California Passes Bill Allowing Omission of Patients’ Names From Abortion Pill Bottles

California legislators have passed one of the strongest measures so far to protect health care providers who send abortion pills to states with abortion bans and the patients who receive them.

The bill, approved by wide margins in the State Assembly Wednesday night and the Senate Tuesday, is expected to be signed by Gov. Gavin Newsom. It would allow health care providers to mail abortion pills with only a minimum of identifying information: Medication labels and paperwork in the packages could omit the name of the patient, prescriber and pharmacist. The legislation is expected to have broad national impact because a majority of medication abortion services across the country use pharmacies based in California to dispense and ship the medication.

The measure is intended to make it harder for states with abortion bans to develop evidence to make legal cases against doctors and others operating under shield laws that were adopted by many states to protect abortion pill prescribers after the Supreme Court revoked the national right to abortion. It is also intended to reassure women in states with bans who seek abortions and who may be afraid to obtain prescription pills, fearing they could be identified by the authorities if their name is on the bottle.

The abortion shield laws in at least eight states prevent officials from obeying subpoenas, extradition requests and other legal actions that states with bans take against abortion providers. That is a stark departure from typical interstate practices of cooperating in legal matters.

James Bopp Jr., the general counsel for National Right to Life, called legislation to strengthen shield laws “almost horrifying.” He said the California bill would result in “no accountability for abortion drugs or the people that prescribed them,” adding “even if you find the doctor, they could say, ‘Well I didn’t prescribe those pills.’ How are you going to prove that the pills she took in this box with no names on it were the ones that he prescribed?”

Shield-law providers have become a major avenue of abortion access for women in states with bans, currently serving an estimated 12,000 patients per month — about one-eighth of all abortion patients in America. As use of shield-law providers has grown, abortion opponents in states with bans have begun filing civil lawsuits and criminal charges, with at least one case — a showdown between Texas and New York — poised to become a constitutional contest likely to reach the Supreme Court.

In response to the escalating legal actions, several states, including New York, Washington and Massachusetts, recently passed measures to allow prescribers to send abortion pills with only the name of their medical practice on the medication packages, not their individual names. But because many providers in those states use California pharmacies to ship the medication, they have had to follow California’s requirement that the prescriber’s name be on the bottle.

That would change under the new bill. “Because California is such a hub for this, we needed to take it a step further,” said Jessica Nouhavandi, a California pharmacist who advised on the legislation. “Protecting just one piece of the puzzle wasn’t enough.”

Pharmacists and prescribers would continue to be required to keep records with the patient’s name and all other information typically required for prescription medication, she said, but the bill would allow abortion patients to receive a “bare bones” label with the name of the drug, directions for appropriate use and a phone number to call for any questions.

Removing the abortion patient’s name from anything in the package the patient receives is especially significant, said Natalie Birnbaum, the state legal and policy director for the Reproductive Health Initiative for Telehealth Equity and Solutions, who helped craft the California bill.

“It’s clear that having a patient’s name on their label for abortion medication is preventing people from getting the care that they need,” she said. Even though state abortion bans currently exempt the patients themselves from prosecution or penalty, “there is confusion, there is fear, there is an increasing abortion stigma,” she added.

Ameet Sarpatwari, an assistant professor of medicine at Harvard Medical School, said that “patient names have historically been on prescriptions and packaging to safeguard safety and prevent misuse and abuse.” But, he said, given that the California bill is limited to abortion medication, and that many studies have shown that abortion pills are safe, the California measure “doesn’t really raise fears.”

Brigid Groves, vice president of professional affairs for the American Pharmacists Association, said that in general, giving patients medications without their name on it raises concerns about “making sure that the right patient at the right time is getting that.”

But she said her organization did not take a position on the California bill. “The concern is, if we start this process or this exclusion for one class of medications, how far does that go?” she said. But, with abortion pills, she said, “I understand wanting to make sure that in this case, people aren’t being targeted or going to have other repercussions because of the medication they’ve been prescribed.”