On September 15, SB 1, Indiana's "abortion ban" bill took effect. IPA provides these FAQs to help answer questions about the law and its effect on pharmacy practice.
We will be hosting a Q&A presentation later this month to discuss SB1, IPA's efforts to enact pharmacist-prescriptive authority for hormonal contraceptives, abortion-inducing medications, and to answer your questions. Look for further communication.
For further questions, contact us at inpharm@indianapharmacists.org.
FAQs
Last updated 9.15.2022
These FAQs are provided for informational purposes only and are not intended as legal advice. Please consult with your own counsel to obtain specific legal advice. Individual pharmacy systems may have their own specific procedures in place with regard to abortion-inducing drugs. Be sure to check your pharmacy's P&P too.
What is the legal status of abortion in Indiana?
Abortion is now illegal in Indiana (as of Sept 15, 2022), whether done with medications or surgically, with the following exceptions:
· Health or life of the mother
· Rape & incest, up to 12 weeks
· Lethal fetal anomaly
What about miscarriages and ectopic pregnancies?
Miscarriages and ectopic pregnancies are excluded from the definition of "abortion." They are often managed by drugs that are dispensed at a pharmacy.
What drugs are commonly used for to induce an abortion? Can any of these drugs be used for other indications?
The FDA-approved regimen for a medication abortion contains mifepristone (Mifeprex) and misoprostol (Cyotec). Mifepristone 200 mg by mouth is taken once, followed by misoprostol 800 mcg buccally once (consisting of two 200 mcg tablets in each cheek) 24-48 hours later.
Misoprostol is also used for management of miscarriage, labor induction, postpartum hemorrhage, and to ripen the cervix prior to IUD insertion or gynecological procedures. It also can be used for stress ulcer prophylaxis.
Mifepristone can also be used for miscarriage management. Under the brand name Korlym, it is indicated for hyperglycemia management in patients with Cushing’s syndrome.
Mifepristone has a REMS program. It is currently in the process of being updated. Pharmacies would be permitted to dispense mifepristone once it is finalized, but these pharmacies must be certified.
Historically, methotrexate was part of the medication abortion regimen, but it is no longer used. However, methotrexate is often prescribed to manage other medical conditions (like rheumatological conditions and ectopic pregnancy)
What if I receive a prescription for an abortion inducing drug from an out-of-state provider? Am I allowed to fill that?
If the abortion-inducing drug is being prescribed to induce an abortion, then you may not fill the prescription. Indiana law limits the dispensing of a drug to induce an abortion to the prescriber.
If the drug is being prescribed for an indication other than an abortion (i.e. miscarriage or ectopic management) (see previous question), then the drug may be dispensed.
Can I refer a patient to a provider in another state where abortion is legal to obtain an abortion or receive medication to induce an abortion?
Yes. There is no law prohibiting a pharmacist from informing a patient where they could legally obtain an abortion.
If I dispense an abortion-inducing drug believing it is to be used for an indication other than inducing an abortion, am I liable if the patient is taking the drug for the purposes of inducing an abortion unbeknownst to me?
Generally, if you have no reasonable basis to believe that the patient is intending to use the drug for an illegal purpose, you should not be concerned about being held professionally liable.
If I receive a prescription for a drug that can be used to induce an abortion, do I need to make any type of inquiry to the prescriber about whether the drug is being prescribed for another indication? If the prescriber is unavailable, can I rely upon what the patient says? Do I need to document that the drug was prescribed for that other indication?
Currently, there is no legal obligation to make an inquiry, as all indications for abortion-inducing drugs are still legal.
Pharmacists should be able to assume that prescriptions are written for a lawful purpose, unless there is a reasonable basis to believe otherwise. In those circumstances (ex. dosage is clearly used to induce an abortion as opposed to another purpose), then it would be prudent for the pharmacist to make an inquiry to the prescriber.
Can contraceptive products, including Plan B, still be dispensed? Do I need to ask patients why they want Plan B?
It is still legal for pharmacies to dispense Plan B, ulipristal (ella), and other contraceptive products to people of all ages. These medications do not induce abortions.
Regarding Plan B specifically, a full regimen of Plan B contains 1.5 mg of levonorgestrel, which is a larger dose of the progestin found in many forms of combined oral contraception. It inhibits ovulation and thickens cervical mucus, which inhibits sperm passage through the uterus. Plan B does not cause an abortion.
There are no states that restrict access to Plan B and anyone, regardless of age or gender, can purchase it.
I heard HHS recently issued a guidance to pharmacies about filling abortion inducing drugs. What does it say?
HHS issued a guidance to all retail pharmacies stating that refusal to fill abortion-inducing drugs may constitute sex or disability discrimination under federal civil rights law. Unfortunately, this guidance has added additional confusion as it does not explicitly state what activities would or would not constitute discrimination, nor how the guidance is to be viewed in states that legally prohibit dispensing abortion-inducing drugs or have “conscience clauses”. The national pharmacy organizations have been actively working to obtain clarity on these points.
