What to know if you've been denied abortion medication at the pharmacy

It has been nearly 11 months since the U.S. Supreme Court overturned the federal right to an abortion and left it to the states to decide on the issue.

Since then, restrictive and sometimes vague state laws have prompted a slew of legal challenges, creating a landscape of uncertainty for abortion access among health care providers, clinics, pharmacies and patients across the nation.

Perhaps one of the most impactful cases since the Supreme Court’s ruling overturning Roe v. Wade is a Texas lawsuit that challenges the Food and Drug Administration’s decades-old approval of mifepristone, one of two drugs prescribed to terminate a pregnancy through 10 weeks gestation. On April 21, the Supreme Court halted restrictions imposed by lower courts that would have limited expanded access to the drug. This means mifepristone remains accessible for now while litigation battles play out in the lower courts.

​​“Confusion and chaos are currently the law of the land when it comes to abortion care,” Dr. Jennifer Lincoln, board-certified ob-gyn and executive director of Mayday, a nonprofit group that helps women get access to abortion pills, told Yahoo News.

Post-Roe, there have been reports of women and teens being denied access to certain medications for chronic illnesses because the medication might result in an abortion. In response to those stories, the Department of Health and Human Services issued a warning to the nation’s 60,000 retail pharmacies that refusals to fill valid prescriptions constituted a violation of federal civil rights law, even if the medications in question might also result in the termination of a pregnancy.

“I have a lot of followers on social media, and they’ve shared stories where their pharmacist has denied a prescription for misoprostol that might be used for miscarriage management, for example, or other medications that might be used for arthritis treatments, like methotrexate, which people are incorrectly not dispensing because they think that it’s going to lead to an abortion,” Lincoln told Yahoo News.

A physician in a particularly conservative part of Florida recently contacted Lincoln through social media to enlist her help after multiple failed attempts to remedy the situation. (The doctor was not comfortable disclosing their identity for fear of retribution.)

Florida currently has a 15-week abortion ban — GOP Gov. Ron DeSantis recently signed a six-week abortion ban bill, which won’t go into effect until the state Supreme Court overturns its previous precedent on abortion. The state also regulates the use of abortion medication, requiring that it has to be taken in the presence of a doctor.

After removing any identifying patient information, the physician shared a photo with Lincoln of a patient’s rejected prescription at a CVS for misoprostol, which can be used for a number of health reasons, including to end a pregnancy.

In this case, the doctor prescribed misoprostol for their patient to take for pain management before an IUD (intrauterine device) insertion. But the pharmacist rejected the prescription, incorrectly stating that a federal judge had recently banned misoprostol.

The pharmacist was most likely referring to the previously mentioned Texas lawsuit regarding mifepristone access, which has not been banned by a federal judge. Neither has misoprostol.

“We understand that the recent court decisions did not impact access to misoprostol and continue to dispense the medication as allowed by individual state law,” CVS told Yahoo News in an email. “This was an isolated incident that was addressed and corrected Tuesday [April 25].”

While pharmacists can refuse to fill a patient’s prescription for reasons like dosage concerns, negative interaction with other drugs or a suspicious prescription for opioids, examples of medication denials highlight a gray area some patients might not be aware of in post-Roe America.

Brigitte Amiri, a deputy director at the ACLU’s Reproductive Freedom Project, spoke to Yahoo News about a pharmacist’s refusal to provide a prescription based on their personal beliefs and what a patient can do. (Responses have been lightly edited for length and clarity.)

Can a pharmacist legally refuse a patient’s prescription based on their personal beliefs?

“Yes, so some states have laws that say that an individual pharmacist can refuse to fill a prescription in a specific context, usually it’s in the reproductive health care context, because of their religious beliefs. But I want to emphasize that those laws typically apply to the individual pharmacist,” Amiri said.

“What we [the ACLU] have always advocated for is that it’s then the responsibility of the pharmacy as a whole to make sure that the customer gets the medication,” she continued. “So in a state where there is a law that allows a pharmacist to refuse to fill a prescription based on a religious objection, that pharmacy as an entity has to make sure that there’s someone in the pharmacy other than that individual who has an objection to make sure that the customer gets the medication that they need.”

(Yahoo News reached out to CVS and Walgreens regarding their company policies concerning a pharmacist’s refusal to fill a prescription based on personal beliefs. In emailed responses, both pharmacy chains said they have policies in place that require an employee to notify the employer of a specific exemption in advance so that accommodations can be made for the patient seeking the medication.)

What can people do if a pharmacy refuses to fill a prescription?

“Each state has a pharmacy board that licenses pharmacies and pharmacists, and filing a pharmacy board complaint to let them know what happened is one of the first things that people could do,” Amiri said.

“Another thing is writing a letter to a chain pharmacy headquarters letting them know what happened and asking them to fix it and also for an apology.

“We had a number of situations where our client not only wanted for this to not happen to other customers, but they also wanted an apology for what had happened to them,” she noted.

Could a pharmacist face legal consequences if they rejected a prescription based on personal beliefs?

“I think this goes back to the distinction of the entity. So a pharmacy has policies in place not to discriminate against their customers and to provide the medications. Whereas an individual pharmacist that may have a religious objection under state law may have the ability to say, ‘I don’t want to fill a certain prescription,’” Amiri said.

“So I think all that distinction is important too, because if the pharmacy is doing its job, then it is making sure that if there’s someone that has a religious objection to providing certain medication and that accommodation is permitted under state law, then the pharmacy overall has someone to make sure that the customer still gets the medication,” she said.

What are some of the more notable things you’ve seen unfold regarding abortion medication over the last year?

“One is that we are in an increasingly hostile environment and so even if abortion is still permitted in a state, you’d still see anti-abortion politicians that are being very aggressive and very hostile and going after individuals who are trying to access abortion or provide abortion,” Amiri said.

“And then the flip side is that in this moment, we are seeing more and more people and companies stand with people who need abortion access. After [President] Biden said that the restrictions on medication abortion were going to be lessened and it could be dispensed at a pharmacy, you saw two major pharmacies pledge their support to carry it.

“Even just having major companies say the word ‘abortion,’ talk about abortion and making a commitment to provide abortion medication in their pharmacies — that’s big. That was a big change,” she added.

“A lot of the pharmacy refusals that I have dealt with in the past were about emergency contraception, about contraception, which should not be controversial. So there are like these two ends of the spectrum: the hostility by anti-abortion politicians on the one hand, and then companies and a lot of the public really being vocal about their support for abortion.”