Mifepristone Access Through Community Pharmacies When Regulated as a Routine Prescription Medication.

Abstract

The mifepristone-misoprostol medication abortion regimen became available in Canada as a normally prescribed medication, without restrictions, in 2017. Despite rapid uptake, patients have reported difficulty accessing this time-sensitive medication. To quantify mifepristone availability within 3 calendar days at community pharmacies. This population-based, cross-sectional study using a mystery caller survey was conducted from July to August 2024 at community pharmacies in British Columbia (BC), Canada. Surveyor posing as a patient with a prescription for mifepristone who requests to pick up the medication within 3 calendar days. For nondispensing pharmacies (ie, unable to dispense within 3 days), surveyors requested a referral to a dispensing pharmacy. Proportion of pharmacies that could dispense mifepristone or provide a valid referral to a dispensing pharmacy; proportion of reproductive-aged (15-49 years) female population residing within 15-minute walking and 15-, 30-, and 60-minute driving times of a dispensing pharmacy, and proportion of the population with poor local availability (<50% of available pharmacies dispense mifepristone). Among 1460 of 1482 community pharmacies, 962 (66%) could dispense mifepristone within 3 days and 169 (12%) provided a valid referral. Only one-third of nondispensing pharmacies (169 of 498 pharmacies [34%]) provided a valid referral to a dispensing pharmacy; 329 pharmacies (23%) neither dispensed within 3 days nor provided a valid referral. Almost all reproductive-aged females (1 095 915 of 1 110 218 females [99%]) in BC lived within a 15-minute drive of a mifepristone-dispensing pharmacy. Urban pharmacies were more likely to be nondispensing and nonreferring (relative risk [RR], 1.78; 95% CI, 1.19-2.80) and less likely to offer same-day dispensing (RR, 0.39; 95% CI, 0.30-0.51) compared with rural pharmacies. Populations in areas with the most residential instability (RR, 1.41; 95% CI, 1.19-1.67) or greater ethnocultural diversity (RR, 1.36; 95% CI, 1.15-1.61) had poorer local availability of mifepristone-dispensing pharmacies. This cross-sectional study found 99% of reproductive-aged BC females lived within a 15-minute drive of a mifepristone-dispensing pharmacy; however, despite relatively good geographic coverage and mifepristone being available as a routine prescription, 23% of pharmacies neither dispensed within 3 days nor provided a valid referral, putting the onus on patients to identify a dispensing pharmacy. These findings may inform policy and initiatives to enhance pharmacist referral networks and improve mifepristone access, as well as service planning for international jurisdictions considering a similar medication abortion framework.