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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Women are using creative and risky tactics to get abortion pills

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

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Good morning, everyone. Don’t forget to look down when you’re walking … you never know what kind of Olympic medal you’ll find. 🥇 Programming note: The Health 202 is copying Congress and will be off on Friday. See you back here Monday.

Today’s edition: Pharmacists can now prescribe covid-19 fighting pills, a major expansion of who can order the medication. Drugmaker AbbVie shielded profits from U.S. taxes, a new Senate report finds. But first … 

Women are searching for ways to circumvent state bans on medication abortion

Republican states have moved swiftly to block access to abortion pills. Now, women are turning to creative — and legally risky tactics — in their quest to obtain the medication. 

Some telehealth abortion services are advising patients to drive across state lines for their virtual appointment and then use an out-of-state address to receive the pills in abortion-friendly states. Other public websites detail how to use commercial mail-forwarding services to ultimately obtain the pills in conservative states, our colleague Christopher Rowland reports.

But some of the new strategies pose significant legal questions. They come at an exceedingly confusing time for abortion access — where restrictions may be enacted in a state, only for courts to pause them a day later. Even before the Supreme Court overturned Roe v. Wade, some GOP-led states had already moved to ban abortion pills from being shipped or prescribed, prompting patients and advocates to seek novel ways of circumventing the restrictions.

“If you’re not following the rules and not acting in good faith, there is a lot of trouble you can get into,” Dianne Bourque, a health-care lawyer specializing in licensing and regulations at the firm Mintz, told Christopher.

New tactics

In 2000, the Food and Drug Administration deemed abortion pills safe and effective for use in the first 10 weeks of pregnancy. Roughly 20 years later, the medication accounts for more than half of all abortions across the country — and President Biden has said he’s committed to ensuring the pills remain legal and available.

Still, accessing the pills is difficult in red states where abortion is banned. Christopher identified three new ways women are obtaining the medication in the nation’s new post-Roe era. 

Forwarding the pills: Groups, like the nonprofit abortion advocacy website Plan C, have publicly posted detailed accounts of how patients can use these services to obtain pills. For instance: a woman living in a state where abortion is restricted, like Texas, could set up a mail-forwarding account to a state where it’s legal, like in Colorado. She could use a Colorado address to accept the shipment of pills after the telehealth visit, and then the mail-forwarding service would send the medication to Texas. 

Don’t ask, don’t tell: Some providers are trying to avoid asking direct questions about where their patient is during the consultation, activists told Christopher. That could create a layer of plausible deniability. The patient just needs to have a shipping address in a state where abortion isn’t blocked — and there’s no way for a provider to know if a patient is using a mail-forwarding service.

Crossing state lines: One nonprofit telehealth provider, Carafem, encourages women to travel to the closest border state where abortion is legal. The patient can pull into a random parking lot for the telehealth visit, and then get the medication shipped to the address of a friend or a post office in the abortion-friendly state.

The politics

Antiabortion politicians may seek to crack down on such workarounds.

“That needs to be stopped,” Alabama state Rep. Andrew Sorrell (R), who has sponsored legislation to outlaw the pills, said in a text message to Christopher. “Put a fine and a criminal penalty on it and make it very risky to try.”

But some states, like Massachusetts and California, have rules preventing local officials from cooperating in an investigation launched by another state where abortion is outlawed. Meanwhile, some abortion rights advocates are lobbying blue states to let providers prescribe and ship pills into states with abortion restrictions.

At the federal level, Attorney General Merrick Garland has already signaled that he’s preparing for legal battles, including on abortion pills. Protecting access to the pills was one of the top priorities Biden announced shortly after the Supreme Court overturned the constitutional right to an abortion.

  • “If states try to block a woman from getting medication the FDA has already approved and that has been available for more than 20 years, my administration will act and protect that woman’s right to that medication,” Biden told governors during a virtual meeting last week.

Agency alert

FDA to allow pharmacists to prescribe covid-19 fighting pills

State-licensed pharmacists will now be able to prescribe Pfizer’s covid-19 treatment Paxlovid directly to patients at high risk of developing severe disease, the FDA announced yesterday. 

Previously, only physicians and other advanced practice clinicians could prescribe the antiviral drug, which has been shown to curb the worst effects of the virus. The Biden administration has been working to expand access to Paxlovid, opening “test-to-treat” sites nationwide where patients who test positive can get a prescription for the medicine. 

  • The move is a win for pharmacy groups, who have been pushing for the agency’s limitation to be lifted so they can help quickly prescribe and dispense the pill, which must be taken within five days after symptoms begin to be effective.
  • Individuals who have tested positive for the virus and want to be prescribed Paxlovid from a pharmacist must provide recent health records that include bloodwork to review for kidney or liver problems, as well as a list of all medications being taken to screen for potential drug interactions. They don't need to take a separate test on site at the pharmacy, according to the FDA.

The American Pharmacists Association:

Other news from around the agencies:

  • The FDA and Juul agreed yesterday to put their legal battle on hold while federal regulators reopen their review of the companies electronic cigarettes, the Associated Press reports.
  • The FDA is developing a new framework that would allow overseas infant formula manufacturers to market their products in the United States beyond the current shortage. Federal regulators plan to issue further guidance this September.
  • Labcorp, one of the nation's largest commercial laboratory testing networks, began testing for Monkeypox yesterday, after criticism that the Biden administration has moved too slowly to respond to the outbreak. The company estimates it will be able to double the nation’s current testing capacity by conducting 10,000 tests per week.

Céline Gounder, editor at large at Kaiser Health News:

On the Hill

Drugmaker AbbVie shielded profits from U.S. taxes, Senate report finds

A report this morning from the Senate Finance Committee alleges the pharmaceutical giant AbbVie has shielded much of its U.S. sales from federal taxes, our colleague Tony Romm reports this morning. 

What Democratic investigators found: The drugmaker behind the popular arthritis medication Humira generated 75 percent of its sales in the United States in 2020, but reported only 1 percent of those sales for tax purposes. AbbVie was allegedly able to shrink its tax burden as a result of former president Donald Trump’s signature tax overhaul, which changed how companies calculate their tax bills on profits generated internationally. 

Senate Democrats are laying the groundwork for a deeper probe targeting the pharmaceutical industry and its sky-high profits. Finance Committee Chair Ron Wyden (D-Ore.) has demanded similar documents from the drugmakers Merck and Abbott.

The report comes as Democrats continue to wrangle over a broad revamp of the tax code. Party leaders had hoped to include updated laws governing what taxes companies pay on income generated both within the United States and abroad in their long-stalled economic spending package but have so far failed to sell their global proposals to Sen. Joe Manchin III (D-W.Va.).

Meanwhile …

The latest version of Democrats’ drug-pricing bill was sent to the Senate parliamentarian yesterday morning, according to a Senate aide. There are certain restrictions around what policies can be included in the fast-track budget maneuver Democrats would use to pass an economic package — and the parliamentarian is the arbiter of those rules. 

The text of the drug bill was publicly released yesterday by the Senate Finance Committee. Notably, it doesn’t include measures related to insulin, such as a $35 monthly cap on the cost of the lifesaving drug for patients with private insurance or on Medicare. This comes amid a bipartisan effort to pass such a limit and other insulin measures from Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine), which Majority Leader Chuck Schumer (D-N.Y.) has pledged to bring to a vote on the Senate floor. It's also been unclear whether the insulin cap would be allowed under the fast-track process.

White House prescriptions

Biden in hot water over potential nomination of antiabortion Republican judge

Newly released emails confirm that Biden had intended to nominate an antiabortion Republican to a lifetime appointment as a federal district judge in Kentucky, the Louisville Courier Journal first reported. 

Kentucky Gov. Andy Beshear (D) released emails dated June 23 from a White House official advising that Biden planned to nominate Chad Meredith, a former state solicitor general, to the judgeship the following day. But the next day, the Supreme Court overturned Roe v. Wade.

Biden has been sharply criticized by members of his own party and abortion rights groups since reports emerged last week of Meredith’s potential nomination, our colleagues Tyler Pager and Cleve R. Wootson Jr. report.

  • Kentucky Rep. John Yarmuth (D) has accused Biden and Senate Minority Leader Mitch McConnell (R-Ky.) of striking a larger deal of judicial nominations. A McConnell spokesperson denied any such agreement.

Politico's Alex Thompson:

In other health news

  • Rep. Judy Chu (D-Calif.) said House Democratic leaders are teeing up another vote on the Women’s Health Protection Act, which would codify abortion rights into law. The bill passed the House last September but was blocked in the Senate.
  • In Texas: Whole Woman’s Health, one of the nation’s largest independent abortion providers, will leave the state after nearly two decades and open up in New Mexico.
  • In the District: D.C. Health Director LaQuandra Nesbitt will resign at the end of the month after a nearly eight-year stint wherein she became one of most visible leaders shaping the city’s response to the coronavirus pandemic, The Post’s Michael Brice-Saddler reports.

Health reads

‘My Body, My Choice’: How Vaccine Foes Co-Opted the Abortion Rallying Cry (Rachel Bluth | Kaiser Health News)

Mississippi’s last abortion clinic will shutter as trigger ban begins (By Katie Shepherd | The Washington Post)

Experts hope LGBTQ youth will call 988 — a new suicide lifeline number (by Julianna McShane | The Washington Post)

Sugar rush

Thanks for reading! See y'all tomorrow.