Physician Launches Initiative to Help Pharmacists Prescribe Abortion Pills

Welcome to “Medical Mavericks,” a series from MedPage Today featuring interviews with healthcare professionals working in unconventional fields of health and medicine.

We spoke with Beth Rivin, MD, MPH, a pediatrician and president and CEO of Uplift International, about her experience launching the Pharmacist Abortion Access Project. The project is the first model leveraging pharmacists to directly prescribe medication abortion to individuals in Washington State. Initially launched as a pilot program, Rivin is now working to expand the initiative more broadly in the state. During our conversation, Rivin shared insights into why this work is so important in the current policy landscape, discussed how other states can follow this model, and offered tips for getting involved.

This interview has been edited for brevity and clarity.

Could you share an overview of your medical background and current positions?

Rivin: I’m a pediatrician and president and CEO of Uplift International. I’ve worked as a clinician and public health professional for over 40 years, and I’ve spent decades working in low- and middle-income countries to improve population health. I’ve been a teacher, practitioner, and researcher in the field of health and human rights, and bioethics as well.

My professional background is rather broad and it ranges from clinical pediatrics and adolescent medicine to clinical trials, epidemiology, emergency humanitarian assistance, public health, system strengthening, maternal child health and health and human rights program design, development and evaluation of programs, and bioethics institutional capacity building.

Where did the idea for the Pharmacist Abortion Access Project come from and how does it work?

Rivin: So, after working for many decades in low- and middle-income countries and being president and CEO of Uplift International [a nonprofit focused on global education and advocacy to advance health and human rights], I realized that Uplift needed to respond to the reproductive health crisis in the U.S. And after Roe v. Wade was overturned and reproductive rights were more clearly in jeopardy, I started talking with leaders in reproductive health around the U.S. and I pulled together a task force. I knew a number of people at the University of Washington and I was introduced to others, and we came up with the idea to do the Pharmacist Abortion Access Project.

And that was in 2022, when we really started to create this new model to improve abortion access, one that would take advantage of our environment and our opportunities in Washington state. We wanted it to be an innovative program that would fill a niche that hadn’t been filled before.

So, the Pharmacist Abortion Access Project was designed by Uplift to expand abortion care by engaging pharmacists to prescribe medication abortion to patients directly. It was pilot tested in Washington state — and this is the first in the U.S. We recruited and trained pharmacists on prescribing medication abortion and understanding all the clinically inappropriate patients and clinical exclusions for medication abortion. They were also trained to use our newly built platform.

So during the pilot, the pharmacists, after reviewing the [patient] history and other information online, prescribed to the patients directly through the platform, and Honey Bee Health, the online pharmacy we partnered with, mailed that medication to patients in the state.

So, it’s all online? A person couldn’t walk into a Washington state pharmacy and request an evaluation and prescription?

Rivin: Currently, that is not available. We decided this was the best way to get to any individual in Washington that wanted and needed medication abortion, and who fit the clinical criteria. Now that the pilot is finished, we’re working on rolling it out more broadly to allow pharmacists anywhere in the state to get trained.

Eventually, we expect that we will have brick and mortar pharmacies in Washington state that will be able to prescribe, and as a matter of fact, dispense medication abortion.

What about cross-state prescribing?

Rivin: One of the criteria that we had for getting a prescription by the pharmacists in Washington state was that the pharmacists were licensed in Washington and had an active license. Just like any other state, Washington requires pharmacists to be licensed in that state to prescribe in that state. As for patients, the individual had to have a Washington state address and reside here.

Currently, Washington is the only state that legally allows pharmacists to directly prescribe abortion medication to patients. There are other states that have taken steps to increase access to abortion, and we look forward to hearing from leaders if they are interested in our model. Many other states can use what we’ve learned.

Why is this initiative so important in the current policy landscape?

Rivin: If access to mifepristone is limited or telehealth is limited, there would be a huge negative impact on millions of women. Approximately 63% of all abortions are medication abortion in states where it is legal, and that shows that for early abortion, medication abortion is the preferred method for American women. One in five are by telehealth currently, and we have some early data suggesting this is increasing. So, more and more women and all individuals seeking early abortion are interested in affordable, safe, convenient, and private access to medication abortion. And that’s why our program is so appropriate — this is a method of asynchronous telehealth abortion where individuals can go online at any hour of the day, attest to certain criteria, provide verification of who they are by uploading a government ID such as a driver’s license, and then fill out a form, which is then reviewed.

I have one other important thing to note, in the case that there are more government access rollbacks. We trust that leaders in Washington will ensure that medication abortion is accessible. Our project also paves the way for in-person access through prescribing by pharmacists. And so, that would be a mitigating factor if telehealth were taken away as a method of prescribing. We feel very supported by the Washington state government.

Why is the issue of reproductive rights so personally important to you?

Rivin: It’s about women’s rights. It’s about their right to health, bodily autonomy, control over one’s own body, control over one’s own life. Access to safe, effective medication and abortion care is essential care. Ensuring that there is access ensures freedom to make one’s own decisions about one’s own health and well-being given their own circumstances. A politician doesn’t know all this.

I was involved in fighting for abortion rights. That fight never ends because governments historically and currently have shown that they take away rights. And I feel like we have to fight for them back. Reproductive rights are human rights.

Being part of the initial fight for U.S. abortion access, you must have never imagined we’d be back here?

Rivin: No, but I have seen around the globe, because of my international work, how women are oppressed. I’ve seen what happens when rights are taken away — and authoritarian regimes do this routinely. They take away women’s rights. They disempower half of the population. We can’t allow this.

How can readers get involved in the Pharmacist Abortion Access Project?

Rivin: It would be great to have more pharmacists interested in doing this in their own states. We would be happy to talk with associations of pharmacists or individual pharmacists.

Please email us at info@upliftinternational.org or you can go to our website and get in contact with us that way. We have a newsletter. Everyone is welcome to join to get updates. We are seeking financial support to continue our work.

Is there anything I haven’t asked about that readers should know?

Rivin: I believe the attacks on abortion in the U.S. have created an urgent medical, public health, and human rights crisis. Even in states where abortion is legal, there are individuals who really need help. They need help to gain better access to abortion care. There are rural communities and individuals who are struggling to make ends meet. And there are other reasons too why people have a hard time accessing reproductive healthcare. So, this is one way to expand access. And we are very excited that we can do this in Washington state and use it as a model, not only for our state, but for other states.

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