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Mifegymiso aka the abortion pill: Questions for doctors and pharmacists

File photo of a pharmacist.

As of Aug. 10, women in Ontario are now able to get an abortion pill for free with a prescription.

But according to one woman who wrote to CityNews, she was asked to pay $300 to receive Mifegymiso – and that, she says, was “after going through hell.”

“I went to go get my prescription and the pharmacist said it’s a $300 charge.. and did not know where to tell me to go to receive it free,” she wrote. The woman added that she had to show her doctors a news article about the pill.

“Not even Peel Public Health was able to help me obtain that abortion pill, and if they can’t, then where even are women supposed to go?” she wrote.

Mark Nesbitt, a spokesman for Ontario’s Ministry of Health and Long Term Care, said that all Ontarians with a valid Ontario health card number and a valid prescription are eligible for coverage of the full cost of Mifegymiso. “Non-residents of Ontario with a valid prescription would be required to pay for Mifegymiso,” Nesbitt added.

Mifegymiso, an alternative to surgical abortion, is a combination of the drugs mifepristone and misoprostol. It can be used to terminate pregnancies at an early stage, up to seven weeks from the start of a woman’s last menstrual period.

However, there are still some questions surrounding the pill, for both doctors and pharmacists. Nesbitt answered the following questions.

Q: Physicians are required to take a test in order to prescribe Mifegymiso. Are there any numbers or statistics available regarding how many doctors are qualified to prescribe the pill?

The online training course offered by the Society of Obstetricians and Gynaecologists of Canada (SOGC) is not mandatory for prescribers (physicians and nurse practitioners) or pharmacists; however, the course is recommended for prescribers. The SOGC estimates that approximately 1,800 pharmacists and physicians in Ontario have completed the online training the course for Mifegymiso.

Since training is not a mandatory requirement for prescribers, the regulatory Colleges are not tracking how many practitioners have completed the training. Each College has provided guidance to their respective members specific for Mifegymiso prescribing and training:

Ontario College of Pharmacists

College of Physicians and Surgeons of Ontario (CPSO) 

College of Nurses of Ontario (CNO)

Q: Is there an awareness campaign planned to inform doctors, pharmacists and patients of the new rules, regulations and restrictions regarding the prescription of Mifegymiso?

Mifegymiso has been available in Canada since January 2017 and prescribers have been able to access the product since then.

The ministry announced funding for Mifegymiso with the 2017 Budget in April, and an additional announcement was made on August 3, 2017. At that time the ministry also communicated directly to prescribers and pharmacies the requirements for having Mifegymiso reimbursed by the ministry.

The Executive Officer notice to pharmacies is available online.

An FAQ for health care providers is also available on the ministry’s website.

Additionally, an FAQ for patients is available on the ministry’s website. 

Regulatory colleges (i.e., College of Physicians and Surgeons of Ontario, College of Nurses of Ontario) have published guidance and policies for prescribers and pharmacists regarding the appropriate prescribing and patient monitoring related to Mifepristone/misoprostol (Mifegymiso).

The College of Physicians and Surgeons of Ontario has issued a guidance document for its members online.

Similarly, the College of Nurses of Ontario has issued information for its members online.

For pharmacists, the Ontario College of Pharmacist has provided guidance to their members regarding Mifegymiso dispensing.

Q:Are there any conditions under which pharmacists are still allowed to charge for the pill?

All Ontarians with a valid Ontario health card number and a valid prescription are eligible for coverage of the full cost of Mifegymiso. Non-residents of Ontario with a valid prescription would be required to pay for Mifegymiso.

Q:If a patient is asked to pay the original $300 price, what recourse do they have?

Please see response to Q3.

Q: Is there a list of specific pharmacies providing the pill for free or are all pharmacies now mandated to provide it for free when presented with a prescription from a qualified doctor?

All pharmacies in Ontario can choose to participate in ordering Mifegymiso and dispensing it to eligible Ontarians.

Pharmacies and pharmacists are not mandated to dispense Mifegymiso. Pharmacists who have a religious or conscientious objection to Mifepristone/misoprostol (Mifegymiso) are required to comply with any policies or other professional expectations set out by the Ontario College of Pharmacists (OCP), such as the Code of Ethics and Professional Obligations when Declining to Provide a Pharmacy Product or Service due to Conscience or Religion Guideline.

Related stories:

Ontario women get free access to abortion pill as of Aug. 10
The abortion pill vs the morning-after pill: What’s the difference?
N.S. now only province that requires a doctor’s referral for abortion: advocates