Abortion pill fight reaches pharmacy board rooms

• "We can effectuate real change by talking to these companies and engaging with them," said Michael Ross, legal counsel for Alliance Defending Freedom's corporate engagement team. "Hopefully Costco will be a trendsetter."
• But those efforts are making retail pharmacies a new ground zero in the fight over abortion access. Costco got swift criticism from one of its home-state senators, Washington Democrat Patty Murray, for accommodating "far-right extremists" she said were whipsawing the availability of basic care.

Between the lines: Pharmacy chains were destined to be involved after the Food and Drug Administration in 2023 allowed retailers to apply for certification to dispense mifepristone, which is part of a two-step protocol used to medically end a pregnancy through 10 weeks.

• The drug, which FDA first approved in 2000, has traditionally been dispensed at doctors' offices, hospitals or health clinics. But as states across the country restrict abortion, mifepristone prescribing via telehealth has significantly increased.

State of play: Costco says it won't pursue approval to dispense mifepristone because demand for the drug is low. The company's understanding is that patients generally get the drug directly from their medical providers, it said in an email.

But the decision, which reportedly came after more than a year of deliberations, is one anti-abortion groups have been pushing for. It extends beyond Costco's membership, since nonmembers can fill prescriptions at its drug counters.

• Last August, Alliance Defending Freedom led a coalition including thousands of Costco cardholders, financial advisers and consultants in urging the retailer not to offer mifepristone.
• "Costco ... needs to carefully consider the cost of alienating its diverse customers and potential customers just to boost one product in its pharmacy, which is one of its ancillary lines of business," their letter said.

That pressure campaign followed New York City Comptroller Brad Lander (D) sending letters to Costco and other pharmacies, advocating that they get clearance to fill prescriptions where legal.

• "Making mifepristone available benefits customers and employees and increases sales, while also generating long-term shareholder value," Lander wrote to Costco last year.

But abortion foes have allied with investor groups like Inspire Investing to warn Costco, Walmart, Albertsons, Kroger and other retail pharmacy operators as well as drug distributors to stay out of divisive political issues that could alienate customers and investors.

• "We say, OK, mifepristone may be a very small part of your sales, but look at all of the different backlash that you might be introducing, the different regulatory backlash from the Trump admin and the legal risk," Ross said.

The Trump administration, Congress or the Supreme Court could still change requirements around the drug.

• The Supreme Court in 2024 preserved access to mifepristone, deciding that doctors who asked justices to stop the FDA's relaxation of restrictions around the drug didn't have standing, without ruling on the merits.
• In May, HHS Secretary Robert F. Kennedy Jr. said he'd directed the FDA to "to review the latest data on mifepristone" — a move that could restrict future availability.

Other large pharmacy chains like Walmart, Kroger and Albertsons have not made public decisions on mifepristone dispensing.

• Kroger told Axios it's still reviewing the FDA's mifepristone drug safety program and will continue to align dispensing practices with federal and state law. Walmart declined to comment, and Albertsons did not respond.

The other side: Curbing mifepristone access could make it even harder for women to access safe abortions, as well as miscarriage care, for which it has an off-label use.

• "By refusing to offer mifepristone, Costco has chosen politics over science, fear over facts, and ideology over the rights of its customers," Mini Timmaraju, CEO of advocacy group Reproductive Freedom for All, said in a statement last Friday.

What we're watching: How Walgreens and CVS respond to pressure to stop filling mifepristone prescriptions.

• "We have a long history of supporting and advancing women's health and we remain focused on meeting their unique health needs," Amy Thibault, CVS executive director of corporate communications and external affairs, said in an email. "This includes providing access to safe, legal, and evidence-based reproductive health services, information, and FDA-approved products."