Seattle-based health care nonprofit Uplift International has launched a groundbreaking initiative designed to address barriers to abortion access in the U.S., particularly in the wake of the shifting reproductive health landscape. The program, known as the Pharmacist Abortion Access Project (PAAP), addresses barriers to access by leveraging telehealth and online pharmacies.

PAAP was initially launched in spring 2023. The first of its kind, the program empowers pharmacists to prescribe mifepristone and misoprostol, the medications approved by the Food and Drug Administration for early abortion care. Throughout the initial pilot, held between Oct. 31 and Nov. 26, 2024, 10 pharmacists trained extensively in patient screening, exclusion criteria, and counseling successfully prescribed medication abortion to 43 patients in Washington state. Prescriptions were dispensed through Honeybee Health, a leading online pharmacy.

“Attacks on access to abortion care have created an urgent medical, public health, and human rights crisis in the United States,” Dr. Beth Rivin, the president and CEO of Uplift International and managing director of PAAP, said in a press release. “Even in Washington State, where abortion is legal, barriers remain for those in rural areas or facing financial challenges. The PAAP pilot demonstrates how pharmacists can bridge these gaps and expand access to critical reproductive health care.”

Rivin said the inspiration for the program came from a realization “that Uplift needed to respond in some way to the reproductive health crisis in the post-Roe v. Wade era.”

The pilot program’s success comes at a time when a majority of states have abortion bans with only limited exceptions, 12 have total bans, and 29 have gestational limits. In 2025, Republicans are expected to bring forth even more anti-abortion laws, including by offering money to civilians who report someone providing or receiving an abortion.

Washington’s legal framework, which has allowed pharmacists to prescribe medication under collaborative agreements since 1979, made the state an ideal setting for the pilot. Yet, Rivin pointed out, even in states where abortion remains legal, access is often limited for some communities. 

“Especially people who are struggling to make ends meet or live in rural areas that don’t have easy access to reproductive health care,” Rivin said in interview with Prism.

The PAAP program seeks to eliminate these barriers by providing a convenient, telehealth-based solution. 

“Prescribing medication abortion fits squarely within Washington pharmacists’ expertise and scope of practice,” Don Downing, co-director of PAAP and professor emeritus of clinical pharmacy at the University of Washington, said in a press release. “Pharmacists are embracing the Pharmacist Abortion Access Project because we welcome the ability to function at the full extent of our licensure and training. This is a model of care with enormous potential in Washington State and across the country.” 

Previously, only physicians and nurse practitioners were allowed to prescribe medication abortion to patients. PAAP opens up a new lane of access. The shift is the result of a 2023 FDA ruling that expanded the availability of abortion pills by allowing retail pharmacies to dispense the pills following a certification process. 

“This level of access would be tremendous,” Rivin said.

Close to 90% of Americans live within five miles of a pharmacy and visit their pharmacy more frequently than their primary care physician. The FDA decision expands abortion access even for rural communities that are farther from abortion clinics. Pharmacists participating in the program expressed pride in their expanded role in a press release from Uplift. 

“Pharmacists are the most accessible health care provider,” one unnamed participant noted. “I’m excited to be part of this trial and make choice happen for more patients.” 

Dr. Jessica Nouhavandi, the co-director of PAAP and co-founder of Honeybee Health, emphasized in the press release the importance of empowering women: “Medication abortion prescribed by a pharmacist and delivered by mail is a safe, effective, and private option that expands access to people who need it.”

One of the program’s significant achievements has been its ability to serve patients who come to Washington from out of state. Rivin noted a marked increase in patients traveling to Washington from states with more restrictive abortion laws. 

“We’re seeing a rise in telemedicine abortions, which accounted for 1 in 5 cases during the pilot,” Rivin said. “This online approach is critical in addressing the growing demand for accessible abortion services.”

Uplift International plans to scale up the program this year. Improvements are already underway, including an enhanced online platform and formalized training curriculum for pharmacists, which is not included in pharmacy school. The training, which Rivin expects to be accredited by the American Pharmacists Association, aims to equip pharmacists nationwide with the skills to provide medication abortions, pending the legal status in their respective states.

“This training is continuing education,” Rivin emphasized. “There’s no action or behavior involved in it. It’s learning.” 

The program does not involve prescribing action unless allowed by state law. As the program grows, financial support will be vital. Uplift International is seeking donations and grants to sustain its efforts. 

“We welcome support from individuals and communities through our website,” Rivin said.

Nouhavandi highlighted the broader potential of the initiative.

“[This project] is the culmination of years of work trying to integrate pharmacists alongside other providers to expand care. We’re proud to be increasing access to medication abortion in Washington, and we hope this opens a pathway for pharmacist provision in other states,” Nouhavandi said.

Beyond Washington, Rivin believes the PAAP model has the potential to revolutionize abortion access in other states. 

“We encourage leaders in states with supportive abortion laws to consider this model. It’s more important than ever as we move into 2025,” Rivin said.