After SCOTUS leak, telemedicine startups are at a crossroads

The debate over abortion is front and center once again, after Politico published a leaked draft on Monday of a Supreme Court opinion indicating the Court voted to reverse Roe v. Wade. And for startups that focus on reproductive health issues, the Court’s decision could be a major turning point.

Medication abortion, which generally costs around $300 from a telemed provider, induce a miscarriage after stopping the growth of the pregnancy. The drugs have a safety rating that exceeds 99% and is an effective way of terminating pregnancy. However, under Food and Drug Administration (FDA) rules, patients seeking the drugs required for a medication abortion cannot get them from a regular pharmacy, unless that dispenser has undergone a specific certification process.

As a result, a growing number of telemed and teleheath startups have sprung up to provide mifepristone or misoprostol (a.k.a. the abortion pill) via a no-touch medical protocol that foregoes pelvic exams or blood tests. As red states, over the years, have tightened and restricted access to abortions, some startups have seen an increase in business, says Kiki Freedman, CEO and cofounder of Hey Jane. That’s likely to increase if Roe v. Wade is overturned, as 13 states have passed “trigger laws,” which would ban abortion almost immediately if the Supreme Court reverses the decision. (All total, 26 states have indicated they intend to ban abortion.) 

That’s going to make it even harder for some people to get an appointment with an abortion provider. And that’s giving the startups a boost. 

“Abortion care via mail is now likely to be the most viable form of access for most of the country,” she says. “Already, Hey Jane has seen an increase in patients reporting that they’re coming [to us] because of longer-than-expected appointment wait times, which suggests to us that bans in places like Texas are already having a ripple effect. Losing Roe would only magnify that.”

If Roe falls, Hey Jane would continue to operate in all six states it currently serves (New York, California, Washington, Illinois, Colorado, and New Mexico), which account for 52% of the abortion volume nationwide, says Freedman. However, she stressed that it’s important for states like New York and California to pass legislation that protects both providers and patients (from in and out of the state).

Companies like Hey Jane, Choix, and Just The Pill already struggle with awareness: Just 20% or so of women realize that medication-based abortions are an option for pregnancies in the first trimester, according to Freedman. But interest in abortion pills is rising, and it should only continue to spike as word of the leaked SCOTUS draft spreads. 

“One of the challenges we face as a newer form of care is that many people are still learning about the safety and efficacy of medication abortion in general, and the knowledge gap is even greater around medication abortion via telehealth,” says Cindy Adam, CEO of Choix. “As understanding about abortion care via telehealth grows—and as access continues to get more restricted—we anticipate even greater influxes of patient care requests.” (Elisa Wells, cofounder of Plan C, a website that provides information on different mail-order-abortion services by state, says traffic to the site on Tuesday jumped from a normal baseline of 2,400 visitors per day to more than 16,000 as of 1 p.m. ET.)

Attorneys at Choix, Adam notes, are currently examining telehealth laws state-by-state to determine whether people can utilize the company’s services in states that are restrictive or have full bans.

Meanwhile, many Republican lawmakers have set their sights on ending access to medication-abortion drugs. Last month, South Dakota’s governor signed a bill into law that restricted medical abortions via telemedicine. It joins at least six other states with similar policies, including Texas, Arizona, Louisiana, West Virginia, Indiana, and Arkansas. And 19 states require that it be prescribed in person. 

Those bans impact U.S. companies, but there is a legal gray area for nondomestic providers of medication-abortion providers. (Medication abortions outnumber surgical ones in Finland, France, and Sweden.) While state laws don’t impact the provider, the patient could be penalized.

Of course, without a formal decision from the Court, Roe v. Wade remains in effect—and pro-choice advocates are increasing their lobbying and fight for abortion access. In the meantime, companies like Hey Jane will continue to see their profiles raised.

“The overturning of Roe v Wade would be an incredible attack on individual liberty and equity—and it has only increased Hey Jane’s drive to fight resolutely for high-quality abortion access for everyone,” says Freedman.