The FDA finalized a rule last week allowing more pharmacies to dispense mifepristone, one of the two pills used in medication abortions, and Florida Gov. Ron DeSantis saw a chance to posture and bluster ahead of the 2024 Republican presidential primaries. The DeSantis administration sent an “all provider alert” on Wednesday, threatening medical providers with criminal charges if they use the expanded access provided by the FDA in violation of either of two Florida anti-abortion laws.
State law does not trump the FDA, legally. But many states have restricted medication abortion beyond FDA recommendations, and this hasn’t gone through the courts and, well, we know about this Supreme Court. Either way, DeSantis is going for pure intimidation factor here. Florida medical providers are intended to think, “Shoot, this guy is arresting people for voting, so what’s he going to do to me if I dispense abortion medication in a way he doesn’t like?”
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The Florida laws the DeSantis administration warned providers not to violate say “[n]o termination of pregnancy shall be performed at any time except by a [licensed] physician” and “[i]t is unlawful for any person to perform or assist in performing an abortion on a person, except in an emergency care situation, other than in a validly licensed hospital or abortion clinic or in a physician’s office.” Currently, Florida bans abortion after 15 weeks (past the recommended limit for using medication abortion) and requires patients to have an ultrasound, be “counseled,” and wait 24 hours after “counseling.” So the state’s laws require in-person appointments even for medication that the FDA says can be prescribed remotely.
Although the FDA has permitted abortion medication to be prescribed through telehealth appointments since 2020, even before the Supreme Court allowed them to ban abortion entirely, many states banned that in order to make it more difficult to obtain an abortion.
This, along with DeSantis’ current threat, should be in violation of the law. There is precedent for the FDA overruling state law.
“It is unusual, but not unheard of, for states to enact policies that overrule an FDA-established protocol for dispensing a drug,” KFF has reported. “In 2014 Massachusetts attempted to restrict an opioid more stringently than the FDA recommended, and after the manufacturer sued, a court invalidated the law, finding the state law was preempted by federal law. The court ruled that allowing the law to stand would ‘undermine the FDA’s ability to make drugs available to promote and protect the public health.’” The same principle applies here. But with the Trump Supreme Court in place, who’s going to enforce that?
There are, however, international services like Aid Access that will prescribe and ship abortion medication to states with abortion bans. Additionally, the Justice Department has said that the U.S. Postal Service can deliver the medications to those states.
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