Pilot Program
Olivia C. Welter, PharmD
Inspired to act when Roe v Wade was overturned, Uplift International partnered with Honeybee Health to expand access to medication abortion in Washington state. The pilot, dubbed the Pharmacist Abortion Access Project (PAAP), experimented with pharmacists independently prescribing mifepristone and misoprostol via telehealth. The pilot ended in late 2024, but project organizers see a path forward.
Pharmacist scope
Beth Rivin, MD, MPH, president and CEO of Uplift International, and her team selected Washington for the pilot because “Washington state has a long history of being a leader of pharmacist-prescribed medication and introduced pharmacist-prescribed emergency contraception in the 1990s.” Rivin noted that in this jurisdiction, prescribing medication abortion fits squarely in the scope of practice of a pharmacist. Because of this, Rivin saw an opportunity for pharmacists to consult directly with patients and prescribe mifepristone and misoprostol when appropriate.
The Washington State Pharmacy Association (WSPA) has been integral in expanding pharmacist scope of practice for decades. Jenny Arnold, PharmD, BCPS, WSPA CEO, said that WSPA has been aware of PAAP but did not actively participate in the initial pilot. According to Arnold, the small, thoughtful group of pharmacists who undertook this project implemented strategies to ensure patient safety. “Participating pharmacists worked in partnership with obstetricians and gynecologists to understand any potential complications to expect for patients taking mifepristone and misoprostol,” said Arnold.
Project details
One component that made the pilot unique was the requirement for patient interaction via telehealth. While the project was operational, patients could not walk into a pharmacy and request prescriptions for mifepristone and misoprostol. Patients could instead enroll in the program virtually and, after they were determined to be eligible candidates for the medication, receive their prescription abortion medication from the online pharmacy Honeybee Health by mail. Rivin indicated that this model helped to expand access to anyone who qualified to receive medication abortion, such as patients in rural areas or those who can’t easily see a physician.
Arnold provided insight into the program structure, sharing that patients had an initial consultation and two follow-up appointments with their pharmacist. Because the pilot established a network of OB/GYN providers, participating pharmacists could actively and appropriately refer patients for any further follow-up care.
A total of 10 pharmacists and 43 patients participated in the pilot. Rivin noted that the participating pharmacists underwent in-depth interviews upon conclusion of the pilot so that Uplift International could learn about and improve the pharmacist experience with prescribing medication abortion.
Honeybee Health does not accept insurance, so the findings of the pilot did not include any information on the feasibility of pharmacists billing the pharmacy benefit using their own National Provider Identification number or billing the medical benefit for medication abortion services.
PAAP expansion
Rivin said that her team is planning to formalize their PAAP pharmacist training as an ACPE-accredited continuing education program. They also plan to upgrade their PAAP online platform to an improved, user-friendly version as the project expands.
According to Rivin, “Uplift International’s Pharmacist Abortion Access Project has proven that pharmacists are willing to prescribe and expand access to medication abortion in Washington state.” Similarly, a 2023 survey, available at apha.us/ImprovingAccessSurvey, conducted by Rafie and colleagues indicated that 75% of surveyed California pharmacy professionals share this sentiment.
Projects such as PAAP may soon be acceptable in other states. As of March 2025, the New York State Assembly is considering a bill that would establish a nonpatient specific standing order for pharmacists to dispense abortion medication. Additionally, a proof-of-concept pilot study conducted by researchers in California found that pharmacists can safely and effectively provide abortion medication under an established protocol.
Looking to the future of the project, Rivin anticipates that prescribing mifepristone and misoprostol at brick-and-mortar pharmacies will become more acceptable as pharmacist-prescribed medication abortion continues. “Pharmacists are currently an untapped professional resource for prescribing medication abortion and are able, with training, to support expanding access to abortion care,” said Rivin. ■