Abortion pill Mifegymiso months away from coming to Manitoba
Province has not decided whether $300 dosage will be funded
The much-discussed abortion pill Mifegymiso will not be coming to Manitoba for at least a few more months.
The drug's Canadian distributor, Celopharma Inc., said it has not received any orders for the pill in the province.
Mifegymiso is a drug product that combines mifepristone to block the hormone progesterone and misoprostol to induce a miscarriage.
In Canada, it has been approved for use in the first seven weeks of pregnancy, although Celopharma has submitted a revised submission to Health Canada to extend that to nine weeks, as is allowed by regulations in other countries.
Health Canada approved Mifegymiso in In July 2015, about 25 years after it was made available for women in France, and after a 2½-year review. It is approved in more than 60 countries, including the United States, where it was approved in 2000.
A year and a half after its approval, Mifegymiso was shipped out to three clinics located in British Columbia, Alberta and Ontario in early January.
Before it can be prescribed, physicians have to complete training, which was partially designed by the Society of Obstetricians and Gynaecologists of Canada.
'It has been a challenge'
Leigh Anne Caron, director of health services at Winnipeg's Women's Health Clinic, said doctors were only made aware of the training in January.
"After we were made aware, one of our physicians took the course right away," she said last week.
"A couple others registered, and I believe some of the physicians at the hospital who provide [abortions] have also looked into the registration."
It's not as easy as getting the training and then ordering the pill, Caron said. Unlike some of the clinics that have ordered Mifegymiso in other provinces, the health clinic has not done medically-induced abortions previously.
"It has been a challenge for us only because we were not previously providing medical abortions," she said.
- RU-486: What you need to know about the recently approved abortion pill
- RU-486 abortion pill approved by Health Canada
Because of the short timeframe for use of the pill — the first seven weeks of pregnancy, as compared to surgical abortions, which are available up to 16 weeks — physicians have to move quickly. Caron said the clinic, which currently only does abortions two days a week, would need immediate availability of ultrasounds to confirm dates, retrieve a medical history and get access to a doctor who is trained to prescribe the medication.
Women using Mifegymiso are given four pills to take at home within 12 to 24 hours. One to two weeks later, there also has to be a follow-up appointment, another ultrasound and blood tests.
"We would have to have a nurse dedicated to [the process of getting patients Mifegymiso] and being able to respond and figure out if we just do it on the procedures days we already have, or if we look at expanding that to other practitioners," Caron said.
However, Caron said they are committed to providing Mifegymiso as an option for women, but it might take a little more time.
Women's Health Clinic is working with the Health Sciences Centre's Women's Hospital, the other site offering abortions in the city, to figure out how to provide the drug in a co-ordinated way.
"We see women who travel to Women's Health Clinic from all over the province to come for surgical abortions," Caron said.
"If women had access to medical abortion they wouldn't need to travel, there would be a reduction of cost for stays and inconvenience as well."
Costs about $300 per person
Mifegymiso has the potential to open up access to procedures for women who do not live in the city but still have access to ultrasounds and followup in their communities. But it costs about $300 per person — putting it out of reach for many women or causing a huge financial burden for clinics trying to offer it, Caron said.
She said she has no idea whether the provincial government will cover the costs of the pill.
"We have been trying since summer to get some response. While we can look at stocking some [Mifegymiso] at our own cost, we can't afford currently to provide this without recovering some of the cost, which means we have to look at asking clients to pay for the procedure, which we don't want to do," she said in an email.
- Abortion drug decision pushed back by Health Canada
- Abortion pill's approval could help Manitobans in rural, remote places
Celopharma resubmitted to the Common Drug Review process, administered by the Canadian Agency For Drugs And Technologies In Health, in October.
That process is expected to take approximately six months, a provincial spokesperson said in an email to CBC News. Following the process, CADTH will make non-binding recommendations, but whether to include Mifegymiso in the drug plan will ultimately be up to the province.
The spokesperson said the province would not begin its process of deciding on Mifegymiso until that drug review is done.
"They already fund abortion, so I'm hoping that they will just see this as an extension of good service and good access," Caron said.
"We are going to continue. We are going to figure out our plan and how to do it. And it might be slow … but we are going to figure it out."
Caron said the Women's Health Clinic is in conversations with Celopharma about how to balance affordable pricing with expiration dates.
However, the clinic will not be ordering the drug until the infrastructure and staff changes have been made to accommodate medical abortions at the clinic, which will happen in spring at the earliest.