The legal effort to ban prescription abortion pills comes just as the fledgling telehealth industry has become a more accepted and established part of abortion care.
This week, Hey Jane, one of more than a dozen virtual abortion providers that have no physical location, has begun contracting with insurers Anthem Blue Cross Blue Shield of Connecticut, Empire Blue Cross Blue Shield of New York and Sana, which provides health plans for small businesses across the country. Hey Jane is also already accepted by Aetna in eight of the nine states in which it operates.
It’s unusual for insurance companies to cover telehealth abortions, and most virtual clinics are cash-only. Clinics are new and abortion insurance varies widely. In the year before Roe v. Wade was overturned, only a third of abortion patients used insurance. Some states required by private insurance companies cover abortion while others prohibit it. However, federal law prohibits the use of Medicaid for most abortions 16 states use state funds to cover them. But even plans that cover abortion generally don’t include these new telehealth providers in their networks.
Health insurance companies tend to cover treatments that are widely accepted by clinicians and are cost-effective, and Hey Jane’s insurance partnerships are the latest sign that virtual abortion clinics are being viewed by the health industry as a safe and desirable option. They also tend to be cheaper than clinic procedures for both patients and insurance companies.
“In abortion care, as in many other areas of health care, we believe that expanding the role of telehealth is a huge lever” to make care more accessible and affordable, said Will Young, CEO of Sana.
Not all insurance companies are ready to cover this new method of providing abortions, said Gaby Santana, business manager at Hey Jane. For example, some require live video visits, while Hey Jane sees most of her patients via messaging. Other insurers told Hey Jane that they only contract with clinics with physical locations.
“Our goal is to make it as big and accessible as possible,” Ms. Santana said. “That’s why we want to get more states and more payers.”
New data shows telehealth bills for a a rapidly growing share of abortions, and Honeybee, the largest online pharmacy supplying abortion pills to order, said it fills more than 10,000 prescriptions a month.
However, these clinics could also be overwhelmed just as they begin to grow. Fifth circuit ruled last week that he should Food and Drug Administration prohibition of telemedicine prescriptions and mail delivery for mifepristone, the first of two drugs usually prescribed to induce abortions. It’s a temporary order while a Texas court considers whether to revoke the drug’s approval entirely. The Supreme Court ruled on Friday that mifepristone will remain available until midnight on Wednesday while it has time to review the case.
The FDA first authorized telemedical abortions in 2020 following an emergency court ruling early in the pandemic and after extensive data showed that it was a safe and effective way offering abortion pills to patients. This created the policy permanently in 2021.
Pharmacists must obtain special certification to dispense mifepristone and report data on each prescription, said Jessica Nouhavandi, co-founder of Honeybee. “I literally had to create protocols and train pharmacists,” she said. “Most don’t even learn about it in school.”
Most start-up clinics operate in only a few states; must have a physician licensed in each state where they see patients. Some are funded by investors or grant makers as they figure out how to build a profitable business. Few have lawyers in their ranks to help them navigate recent legal challenges.
They created an informal network to help each other, with group chats about electronic medical records or legal issues. A nonprofit called Plan C provides counseling and sometimes small grants and a database of providers.
They began discussing what they would do if the court case prompted the FDA to pull mifepristone off the market. Many are going to offer the second drug, misoprostol, which is effective when used alone to terminate the pregnancy, but may bring more side effects.
Dr. Rachna Kaul runs Maitri Wellness, a solo primary care practice in New Jersey. But she began offering telemedical abortions during the pandemic, and now her office ships dozens of pill packages a day to the three states where she is licensed. It charges cash prices to patients who can afford the service and uses grants to cover costs for patients who cannot afford the service.
Dr. Kaul said adding the service was easier for her than for many of her peers because she was self-employed. “We didn’t have any funding in the beginning, so we took it all out of our own pockets,” she said. “I could do any other job and make a lot more money. This is such a huge need.”
Juniper Midwifery, which provides 175 medical abortions a month to women in six states, is run by two midwives with day jobs at a New York hospital and clinic. They operate out of the home or on the go.
“It’s just the two of us,” said Marisa Poverman, who founded Juniper with Jillian Barovick. “We’re still in the very early stages of things. So this week was a little weaker. Are we going to be able to continue to give people access in this way?
Juniper saw its first patients in August. Mrs. Poverman created the website using WordPress and their husbands purchased it. They raised money from friends and family to get it off the ground and now have a grant from New York State. They only accept cash and use the grant to subsidize prices or provide free care to patients who need it.
In contrast, Hey Jane is among the most established providers with $9.6 million in venture capital investment and 40 employees. Abortion on Demand and Aid Access operate in the largest number of states. (Separate branch of Aid Access also operates in states where abortion is illegal, by connecting women with doctors and pharmacies abroad.)
Carafem is another larger operation, a provider that offers telehealth abortions in 16 states and also has several physical clinics. Melissa Grant, director of operations, said one of the hardest parts of her operation was learning the different rules in each state.
Questions about insurance coverage reflect—and often amplify—these complications. Ms. Grant said her providers are working hard to help patients find out what their insurance covers and are trying to convince other health plans to work with the company.
“Not every plan covers abortion,” she said. “Unfortunately, when you put telehealth on top of that, there are a lot more carriers who are refusing care.”
Even if they have coverage, not all patients want to use it, said Dr. Stephanie Colantonio, a primary care physician who offers telemedicine abortions in California through Luna Flow Health. “Some patients are so nervous about privacy and security that they prefer to pay out of pocket,” she said.