NYC residents have more access to abortion pills than ever before. The Supreme Court could change that.

It’s easier than ever for New Yorkers to get abortion pills. But that ease of access may be jeopardized as the U.S. Supreme Court considers a case that could cut off options for obtaining one of the two drugs used in medication abortions.

New York City-based start-ups like Hey Jane and Juniper Midwifery are part of a wave of online clinics that have popped up in recent years to prescribe the pills remotely and send the medication through the mail. Many traditional providers, including the city’s public hospital system, have started offering similar telehealth options.

For those who don’t want to wait on deliveries, Walgreens recently announced that certain locations in New York will also start dispensing abortion pills to customers with prescriptions as part of a rollout to several states. CVS could be on its heels: A spokesperson for the pharmacy chain said it now carries abortion pills in Massachusetts and Rhode Island and will phase in other states in the coming weeks.

But this level of accessibility could change. The Supreme Court is set to hear a case next week that challenges the U.S. Food and Drug Administration’s 24-year-old approval for the abortion medication mifepristone. A lower-court judge previously ruled that mifepristone should be taken off the market, though that ruling never went into effect. That judge repeatedly cited a study questioning the drug’s safety, which has since been retracted.

The case also challenges newer federal policies easing restrictions on abortion pills. Even if the Supreme Court preserves FDA approval for mifepristone, it could roll back more recent Biden administration rules that have allowed the pill to be delivered through the mail and dispensed at pharmacies — instead of obtained in person at a clinic.

Mifepristone is part of a two-pill regimen for medication abortions, along with the drug misoprostol. The Supreme Court ruling won’t affect access to misoprostol, which is also approved by the FDA for other medical conditions. Misoprostol is considered effective for medical abortions on its own, but not as effective as the two-drug regimen, according to the American College of Obstetricians and Gynecologists. Using misoprostol on its own is more likely to require additional doses to complete the abortion, and more frequently results in the need for follow-up care, according to one 2018 study.

If access to mifepristone is restricted through telemedicine and pharmacies, New Yorkers might have to go back to getting the drugs via clinics, or opt to take misoprostol on its own.

The Supreme Court case could curtail access to mifepristone as medication abortions are on the rise. Medication abortions now account for63% abortions in the United States, up from a little over half in 2020.

Navigating the new abortion landscape

Marisa Poverman, a midwife at Jacobi Hospital in the Bronx, first began using phone and video chats to prescribe her patients abortion pills during the COVID-19 pandemic.

She was taking advantage of special pandemic-era rules the Biden administration put in place in 2021, which suspended the requirement that patients had to get abortion pills from clinics in person. That change, which the Biden administration has since made permanent, opened the door for Juniper Midwifery, an online-only abortion clinic that Poverman launched “as a passion project” with a fellow New York City midwife in 2022.

Although the early-pandemic reluctance around going to the doctor in person has dissipated, the appeal of mail-order abortion medication remains, Poverman said.

“People are working, have families, don't necessarily have the time to take a morning or potentially a whole day to go to a clinic and have that care,” she said. “A lot of people like the privacy of it as well as the speed.”

Poverman said she’s still figuring out what to do if the Supreme Court restricts access to mifepristone.

“We do have a small stockpile of [mifepristone], but that wouldn't last us very long,” Poverman said.

Juniper Midwifery is a small operation that has gotten off the ground with the help of grants from New York state and Plan C, an organization that vets online purveyors of abortion pills. But it joins a growing landscape of virtual providers.

Nearly a third of abortion providers in the United States now offer pills by mail, according to a new study from the Guttmacher Institute. Online-only clinics only recently came on the scene, but accounted for about 8% of all abortions provided within the formal health system in the first half of 2023, Guttmacher found.

Hey Jane launched in 2021 and has since become one of the most prominent online abortion providers. Its clinicians prescribed abortion pills to about 25,000 people last year, with New Yorkers making up about a fifth of patients.

Hey Jane will prescribe misoprostol alone if access to mifepristone is restricted, said Kiki Friedman, the company’s cofounder and CEO.

“But it’s more uncomfortable for patients and that's why clinicians don't prefer it,” she said. “It really points to the cruelty of this [Supreme Court] case.”

NYC Health and Hospitals has meanwhile written more than 350 telemedicine prescriptions for abortion pills since launching its virtual service in October. Planned Parenthood now also offers telehealth, although it requires patients to come in to pick up their pills.

All of these organizations say they are interested in working with brick-and-mortar pharmacies that are now dispensing abortion pills to provide another option for patients.

Having abortion pills available at pharmacies also means a broader range of health care providers could start prescribing abortion pills, even if they might not otherwise have kept them on-hand, said Dr. Linda Prine, an abortion provider in New York.

But it may take time for that option to scale up. Walgreens won’t say how many of its New York pharmacies offer abortion pills or which locations carry them for safety reasons, according to a spokesperson.

How popular and widespread these options become will likely depend on the outcome of the Supreme Court case, which is expected this summer.

Prine said it was a good sign that CVS and Walgreens decided to start stocking mifepristone ahead of the Supreme Court hearing.

“It sends a message that this is here to stay,” she said.

But Prine is worried about her ability to continue getting patients mifepristone. She started using telemedicine to prescribe and send pills to patients in states with more restrictive abortion laws last year. She’s taking advantage of a ‘shield law’ Gov. Kathy Hochul signed in June that says New York won’t cooperate with any attempts by states with abortion bans to prosecute providers who prescribe across state lines.

She said if mifepristone becomes restricted in the country, patients could still get the pills from abroad, through organizations like Aid Access. U.S. providers could start prescribing misoprostol only — an option Prine does not like — or they could engage in civil disobedience and send mifepristone anyway, she said.

This story has been updated to correct the amount of medication abortions that occur in the United States, and the year the Hey Jane sexual health clinic launched.