/study\/NCT03913104"},{"key":"ioi240027r18","unstructured":"US Food and Drug Administration. Highlights of Prescribing Information: Mifeprex. Food and Drug Administration; 2023. Accessed August 22, 2023. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2023\/020687Orig1s025Lbl.pdf"},{"key":"ioi240027r19","unstructured":"National Abortion Federation. Clinical Policy Guidelines For Abortion Care. 2024. 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