Calls to boycott Walgreens swelled online on Friday after America’s second-largest drugstore said it will not distribute mifepristone, a drug that is part of the most common method of abortion in the country, in some states where the abortion remains legal.
The announcement, first reported by Politico, comes after 20 Republican attorneys general sent a letter to Walgreens threatening it with legal action if it distributed the drug in their states, including some where abortion isn’t banned. Under the new policy, Walgreens would not distribute the drug in some states which permit abortion: Kansas, Florida, Georgia, Alaska, Indiana, Iowa, Ohio, South Carolina, and Utah. “We intend to be a certified pharmacy and will distribute Mifepristone only in those jurisdictions where it is legal and operationally feasible,” Walgreens said in a statement to TIME.
On Feb 17, in response to the letter, Walgreens wrote to Kris W. Kobach, the attorney general of Kansas, that the company: “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.” In 2022, Kansas voters rejected a constitutional amendment that would have allowed the legislature to ban abortion.
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After the Biden Administration announced in January that pharmacies can become certified to distribute mifepristone for the first time, Walgreens and the largest pharmacy chain, CVS Health, said they would seek certification to dispense the pill. Whether other drug store companies will follow Walgreens remains uncertain; Walmart, Kroger, CVS, Cigna/Express Scripts, Optum/RX and Costco did not respond to a request for comment from TIME.
However, experts warn that Walgreens’ decision could have major consequences from both a health and legal perspective.
Given barriers to abortion are on the rise, the decision is particularly concerning, says Dr. Raegan McDonald-Mosley, an OB-GYN and CEO of the abortion rights group Power to Decide. Pharmacies can be a crucial access point to mifepristone, especially in rural areas where healthcare is inaccessible. “It’s not good public health practice, it’s not good medicine, to not make available something that we know is safe, and effective, and commonly utilized,” she says.
McDonald-Mosley says that she’s concerned that patients seeking abortions, suffering miscarriages or who need the drug for other reasons could be at an increased health risk if they do not have access to mifepristone, and if they have to rely on a treatment that is less effective. “If you decrease effectiveness, even a small amount, but apply that to a large number of people in the population, there are absolutely going to be people who suffer consequences,” says McDonald-Mosley. “There could be potentially more incomplete abortions, people dealing with hemorrhages or other consequences.”
The attorneys general’s letter argued pharmacy companies would be in violation of federal law, which prohibits the distribution of abortion drugs by post. The Biden administration has contended that sending mifepristone by mail does not violate the law, writing in that “the mere mailing of such drugs to a particular jurisdiction is an insufficient basis for concluding that the sender intends them to be used unlawfully” and noting that the drug has multiple uses, including abortion.
But regardless of the legality of distributing mifepristone by mail, Walgreens’ decision could lead to a “domino effect”—with smaller companies, which don’t have the deep pockets of Walgreens, deciding to follow the pharmacy giant’s lead, says Allison Whelan, a Georgia State University assistant professor of law. Whelan says this goes to show just how much the legal landscape surrounding abortion has been disrupted. “I think this is just how tenuous and uncertain access to either surgical or medication abortion is, even in states where the practice or the medications remain legal,” says Whelan. “The rule of law is under threat where the threat of litigation can allow someone to feel like they could be sued, even when they are squarely in line with the law of the jurisdiction.”
On Twitter, the response to the decision was divided between supporters and advocates of abortion access. Lila Rose, the CEO of the anti-abortion rights organization Live Action, hailed the decision as a victory. “After weeks of the pro-life movement protesting, Walgreens is backing down from distributing the lethal abortion pill in several states. Drugs that kill children don’t belong in neighborhood pharmacies. Keep the pressure on!” she wrote
Abortion rights opponents had also urged Walgreens and CVS not to dispense drugs that induce abortions. “We will be working with both federal and state lawmakers, along with consumers, to keep neighborhoods across America free from abortion if CVS and Walgreens ultimately go down this path,” Tony Perkins, the president of the Family Research Council, said in a January statement.
By Friday morning #BoycottWalgreens was trending on Twitter in response to Walgreens’ announcement. “Losing money is the only thing they understand as a threat to their business, not principles,” tweeted user Judi Cunningham.