Almost a year after major pharmacy chains began waffling at the prospect of filling mifepristone prescriptions, Walgreens and CVS began dispensing the abortion pill in Nevada during the last few weeks.

The decision comes after a concentrated push by Sen. Catherine Cortez Masto (D-NV), who called on the chains to follow through with Food & Drug Administration (FDA) guidance updates finalized in 2023 allowing mifepristone to be dispensed and sold at pharmacies.

Now the most common means of terminating a pregnancy, mifepristone is the first of a two-pill drug regimen that patients can take within the first 10 weeks of pregnancy. The pro-abortion rights Guttmacher Institute estimates that medication is now used for more than half (54 percent) of all abortions.

Mifepristone is available in Nevada via mail or at clinics, but abortion rights advocates say the pharmacy option will make access as simple as patients visiting their regular doctor’s office (which often are not certified to stock the abortion pill), obtaining a prescription and then picking it up at their local pharmacy. 

But the drug’s new availability in Nevada could be imperiled — or made more significant — by a case before the U.S. Supreme Court asking justices to consider the legality of the drug itself and the FDA’s recent moves to expand its access.

And if the Supreme Court rules against the FDA, its impacts would be felt even in states that have legalized abortion — such as Nevada.

“It's not a red state-blue state thing,” said Rebecca Gill, a political science professor at UNLV. “There is no state law … that exempt[s] us from this.”

To dispense or not to dispense

In January 2023, the FDA issued a rule permitting pharmacies to dispense mifepristone at their physical locations to patients with a prescription, circumventing the need to return to a doctor’s office or rely on the mail to receive the time-sensitive drug. As part of the Biden administration’s effort to make abortion more accessible, the dispensing of mifepristone quickly became the latest battleground in a protracted war between the Democrat-led federal government and Republican-run states aiming to restrict abortion access.

When drug wholesaler AmerisourceBergen and retail pharmacy chain Walgreens announced last March they would not move forward with dispensing the pill in states where they faced legal blowback from Republicans — potentially imperiling access in other states where abortion is legal, given the need for a certification process from the FDA — Cortez Masto pounced.

In both public letters and private conversations, the senator made the case that the patchwork of state abortion laws should not preclude Nevadans, who are guaranteed the right to an abortion through 24 weeks of pregnancy, from being able to access prescribed mifepristone at pharmacies.

“I started with the fact that Nevada is a proud pro-choice state,” she said in a recent interview. “Nevada should not be penalized because other states wrongly have restricted a woman's access to abortion.”

After months of deliberation and then a certification process, Walgreens and CVS — which initially had been mum on their plans — announced this March that they would begin dispensing the abortion pill in pharmacies in select states. Nevada was not included in the initial rollout, and the recent expansion to the Silver State, first reported in The Nevada Independent, was not publicized.

Now, Nevada patients with a mifepristone prescription can pick the pill at either pharmacy. Without making any formal announcements, the companies each confirmed to The Nevada Independent that mifepristone is now available at their pharmacies in Nevada. CVS began dispensing the abortion pill in Nevada on March 19, and Walgreens followed suit on April 17.

Two independent pharmacies — A1C Pharmacy in Las Vegas and three locations of Renown Pharmacy in Reno — have also elected to begin dispensing mifepristone. 

Denise Lopez, the Nevada director of abortion rights organization Reproductive Freedom for All, said pharmacy dispensing will also make it easier for people seeking abortions and coming from neighboring states, who have at times overwhelmed Nevada’s reproductive care providers.

“In Utah and Arizona and Idaho, there's a lot of restrictions and bans,” Lopez said. “So this [new pharmacy policy] is going to definitely help people who are trying to get access to the services that they need.”

Jason Guinasso, the attorney for the Coalition for Parents and Children PAC, a Nevada group that sued to stop a pair of statewide abortion ballot questions, said he has concerns about patients receiving mifepristone in the mail and having complications. But he was accepting of the new pharmacy policy.

“If they're doing that under the supervision of their doctor and it’s dispensed through a pharmacy, then at least you've got some oversight,” Guinasso said.

Legal threats

However, pharmacies could stop filling prescriptions for mifepristone in July when the Supreme Court is expected to issue a ruling on the case brought by a group of doctors seeking to end the FDA’s approval of the drug.

The case has been working its way through the courts since 2023, when a group of conservative doctors filed a lawsuit challenging the FDA’s 2000 approval of the abortion pill and subsequent updates expanding how far into a pregnancy it can be used and means of access. The plaintiffs sued on the basis that the FDA’s approval process for the drug was improper, rather than presenting an incident in which the doctors suffered. 

In April 2023, a federal district court judge ruled in favor of the plaintiffs, temporarily ending the FDA’s approval of the drug and blocking its use. FDA approval — and ability to send the drug in the mail — was quickly restored by an appeals court and the Supreme Court while the case continues to move through the courts. 

In August 2023, a federal appeals court ruled that mifepristone is legal but that sending it in the mail is not, setting up the Supreme Court to make a final ruling. 

Despite the fact that abortion is legal in Nevada, a Supreme Court ruling in favor of the plaintiffs would in effect eliminate mifepristone access in the state, including the new availability at drugstores. 

If the justices affirm the appeals court’s ruling that mifepristone cannot be sent in the mail, then the fact that pharmacies can distribute it at their physical locations would become more significant, especially for rural Nevadans for whom multiple trips to a doctor’s office is impractical or who are unlikely to live anywhere near a clinic or practice that is certified to dispense abortion pills.

“This would put more pressure on those pharmacies to dispense, because they would be the only means of access,” Gill said.

And if the justices rule in favor of the FDA or throw out the case, then access to mifepristone will remain as is in the state.

Guinasso said the case will represent an important data point in the post-Roe landscape about the parameters in which the justices are willing to issue decisions on abortion.

On March 26, the Supreme Court heard arguments in the case. Several justices — including the three Trump appointees, who have become swing votes within the court’s 6-3 conservative majority — seemed skeptical of the conservative doctors’ claims, suggesting the case might be decided on the plaintiffs’ standing rather than the merits of the case.

Cortez Masto, who has sounded alarms about conservative groups going after additional abortion rights through the federal judiciary, said the mifepristone case is one of several threats she’s monitoring. 

“We have to be vigilant about everything — every potential challenge and restriction that right wing-Republicans want to do to further restrict women's rights in this country when it comes to reproductive freedom,” she said.