Legislation Restricting Access to Medication Abortion
- Iowa’s HF 2788 (effective July 1) requires abortion pills to be prescribed and dispensed in person, ending telehealth medication abortion there. The law requires the medication to be prescribed in person and dispensed in a medical setting, cutting off Iowans’ access through telehealth and mail-order providers, many of which operate from other states. Republican supporters said in-person visits protect women’s safety and keep “black market” pills out of the state. Democrats and advocates said the law will make care very hard to reach in rural areas that already face OB-GYN shortages.
- Mississippi’s HB 1613 (effective July 1) bans making, distributing, prescribing or possessing abortion pills, with penalties of 1–10 years in prison. The bill began as a drug-trafficking measure, and an amendment added language outlawing the dispensing or shipping of abortion-inducing drugs. It also lets the Attorney General bring civil suits for injunctions and penalties in addition to criminal prosecution. The law explicitly exempts lawful care such as treating miscarriages and ectopic pregnancies.
- Oklahoma’s HB 1168 (effective August 13) makes it a felony to possess or deliver abortion pills for someone else’s abortion. Patients using the pills themselves are exempt. The law covers mifepristone, misoprostol and methotrexate, and a conviction can bring up to 10 years in prison, a fine of up to $100,000, or both. It is model legislation from Students for Life Action, whose president said it was written to target people shipping pills into Oklahoma from other states. Pharmacists, manufacturers and distributors handling the drugs for lawful medical purposes are exempt.
- South Dakota’s HB 1231 bans dispensing, distributing and advertising abortion pills. A federal court blocked only the advertising ban. In July, a federal judge granted a preliminary injunction to Mayday Health and a local attorney, finding the nonprofit likely to win its free-speech challenge. In October, the 8th Circuit rejected the state’s bid to lift that block, so the advertising ban stays unenforceable while the case proceeds.
- Texas’s HB 7 lets private citizens sue pill providers. Modeled on Texas’s 2021 private-enforcement law, it allows up to ten times the monetary penalties and only requires proof that a defendant engaged in prohibited conduct. It took effect December 4, 2025, and includes language blocking providers from countersuing under their home states’ shield laws; pregnant women themselves cannot be targeted.
Legislation Protecting or Expanding Access to Telehealth Medication Abortion
Newsom signed a nine-bill package on September 27, expanding California’s reproductive health protections.
- AB 1854 bars arrests of anyone the Governor has declined to extradite for providing legally protected health care. It responds directly to Louisiana’s attempt this year to extradite Dr. Remy Coeytaux, which Newsom rejected. The law also widens California’s shield protections so that more businesses and individuals, including financial services companies, cannot comply with out-of-state legal demands for protected information.
- Newsom drew criticism for vetoing AB 2164, which would have written California’s no-extradition policy into law. The bill would have codified and expanded Newsom’s own 2022 executive order, requiring future governors to reject extradition requests tied to reproductive or gender-affirming care. In his veto message, Newsom said extradition is an exclusively executive function. Reproductive Freedom for All warned that without the bill, providers are “one election away from extradition,” pointing to Republican gubernatorial candidate Steve Hilton.
- Oregon and Hawaii strengthened their shield laws.
- Oregon’s HB 4088 adds extradition protections. It bars the governor from granting extradition when the demand stems from reproductive or gender-affirming care that is legal in Oregon, putting into statute a policy Governor Kotek already followed. It also prohibits state law enforcement from sharing information with federal officials about protected care, and expands privacy protections for providers in court and public records.
- Hawaii’s Act 59 (HB 1875), signed May 29, extends the state’s existing shield law, which already covered abortion, to gender-affirming care. Hawaii’s earlier protections bar state agencies from releasing abortion-related information or assisting other states’ investigations into abortion services.
Telehealth Expansions and Improvements Impacting the Equitable Provision of Medication Abortion Provision in TMAB Access States
- New Jersey expanded telehealth prescribing and pay parity. A new law loosens in-person exam requirements for prescribing Schedule II controlled substances via telehealth, with full exemptions for groups such as cancer, hospice and substance-use-disorder patients. Separately, Governor Sherrill signed a law on June 30 extending the requirement that insurers, including Medicaid, pay the same for telehealth as for in-person care through December 31, 2027. However, the Third Circuit ruled on August 31 that out-of-state doctors need a New Jersey license to treat patients there. The court rejected a free-speech challenge from two out-of-state specialists and their patients, finding the requirement protects patient safety and treats in-state and out-of-state doctors equally. A New Jersey license typically costs about $550 and takes around three months.
- Missouri’s HB 2372 lets doctors establish a patient relationship by telemedicine without an in-person exam. The provision is part of a large health care omnibus bill signed by Governor Kehoe, with most provisions taking effect August 28. It also adds guardrails for questionnaire-based telemedicine: the provider must be tied to a licensed Missouri health care entity and send a written report to the patient’s primary care doctor within 14 days.
- Alaska (HB 14) passed telehealth pay parity. Starting January 1, 2027, insurers must reimburse telehealth, including behavioral health visits, at least at the same rate as comparable in-person care. Advocates said this matters especially in rural Alaska, where telehealth is often the only practical option.
- D.C. (B26-0356) added coverage for remote monitoring during pregnancy and postpartum. The law, which took effect in July, amends D.C.’s Telehealth Reimbursement Act to cover remote monitoring of blood pressure and blood glucose during pregnancy and for up to 12 months after birth. It clarifies a 2019 postpartum coverage law that had already required Medicaid to cover digital health tools used to manage a pregnancy.
