Provinces take patchwork approach to Financing for abortion pill Mifegymiso

Nearly eight months after the abortion pill became available in Canada, three states have to decide whether to finance the medication, while others have chosen to provide only limited coverage, mostly for low-income girls, according to a Globe and Mail survey.

The patchwork approach to policy for Mifegymiso, a two-drug mix that retails for about $300, has contributed to the slow uptake of the drug in those areas of the country where surgical abortions remain a more affordable option.

But in states with universal accessibility — New Brunswick, Ontario and Alberta have already made Mifegymiso free to all women with a health card and Quebec has promised to follow suit this fall — even more family physicians are stepping up to prescribe the drug for medical abortions, some of them in towns and cities with no additional abortion services.

“As time rolls on, we are hearing of more suppliers taking up the telephone and getting prescribers of Mifegymiso,” said Sandeep Prasad, the executive director of Action Canada for Sexual Health and Rights, an Ottawa-based advocacy group that connects women with abortion providers. “It’s becoming more and more available in pharmacies. But all this, sadly, is a slower-going process than you might like.”

The introduction of Mifegymiso has also been marred by confusion around the principles for the contentious medication.

When Health Canada approved Mifegymiso two decades back, it did so with limitations proposed by the drug’s manufacturer, including one that said women needed to swallow the first pill in the package before a physician and another that said physicians — not pharmacists — needed to distribute the medication directly to their patients.

Health Canada has since eased those constraints at the urging of pro-choice advocates who cautioned forcing physicians to distribute the pills — that isn’t common practice in Canada — could discourage family doctors from prescribing Mifegymiso.

The national department is now leaving it up to the regulatory bodies which govern physicians and pharmacists in each state to determine if pharmacists can hand out the abortion pill how they do with many pharmaceuticals.

Health Canada issued a “Dear Healthcare Professional” letter in May that further explained the conditions for prescribing Mifegymiso.

“I think if we had to do it all over again … the time and the manner that it had been rolled out possibly could have been enhanced,” said Supriya Sharma, Health Canada’s chief medical advisor. “Having said this, I believe we are really learning about the item and how it’s being used once it has been out in the system.”

Now that the protocol has been clearer, the uptake in primary care is “beyond what we’d hoped for” in this stage of the rollout, said Wendy Norman, a family physician and University of British Columbia professor who’s leading an independent research project on the launching of Mifegymiso.

“We have seen about a quarter of those doctors that are a part of our [Mifegymiso] community of practice are new to providing abortion, and 8 percent of these are from communities that never had diplomatic care before,” she said.

Persuading family physicians to prescribe Mifegymiso is essential to expanding abortion access outside of major cities and present abortion clinics, Dr. Norman added.

Mifegymiso is comprised of two drugs, sold together in a combination pack. Initially, Mifepristone, blocks the hormone progesterone, causing the lining of the uterus to break down. The next drug, Misoprostol, is taken 24 to 48 hours afterwards and induces contractions like those of a natural miscarriage.

Considered the gold standard in abortion medication, Mifepristone wasn’t approved for sale in Canada before July, 2015, decades after it had been approved in places like France and China and 15 years after it received FDA approval in the USA. (Misoprostol was available in Canada at the moment.)

The mix kits became available in Canada in January.

It’s hard to say how many Canadian physicians are now prescribing Mifegymiso and the number of pharmacies are stocking it.

As of the last week of August, 3,079 doctors and pharmacists had registered for or completed an internet Mifegymiso training class conducted by the Society of Obstetricians and Gynaecologists of Canada (SOGC). Over half were from Ontario.

Although Quebec has promised universal financing of this medication, it’s not yet available in the state, according to the drug’s Canadian distributor, Celopharma Inc..

The ministries of health in Newfoundland and Labrador, Prince Edward Island and Nova Scotia told The Globe they hadn’t yet determined whether to cover the medication.

Meanwhile, women in these states have to rely on private insurance or pay out of pocket if they need a medical abortion — assuming they could find a doctor willing to prescribe Mifegymiso in the first location.

Lianne Yoshida, a family physician and the medical co-director of the Termination of Pregnancy Unit (TPU) in the Queen Elizabeth II Health Sciences Centre in Halifax, prescribed her first two kits of Mifegymiso only last month. The girls found her through word-of-mouth referrals, ” she said.

Mifegymiso isn’t accessible at the TPU at Halifax, which supplies more than 85 percent of Nova Scotia’s surgical abortions, or in the Summerside hospital that offers the only surgical abortions on the island.

Dr. Yoshida, who travels to PEI twice a month to do abortions, is unaware of any doctors on the island prescribing the medication, although 55 physicians and pharmacists on the island had registered for or completed the SOGC class as of Aug. 3.

“Obviously, I would like them [Nova Scotia and PEI] to follow New Brunswick and cover it for everybody with a health card absolutely. That would be a massive step,” she said.

Dr. Yoshida, together with her provincial government’s support, is also in the middle of crafting a strategy to produce surgical abortions more easily available in Nova Scotia, the last place in Canada where girls still require a referral from a family doctor to get an abortion.

Three other states — Manitoba, Saskatchewan and British Columbia — have obtained a partial approach to financing Mifegymiso.

Manitoba has made it free at locations that currently provide abortions in the Winnipeg and Brandon regions. The state has also added it to its drug-plan formulary, so it’s covered mainly for girls poor enough to qualify for social help.

In Saskatchewan, where the medication will be added to the state’s formulary effective Tuesday, low-income girls who qualify will pay $2 or less for the medication.

And British Columbia has taken a similar approach, adding it to its own hospital and drug-plan formularies. The three territories are providing partial coverage for Mifegymiso to women who otherwise qualify for public drug programs. The federal government’s Non-Insured Health Benefits program, which covers eligible First Nations and Inuit individuals, also pays for Mifegymiso.

Dr. Norman said the partial funding is a “double whammy” that leaves out women who require access to cheap abortions most.

“What we are seeing [at abortion clinics] is the working poor. We are seeing single moms. We’re seeing the men and women that are fighting to get through their life but are not low[-income] enough they’re on social assistance,” she said. “If they were, they could afford high quality contraception and they would not be having unintended pregnancies.”

A spokeswoman for the Minister responsible for the Status of Women in Manitoba said through email that “access to reproductive health services is important to women in Manitoba” and underscored that medical abortions will be free of charge in the state’s existing abortion centres.

A spokesman for the B.C. Ministry of Health said the state’s new NDP government “will be reviewing policy of Mifegymiso to decide whether the current strategy works for B.C. women.”

Courtesy: The Globe And Mail

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