The problem with Walgreens and mifepristone

This article was published in February 2023

When Governor Gavin Newsom announced that California would no longer do business with Walgreens, most reacted with surprise. While retweeting a CNN story about the pharmacy giant choosing not to distribute the abortion pill mifepristone in 20 states, Newsom wrote: “California won’t be doing business with Walgreens — or any company that cowers to the extremists and puts women’s lives at risk. We’re done.”

It was action without a warning shot, and it clearly took the pharmacy giant by surprise. Walgreens — which, for any Brits and New Yorkers keen to join the boycott, shares a parent company with Boots and Duane Reade — operates nearly 600 stores in California and is the second-largest pharmacy chain in the United States. It is responsible for around 10 per cent of the pharmacy market in the west coast state. That means that taking a stand against Walgreens would be costly for the company, but also potentially for Californians themselves. The state is huge — the most populous in the country, with the third-largest landmass after Alaska and Texas — and many in rural locations known colloquially as “healthcare deserts” rely on supersize Walgreens stores to access in-network medication. Because of the company’s size, it is able to accept most health insurance plans versus a local pharmacy on an isolated small-town street.

Pulling all business with Walgreens may, then, have the unintended effect of cutting off some Californian women’s ability to access the abortion pill altogether.

Yet it remains unclear what California no longer “doing business with Walgreens” actually means. Newsom has been cagey about details, and his spokesman Brandon Richards told CNN that his team is currently “reviewing all relationships between Walgreens and the state”. It’s hard to imagine the forced closure of over 600 stores going ahead. It’s possible that “doing business” refers to pensions or sharing in California-specific innovations. The state recently announced that it plans to make its own insulin as a solution to keeping costs down for diabetics. If that comes to fruition, and insulin for $35 or less per month becomes the norm in the state as opposed to the usual $200-plus co-pay for privately insured citizens at the moment, then cutting Walgreens out of the deal could drive thousands away from the stores almost immediately.

What’s most bizarre about Newsom’s statement is that Walgreens didn’t see it coming. Just days earlier, it had responded to pressure from Republican politicians from jurisdictions where abortion is both legal and illegal by agreeing not to distribute mifepristone in any of their 20 states. On 1 February, the attorneys general of states where abortion has been effectively outlawed, like Kentucky and Texas, co-signed a letter alongside colleagues from other states — such as Alaska, Montana, Iowa and Florida — where abortion remains legal. The letter was sent to Walgreens and competitors including CVS, Rite Aid and Walmart, and purported to concern the protection of women and children. It effectively threatened the pharmacies with numerous legal actions if they continued to sell mifepristone. The message was clear: We intend to make this hard for you.

In late February, Walgreens was the only company to publicly respond to the pressure. In a letter dated February 17, a representative of the Walgreens Boots Alliance responded to all of the signatories, stating: “Walgreens does not intend to dispense mifepristone within your state and does not intend to ship mifepristone into your state from any of our pharmacies. If this approach changes, we will be sure to notify you.” To many people’s surprise, this letter didn’t exclude the attorneys general who had written from states where the abortion pill remains legal. It looked very much like Walgreens was throwing women to the dogs at the first sign of trouble.

Perhaps Walgreens didn’t imagine that liberals would be as strident in their blowback as conservatives were in their pressure campaign. Or perhaps the pharmacy simply doesn’t have a strategy to deal with the fallout of Roe v Wade’s overturn, even months down the line. Either way, they released a statement in the wake of California Governor Newsom’s announcement that directly contradicted what they’d said days earlier. “We want to be very clear about what our position has always been: Walgreens plans to dispense mifepristone in any jurisdiction where it is legally permissible to do so. Once we are certified by the FDA, we will dispense this medication consistent with federal and state laws. Providing legally approved medications to patients is what pharmacies do, and is rooted in our commitment to the communities in which we operate,” the company wrote in a statement on March 6th. The Independent approached Walgreens for further explanation and was directed back to the statement on the Walgreens website. Requests for further clarification, considering that the statement directly contradicted what was said in the letter days earlier, were ignored.

Whether or not Walgreens is backpedaling, enough damage has clearly already been done. Filmmaker Michael Moore addressed the controversy in his popular Substack newsletter on 5 March with a simple headline: “Boycott Walgreens, a pharmacy that stands with anti-abortion extremists against the rights of women”. #BoycottWalgreens began trending on Twitter. Walgreens stock began to plummet. Stories on social media began to proliferate about people cancelling their Walgreens accounts or clogging up the company’s inboxes and phone lines with angry missives. People began reminding each other that the typical Walgreens customer, as well as the typical Walgreens employee, is female. By this point, it was 8 March: International Women’s Day. Few could imagine an organisation finding itself in a worse PR bind for the biggest female-centred day of the year. Walgreens became central to the celebrations in the worst way possible — as an example of how collective action by women can be used to take sexist corporations down.

What is perhaps the most concerning about Walgreens’ initial caving to the pressures of Republican attorneys general is the fact that many of those politicians were attempting to directly subvert democracy. Kansas is a pertinent case in point. The ruby-red state ran a referendum not long after Roe v Wade’s overturning by the Supreme Court, in August 2022. It was widely expected that Kansans would vote in that referendum to overturn the state constitution and make abortion illegal. This was the first state to test the waters after SCOTUS’ decision. Anti-abortion campaigners planned to declare the results as proof that the “moral majority” agreed the procedure should be illegal.

But the plan never came to fruition. Instead, in an unexpected twist, 59 per cent of Kansans voted “no” on an amendment that would have banned abortion in the state. The victory went to the Biden administration instead, who released a triumphant statement about the importance of allowing women to make their own healthcare decisions. It seemed that far-right campaigners on the issue had forgotten why a huge proportion of Americans — especially in rural states like Kansas — vote Republican. These Republican voters are not necessarily evangelicals; in fact, they are more often than not libertarian-minded people whose main concern is keeping the government out of their business. And bringing in rules about what women can do with their own bodies in the privacy of their own homes really smells like bringing the government into their business.

Mifepristone is an abortion pill that works when a woman has been pregnant for eight weeks or less. Different to Plan B, it ends an early pregnancy by cutting off progesterone and opening the cervix (Plan B, sometimes known as the morning-after pill, is not an abortion pill and instead works to prevent implantation before a pregnancy occurs.) Around 80 per cent of abortions in the US are performed at this early stage, many of which can be conducted at home by taking mifepristone. Despite Republican horror stories and Trumpian lies about abortions being conducted “at birth”, just 4 per cent of abortions are carried out after 16 weeks, and most of those are because of an immediate health danger to the mother or the sad finding that a fetus has a condition incompatible with life.

Importantly, mifepristone is also prescribed by doctors to women who are experiencing a miscarriage. It helps to clear the uterus of any debris from a failed pregnancy that could lead to serious infection and potentially fatal sepsis.

Put simply, when access to mifepristone is politicized and then made difficult, people die. That Walgreens treated the issue so flippantly in the first place is a red flag — and is probably enough for a lot of its customers to never shop there again.