Bill Overview
Title: Protecting Access to Medication Abortion Act
Description: This bill directs the Food and Drug Administration (FDA) to take steps to allow patients to receive prescriptions for mifepristone, a drug approved by the FDA for medical abortion, via telehealth and for prescriptions for the drug to be filled by mail. (Mifepristone is subject to a Risk Evaluation and Mitigation Strategy, which imposes various safety-related requirements. During the COVID-19 public health emergency, the FDA suspended enforcement of the current strategy's requirement that the drug must be dispensed in person, and this suspension is still in effect. In December 2021, the FDA stated the data supported modifying the strategy to remove the in-person dispensing requirement.) Under this bill, the FDA must require the holder of the relevant approved drug application to submit a proposal to modify the strategy. The modification shall (1) remove the in-person dispensing requirement, (2) allow patients to access prescriptions for mifepristone via telehealth, and (3) authorize all pharmacies certified to dispense mifepristone to patients to do so via mail.
Sponsors: Sen. Smith, Tina [D-MN]
Target Audience
Population: Individuals seeking access to medication abortion services
Estimated Size: 335000
- Medication abortion is widely used globally as a method of terminating pregnancies, and mifepristone is a key drug used in this process.
- The World Health Organization estimates that there are approximately 40 to 50 million abortions performed worldwide each year.
- Medical (medication) abortions account for a significant portion of these procedures, and access to mifepristone is essential for these to be performed safely.
- The impact of increased access to medication abortion through mail and telehealth could potentially affect millions of individuals seeking abortion services globally.
- Considering the prevalence of telehealth services and increasing accessibility to mail delivery systems globally, a significant portion of the global female population of reproductive age (15-49 years) could be considered impacted.
Reasoning
- The target population for this policy mainly includes women of reproductive age who seek access to medication abortion services. This covers a significant portion of the U.S. population, considering approximately 39% of all abortions in the U.S. are medication abortions.
- The budget constraint indicates that the program has significant, but not unlimited, resources. It must prioritize efficiency in reaching the target population through telehealth and mail delivery.
- Since this policy primarily affects women of reproductive age, interviews should consider a diverse range of socio-economic and geographic backgrounds to account for varying levels of current access to health clinics.
- The policy will likely have varying impacts, from high to low, depending on the current accessibility of abortion services in different states and regions due to varying state laws and availability of services.
- There will be individuals not strongly impacted by this policy, particularly in states where access to abortion services is already unrestricted and in-person options are remote or unnecessary.
Simulated Interviews
Graduate Student (Kansas)
Age: 25 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- This policy could be a game-changer for me and others in my state who face significant barriers to accessing abortion services.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 9 | 5 |
| Year 20 | 7 | 4 |
Healthcare Professional (California)
Age: 32 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- Although California already facilitates abortion access, making misoprostol available via mail could streamline services and reduce clinic congestion.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 9 | 8 |
| Year 5 | 9 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 7 | 7 |
Retail Worker (Texas)
Age: 28 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- Living in Texas, accessing safe abortions is tough. This policy would be a relief, letting me get prescriptions through telehealth.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 6 | 4 |
Software Engineer (New York)
Age: 40 | Gender: female
Wellbeing Before Policy: 9
Duration of Impact: 2.0 years
Commonness: 15/20
Statement of Opinion:
- This policy would standardize access across the country, making it fairer, even though I personally don't face current barriers.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 9 | 9 |
| Year 2 | 9 | 9 |
| Year 3 | 9 | 9 |
| Year 5 | 9 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 7 | 7 |
College Student (Ohio)
Age: 21 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- Having access to mifepristone through mail would be really helpful since I can't afford frequent trips to clinics.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 6 | 5 |
Small Business Owner (Florida)
Age: 37 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 9/20
Statement of Opinion:
- This policy could save much time and stress, making healthcare more convenient for busy people like me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 6 | 6 |
Stay-at-home Mother (Kentucky)
Age: 30 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 8.0 years
Commonness: 6/20
Statement of Opinion:
- The policy would be quite beneficial given Kentucky's restrictive stance; remote access could ease a lot of tension.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
Educator (Illinois)
Age: 50 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 3.0 years
Commonness: 11/20
Statement of Opinion:
- The stress reduction for younger women and others would be significant. It upholds reproductive rights.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 7 | 7 |
Freelancer (Utah)
Age: 26 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- The ability to get such a sensitive service through telehealth and mail would ensure privacy and save time.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 5 | 4 |
Barista (New Mexico)
Age: 29 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- The policy would provide a much-needed option, especially for those who can't afford time off work or travel extensively.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 5 |
Cost Estimates
Year 1: $1800000 (Low: $1500000, High: $2500000)
Year 2: $1600000 (Low: $1400000, High: $2200000)
Year 3: $1500000 (Low: $1300000, High: $2100000)
Year 5: $1400000 (Low: $1200000, High: $2000000)
Year 10: $1300000 (Low: $1100000, High: $1900000)
Year 100: $1000000 (Low: $800000, High: $1500000)
Key Considerations
- Implementation timelines for the FDA to modify the Risk Evaluation and Mitigation Strategy may affect overall cost and savings trajectories.
- Public acceptance and adaptation to telehealth for acquiring medication abortion will determine the scale of utilization and impact.
- Potential legal and political challenges to the policy could influence its execution and cost.