Closing the Gap: Expanding Access to Mifepristone for Early Pregnancy Loss Through Operational Innovation

Management of early pregnancy loss (EPL) with mifepristone plus misoprostol is the evidence-based standard of care endorsed by the American College of Obstetricians and Gynecologists. This 2-drug regimen demonstrates superior outcomes compared to misoprostol alone or expectant management, including fewer complications, higher success rates, and reduced need for surgical intervention. Though mifepristone use for EPL management is legal in all 50 states, it is vastly underutilized in emergency departments (EDs), which see a substantial percentage of patients with EPL. This is partly due to regulations around prescribing and dispensing it that create logistical barriers, especially in unscheduled care settings. Expanded access to mifepristone in the ED has the potential to reduce disparities in medical care for EPL, especially for patients in rural or underserved areas. Medical therapy for EPL is often mischaracterized as elective abortion, which it is not. This concept paper defines the role of emergency clinicians in prescribing evidence-based medical treatment exclusively for patients with EPL. As restrictive state laws begin to misclassify EPL management as elective abortion care, EDs must be equipped to deliver evidence-based patient care with clarity. Protecting access to guideline-supported medical care for EPL can reduce morbidity and mortality and prevent delays in appropriate care caused by geographic, legal, or institutional barriers. This paper proposes 5 adaptable care models for integrating mifepristone into emergency and urgent care workflows, from on-site prescribing and dispensing to hybrid pathways that incorporate telehealth and follow-up referrals. Each model addresses different levels of institutional readiness, state legal frameworks, and clinical capacity. Implementation guidance includes protocols for eligibility screening, prescribing and dispensing options, and follow-up.