Online pharmacies and telehealth saw a boom in recent years, thanks to the pandemic.
But now, additional eyes are on these startups as federal protections for the right to an abortion were struck down this summer in a Supreme Court ruling.
The court’s decision in June reversed the 1973 Roe v. Wade ruling, which gave pregnant women the right to an abortion until fetal viability, or when the fetus could survive outside the womb. By overturning Roe v. Wade, the Supreme Court made it so that states could ban or restrict abortions.
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How this will or won’t impact abortion pill providers continues to be muddy regulatory waters. In the meantime, existing digital health companies could expand their offerings to include abortion pills.
Medication-based abortion provides an option for women early in their pregnancy. The combination of the pills mifepristone and misoprostol was approved by the U.S. Food and Drug Administration in 2000 to terminate a pregnancy up to 11 weeks, according to the Guttmacher Institute, a research and policy organization focused on sexual and reproductive rights.
Because of the COVID-19 pandemic, the requirement that women needed to visit a provider at a hospital or clinic to be prescribed mifepristone and misoprostol was eliminated in July 2020.
The change in rules led to an uptick in medication-based abortions, which now account for half the abortions in the United States, per the Guttmacher Institute. That’s up from more than one-third in 2017.
Since the change in rules, at least two startups focused on providing medication abortions received funding, according to Crunchbase data. Those include New York-based Hey Jane and San Rafael, California-based Choix.
Hey Jane serves patients in California, Colorado, Illinois, New Jersey, New Mexico, New York and Washington, while Choix serves women in California, Illinois, New Mexico and Colorado.
Both companies provide virtual or text-based consults with patients who are early in their pregnancy and located in eligible states before shipping abortion pills, all for a flat fee.
Choix saw a 600% increase in web traffic on the day the decision to overturn Roe v. Wade was announced, according to CEO Cindy Adam. The company also experienced a 50% increase in the number of patients seeking care since the ruling, and it anticipates that increase to continue as people turn to medication abortion.
“Telemedicine clinics like Choix can also alleviate capacity issues, helping local clinics to reserve in-person visits for patients who require or prefer in-person care or are traveling from out of state,” Adam wrote in an email.
The company’s goal is to expand to every state where it can legally provide abortion medication by the end of next year, given how in flux the current situation is.
Medication abortion is currently in a bit of a gray legal area. While states now can ban abortions, mifepristone is approved by the FDA. On June 24, Attorney General Merrick Garland said in a statement that, ”states may not ban Mifepristone based on disagreement with the FDA’s expert judgment about its safety and efficacy.”
Will more startups offer abortion pills?
While there are only two venture-backed startups in the Crunchbase database focused on providing the abortion pill, that doesn’t mean other health care startups aren’t looking to expand their services in light of the Roe v. Wade ruling.
Deena Shakir, a partner at venture capital firm Lux Capital, who invests in the future of health, noted that the number of companies focused solely on providing abortion pills doesn’t provide the full picture of how startups are responding.
Some existing digital health companies are working toward offering the abortion pill and expanding their women’s health services as well, said Shakir.
Lux portfolio company Carbon Health, for example, said in November that it would begin offering medical abortion in California, Shakir noted.
And Adam of Choix said she is aware of other online pharmacies working to become certified to dispense mifepristone.
Online pharmacies grew more popular during the pandemic, as more people looked to have their medications shipped directly to them. But currently, there are only two online pharmacies licensed to distribute the abortion pill, according to Time, including venture-backed Honeybee Health.
Shakir noted that it’s important for existing health care companies to expand services, given how difficult it is to start and roll out a company in a field as highly regulated as health care.
“I do think that it’s critical, because, especially if you’re starting a new company, it’s not easy to start and scale across states,” Shakir said. “So is making sure existing companies and companies focusing on other aspects of health care are stepping up to the plate.”
Women’s health has historically been dismissed as niche—something that Shakir said doesn’t make sense, considering women consist of half the population and make up around 80% of the dollars and decisions in health care.
Digital health is a relatively nascent space, though it’s gaining interest from investors as it matures, Shakir said.
“Human health is ‘recession proof’ in that we will continue to get sick and give birth and die and have significant health care needs,” Shakir said. “And the major stakeholders in this industry, going beyond patients, the pharma companies, the providers, the payers … are under pressure to propel pandemic digital progress and make it permanent.”
Illustration: Dom Guzman
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