Walgreens Faces Blowback for Not Offering Abortion Pill in 21 States


The chain’s situation shows the complicated legal and reputational landscape that it and its competitors must navigate in the post-Roe era.

People walking in front of the entrance to a Walgreens.
Walgreens said it had determined that it would be illegal for pharmacies to dispense an abortion pill in 21 conservative states.Credit…Michael Dwyer/Associated Press

Walgreens landed at the center of a consumer and political firestorm in recent days, after saying it would not dispense an abortion pill in 21 states where Republican attorneys general have threatened legal action against pharmacies that try to distribute the medication.

The company confirmed late last week that it would not distribute mifepristone, the first pill in a two-drug medication abortion regimen, weeks after it and other large pharmacy chains received letters signed by those attorneys general. In each of the states, abortion is either banned or laws or proposed or pending legislation would prevent pharmacists from dispensing pills.

The situation starkly reflects the patchwork legal framework that sizable pharmacy chains like Walgreens, which is the second largest in the country, must navigate after last summer’s Supreme Court decision overturning Roe v. Wade, which for nearly 50 years had enshrined a national right to an abortion.

Since then, 13 states have made abortion illegal while others have tightened access to it, including through restrictions related to abortion pills.

While chains like CVS and Rite Aid face the same legal and reputational quagmire as Walgreens, they are staying quiet on the matter.

A spokesman for Walgreens, Fraser Engerman, said Tuesday that the chain had always said it would dispense mifepristone where state laws allowed pharmacists to do so and that it had decided before it received the letters from the attorneys general that it would face legal repercussions in those 21 states. The Food and Drug Administration said in January that retail pharmacies could become certified to offer mifepristone, which could previously be dispensed only by clinics, doctors and a few mail-order pharmacies.

“We understood the moment we decided to participate in the F.D.A. program that we would have to navigate these two set of restrictions, including complete abortion bans and requirements around who can actually dispense the medication,” Mr. Engerman said.

“We have said from the beginning we will dispense this medication wherever we legally can once we are certified by the F.D.A.,” he added, “but at the same time we have to follow the law.”

But by publicly confirming that it would not dispense in the 21 states, Walgreens faced blowback from consumers and politicians alike.

There were social media calls for shoppers to boycott the company. Gov. J.B. Pritzker of Illinois, where Walgreens has its headquarters, held a video call on Friday with the company’s senior leadership, including the chief executive, Rosalind Brewer. Mr. Pritzker, a Democrat, urged them to rethink their stance in response to the Republican threats.

Another Democrat, Gov. Gavin Newsom of California, said on Twitter that his state “won’t be doing business” with Walgreens “or any company that cowers to the extremists and puts women’s lives at risk.” Brandon Richards, Mr. Newsom’s deputy communications director, later said the governor’s office would scrutinize state contracts and survey agencies dealing with health care, adding that it was “reviewing all relationships between Walgreens and the state.”

Walgreens’ stock was down almost 4 percent, to $34.14, by the close of trading on Tuesday.

The American Pharmacists Association had urged the F.D.A. to allow retail pharmacies to distribute mifepristone, even though the medication is unlikely to generate significant revenue. In a statement at the time, the association said it wanted the agency “to level the playing field by permitting any pharmacy that chooses to dispense this product to become certified.”

Shortly after the policy change was announced, Walgreens and CVS said they planned to become certified and offer mifepristone in states where laws would allow pharmacies to dispense it. The pharmacies did not say they would dispense the pill in all states where abortion is legal.

Their statements indicated that states with abortion bans would be off limits and that they would not try to dispense the pills in states where abortion remained legal but other legislation could prevent pharmacies from providing the drug — by requiring, for example, that only doctors give it to patients.

In Alaska, Iowa and Montana — whose attorneys general signed the letter sent to the pharmacy chains — abortion is still legal, but laws or proposed restrictions apply to the provision of abortion pills. The same is true of Kansas, whose attorney general sent a separate letter to the chains and where a law requiring physicians to dispense the drug is currently enjoined by a legal challenge.

“Violating the has-to-be-done-by-a-physician requirements in some of these states is punishable by jail,” Mr. Engerman said. “In other states, it’s punishable by a civil fine, and in a number of them it’s punishable by licensing sanctions. And so these are restrictions that present real risks to pharmacists.”

The stakes are high for Walgreens, CVS, Rite Aid and the other companies with large pharmaceutical arms, including Kroger, Albertsons and Walmart. The Republican attorneys general wield powerful weapons, including the ability to press charges against companies or individual pharmacists who dispense the abortion pills or even pull the company’s pharmaceutical license in the state.

In an emailed statement, Rite Aid said it was continuing to monitor and evaluate the situation. CVS, Walmart, Costco, Kroger and Albertsons did not respond to emails seeking comment.

“All of the pharmacies are facing the same problem,” said Andrew Gilman, the chief executive of CommCore Consulting Group, a crisis communications firm. “But Walgreens, as the first one to be publicly identified with going along with the state attorneys general request, will face the biggest hit to its reputation.”

The fact that the major pharmacy chains have said since January that they would abide by all relevant state laws has gotten subsumed in the swirl of heightened tensions around the availability of abortion services. And with medication accounting for more than half of abortions in the United States, the pills have increasingly become the focus of lawsuits, legislation and other tactics.

“There is a lot of noise and confusion out there about what’s going on with respect to the availability of these drugs,” said Ilisa Bernstein, the interim chief executive of the American Pharmacists Association. She added, “The court cases, the letters, that’s just creating even more complication and confusion, particularly for pharmacies.”

Ms. Bernstein said pharmacies had a range of concerns to worry about.

“It’s the states that hold a pharmacy’s license, so they’re going to follow state law so that they can maintain their license,” she said, adding: “It’s the safety of pharmacy staff, too. Just having the ability for your staff to come into work safely and then work in a safe space.”

Currently, few pharmacies have completed the certification process to be able to distribute mifepristone. The process is overseen by the two companies that manufacture the pill and involves logistical measures that go beyond the steps pharmacies use with most other medications, such as designating an employee to ensure compliance. It also requires that pharmacies keep confidential the names of the certified health providers who prescribe mifepristone to protect their privacy and safety.

A chain like Walgreens would not be able to list a doctor’s name in a companywide database, for example. It would have to keep that information restricted to the store that filled the doctor’s prescriptions.

“The manufacturers are being very cautious in how they release the product, they’re being very cautious in terms of certifying pharmacies to be able to dispense the product, and even others in the supply chain, such as wholesalers, are being very cautious to make sure that they’re selling it to pharmacies who can legally dispense it,” Ms. Bernstein said.

Pharmacies like Walgreens and CVS already dispense the second medication in the abortion regimen, misoprostol, which has never been as tightly restricted as mifepristone. It is used for several different medical conditions and is available through a typical prescription process.

Rebecca Robbins and Shawn Hubler contributed reporting.