Managed Care Outlook 2025

Legal and regulatory challenges - chess pieces icon

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In the post-Dobbs landscape, there has been a renewed focus on medication abortion as an option for expanding access to abortion care for people residing in states with abortion bans or restrictions. Given the increased availability of medication abortion throughout the U.S. via telemedicine, this area has attracted several legal challenges that could create exposure and compliance risk for managed care organizations (MCOs).

The two-drug combination of mifepristone and misoprostol is the most common medication abortion regimen in the U.S. and can be safely used until up to 10 weeks of pregnancy according to the U.S. Food and Drug Administration (FDA). The FDA first approved mifepristone, the primary drug used in medication abortion, in 2000; since that time, reliance on the mifepristone and misoprostol regimen has increased steadily as it has become more accessible through telemedicine. In 2023, medication abortion accounted for more than 63% of all abortions nationwide, up from 53% in 2020.

More than 10 states require at least one trip to an abortion clinic before being prescribed medication abortion, effectively banning the use of telemedicine to accessSince 2000, the FDA has repeatedly expanded the availability of medication abortion and broadened the use of telemedicine dispensing. For instance, in December 2021, the FDA removed the in-person dispensing requirement for mifepristone, and in January 2023 it approved a rule to expand the certification program to allow retail and mail-order pharmacies to fill prescriptions for the drug. Before that latest rule change, a pregnant person had to receive mifepristone directly from a physician or by mail via a telemedicine appointment.

The FDA has approved mifepristone as safe and effective, but the availability of medication abortion is largely dependent on state law. Following the Dobbs decision, some states have attempted to restrict access to medication abortion via telemedicine either by mandating an in-person visit with a physician, requiring a state-mandated in-person counseling session or ultrasound, imposing a requirement for in-person dispensing, or requiring medication abortion to be provided by a physician. For example, in addition to the 14 states currently enforcing a near-total ban on all abortion, five states where abortion is permitted until at least six weeks of pregnancy restrict access to medication abortion via telemedicine—Arizona, Nebraska, North Carolina, South Carolina and Wisconsin require that a patient being prescribed medication abortion have an in-person visit with a physician, and Arizona and North Carolina also ban mailing abortion-inducing drugs to a patient.

Key takeaways
  • Since states began introducing abortion restrictions following the Supreme Court’s Dobbs decision, medication abortion via telemedicine has enabled those in restrictive states to access related care
  • The rise in telemedicine for medication abortion has led to legal challenges, posing compliance risks for MCOs
  • Despite FDA approval, state laws significantly impact the availability of medication abortion, with some states imposing strict in-person requirements
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