A new University of Southern California study published Monday in the Journal of the American Medical Association reveals that mail-order pharmacy has become the overwhelming delivery mechanism for mifepristone — the first pill in a two-drug medication abortion regimen — in states where telehealth abortion is permitted.
Since January 2023, U.S. pharmacies have filled approximately 2,700 mifepristone prescriptions monthly. In the 27 states and Washington D.C. where telehealth abortion access is legal, fewer than 2% of those prescriptions were filled at physical retail pharmacy locations. In the 11 states where abortion is legal but telehealth is restricted, 61% were dispensed in person at brick-and-mortar pharmacies.
The findings come despite a 2023 FDA decision authorizing retail pharmacies to dispense mifepristone directly. Medication abortion now accounts for 60% of all abortions performed in the United States — a figure that has climbed sharply since the Supreme Court’s Dobbs decision returned abortion policy to the states. Senate Republicans have launched a formal investigation into mifepristone manufacturers and have urged the FDA to restrict online sales of the drug.
The normalization of mail-order abortion pills represents one of the most significant — and least scrutinized — shifts in how abortion is being carried out in America. The FDA’s loosening of mifepristone safeguards was never about women’s health — it was about making abortion as frictionless and invisible as possible.
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