Abortion care in the US has historically been provided in clinics that are separate from other healthcare services, resulting in significant gaps in access to care for many individuals who do not have a clinic nearby. However, one innovative solution to this problem is the use of telehealth, which is increasingly being utilized to provide medication abortion in new areas.
Traditionally, patients visit a health center in person to receive abortion care from a clinician. Today, medication abortion via telehealth is offered by many health centers in at least 10 states, and some independent abortion providers are also integrating telehealth.
Under the site-to-site model, patients must still visit a health center for a consultation and screening with on-site staff. However, if eligible, patients are connected to a clinician at another health center via videoconference.
Research has shown that this model is safe, effective, and well-received by both patients and providers. Overall, telehealth is a promising solution for increasing access to abortion care, particularly for those living in areas without a health center providing abortion care within a reasonable distance.
Barriers to Telemedicine Medication Abortions
Expanding access to medication abortion through telehealth is one clear solution, but the politicization of abortion has limited its potential for innovation and expansion. To fully realize the benefits of telehealth abortion provision, the following obstacles must be overcome:
- State telehealth abortion bans
Currently, 17 states require the prescribing clinician to be physically present when dispensing medication abortion, which effectively prohibits telehealth use. Removing these limitations would enable healthcare providers to enhance the accessibility of medication abortion services for patients in these states by utilizing the site-to-site approach developed by Planned Parenthood.
- FDA restrictions
The FDA has imposed restrictions on Mifepristone, one of the two drugs included in FDA-approved medication abortion kits, such as the MTP kit. These restrictions include a Risk Evaluation and Mitigation Strategy (REMS) enforced by the FDA, which mandates that the medication can only be prescribed by certified providers and dispensed exclusively in clinics, medical offices, or hospitals. This restriction, which is medically unwarranted, prevents the medication from being sold at pharmacies, unlike most other safe and effective medications.
- Telehealth services across the country
Expanding telehealth services across state lines presents challenges due to variations in state laws and policies regarding medical practice, licensing, insurance reimbursement, malpractice, and patient protection. These differences create a complex environment for providers to navigate, with some state laws serving as barriers to telehealth, such as those requiring an in-person exam or an established physician-patient relationship before furnishing a prescription remotely.
The presence of abortion-related restrictions introduces additional complications, as anti-abortion lawmakers have imposed numerous burdensome and unnecessary regulations on both abortion providers and patients. These restrictions necessitate a thorough evaluation of their applicability whenever a clinician seeks to offer services in a new state. Although multistate compacts could potentially address licensing challenges, policymakers must ensure that policies designed to facilitate telehealth services across state lines do not inadvertently exclude abortion care.
- Funding
Funding is another key challenge, as abortion providers are already excluded from many traditional sources of funding and technology, and antiabortion policymakers frequently seek to exclude them from public funding streams. In order to guarantee that abortion providers can effectively implement telehealth advancements and maintain financial sustainability, it is crucial that they are not overlooked when it comes to receiving dedicated telehealth resources, including public grants.
Additionally, reintegrating abortion providers into broader healthcare networks, reversing existing funding restrictions, and defending against new encroachments are larger changes that could help ensure providers can build the infrastructure needed for telehealth services.
- Affordable medication
Accessing affordable medication abortion services is crucial, as affordability plays a significant role in receiving appropriate abortion care. However, the current barriers to insurance coverage for abortion, coupled with the evolving telehealth policies, have the potential to worsen disparities in access. Although certain states require insurance plans to cover telehealth services, it does not guarantee that telehealth services will be reimbursed at the same rate as in-person services.
Furthermore, the Hyde Amendment and similar federal policies limit insurance coverage of abortion, blocking millions of people from accessing care. In order to enhance the availability of telehealth abortion services for individuals from low-income and marginalized backgrounds, policymakers need to remove financial obstacles and guarantee that both public and private health insurance plans explicitly include and appropriately reimburse abortion services.
Takeaway
Looking forward, telehealth abortion has the potential to significantly increase accessibility for individuals and communities nationwide. However, several barriers, some specific to abortion and others related to telehealth in general, must be overcome to fully realize this potential. Furthermore, in the event that the conservative majority within the U.S. Supreme Court acts to limit abortion rights, and as state policies become more divided on this issue, telehealth may emerge as a vital method to enhance the capabilities and expand the coverage of the remaining abortion providers. To prepare for this possibility and to expand abortion access currently, policymakers must act to remove current restrictions and ensure that telehealth-related policies and funding opportunities include abortion.
