FILE - Boxes of the drug mifepristone sit on a shelf at the West Alabama Women's Center in Tuscaloosa, Ala., on March 16, 2022. Walgreens said Thursday, March 2, 2023, that it will not start selling mifepristone, an abortion pill, in 20 states that had warned of legal consequences if it did that. (AP Photo/Allen G. Breed, File)

Walgreens says it will not start selling an abortion pill in 20 states that had warned of legal consequences if it did so.

The drugstore chain’s announcement Thursday signals that access to mifepristone may not expand as broadly as federal regulators intended in January, when they finalized a rule change allowing more pharmacies to provide the pill.

Here’s a closer look at the issue.

ABOUT THE ABORTION PILL

The U.S. Food and Drug Administration approved mifepristone in 2000 to end pregnancy, when used in combination with a second drug, misoprostol. The combination is approved for use up to the 10th week of pregnancy.

Mifepristone is taken first to dilate the cervix and block a hormone needed to sustain a pregnancy. Misoprostol is taken a day or two later, causing contractions to empty the uterus.

More than half of U.S. abortions are now done with pills rather than with a procedure, according to the Guttmacher Institute, a research group that supports abortion rights. In rare cases, the drug combination can cause excess bleeding, requiring emergency care.

WIDENING ACCESS

For more than 20 years, the FDA limited dispensing of mifepristone to a subset of specialty offices and clinics due to safety concerns.

The agency has repeatedly eased restrictions and expanded access, increasing demand even as state laws make the pills harder to get for many women.

In late 2021, the agency eliminated an in-person requirement for getting the pill, saying a new scientific review showed no increase in safety complications if the drug is taken at home. That change also permitted the pill to be prescribed via telehealth and shipped by mail-order pharmacies.

Earlier this year, the FDA further loosened restrictions by allowing pharmacies like Walgreens to start dispensing the drug after they undergo certification. That includes meeting standards for shipping, tracking and confidentially storing prescribing information.

STATES STEP IN

Typically, the FDA’s authority to regulate prescription drug access has gone unchallenged. But more than a dozen states now have laws restricting abortion broadly — and the pills specifically — following last year’s Supreme Court decision overturning the federal right to abortion.

Last month, attorneys general in 20 conservative-led states warned CVS and Walgreens in a letter that they could face legal consequences if they sell abortion pills by mail in their states.

In addition to state laws, attorneys general from conservative states have argued that shipments of mifepristone run afoul of a 19th century law that prohibited sending items used in abortion through the mail.

WALGREENS' REACTION

A spokesman says the company told the attorneys general that it will not dispense mifepristone in their states and it doesn't plan to ship the drug to them as well.

But Walgreens is working to become eligible through the FDA’s certification process. It plans to dispense the pills where it can legally do so.

The company is not currently dispensing the pills anywhere.

OTHER DRUGSTORES

Rite Aid Corp. said it was “monitoring the latest federal, state, legal and regulatory developments” and would keep evaluating its policies. The Associated Press also sought comment from CVS Health Corp., retail giant Walmart and the grocery chain Kroger.

Some independent pharmacists would like to become certified to dispense the pills, said Andrea Pivarunas, a spokeswoman for the National Community Pharmacists Association. She added that this would be a “personal business decision," based partly on state laws. The association has no specifics on how many will do it.

OTHER LEGAL ISSUES

In November, an anti-abortion group filed a federal lawsuit in Texas seeking to revoke mifepristone's approval, claiming the FDA approved the drug 23 years ago without adequate evidence of safety.

A federal judge could rule soon. If he sides with abortion opponents, mifepristone could potentially be removed from the U.S. market.

In January, abortion rights supporters filed separate lawsuits challenging abortion pill restrictions imposed in North Carolina and West Virginia.

Legal experts foresee years of court battles over access to the pills.

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AP Health Writer Matthew Perrone contributed to this story.

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