Out-of-state doctors are pushing for laws that will make it harder to detect who prescribes and sends abortion medication, as anti-abortion lawmakers look for ways to stop the flow of pills to their states. 

Patients have continued to receive abortion pills in states with near-total bans, so much so that the number of abortions has actually increased since the fall of Roe v. Wade, despite near-total abortion bans. This is mostly thanks to “shield laws.” Working from states like New York, California and Massachusetts, providers meet virtually with pregnant patients in states with bans and write them abortion pill prescriptions. Patients receive the pills in the mail to take from home. One in 5 abortions are now done through telehealth, according to the Society of Family Planning, and about half of those are for people getting care because of shield laws. 

Now, doctors are working to anonymize that process by pushing to hide the name of the prescriber from the labels of mifepristone and misoprostol — the two drugs used in medication abortions. The effort marks a new step in the escalating battle between states over whether and how people in America can get abortions — and to what extent individual states’ laws can influence medical care coming from another.

“We are seeing two very different worlds right now in the United States in terms of the directions of laws and policies,” said Dr. Angel Foster, who provides telehealth abortions from Massachusetts to people in states with bans. “Shield law states are doing more to not only protect reproductive rights within their own state, but to protect avenues for all abortion seekers in the country to be able to get safe and legal care.”

Typically, prescription bottles include information such as the name of the doctor who prescribed medication, details about the medication and appropriate dosage, and the name of the patient receiving medication. But that information has become invaluable in civil and criminal cases filed by anti-abortion law enforcement officers.

A handful of states — New York, Maine, Vermont and Washington — have already passed laws to remove prescriber names from abortion pill bottles. Proposed legislation in Massachusetts, currently working through the state Senate, would similarly allow this change, although at least one shield law practice in the state, Foster’s Massachusetts Medication Abortion Project, has already removed prescribing doctors’ names from pill bottles citing guidance they received from the state attorney general. 

A proposal in California, the largest shield law state, would go a step further. The bill, currently making its way through the state Senate, would remove not only the name of the prescribing health care provider but also the patient receiving medication. Proponents say that could protect patients who are concerned about someone discovering they ordered abortion pills.

The legislative trend comes as abortion opponents are ramping up efforts to stop telehealth abortion. Both Texas and Louisiana’s attorneys general have pushed criminal and civil cases targeting Dr. Margaret Carpenter, a New York-based physician who allegedly prescribed abortion pills to patients in those states. The cases pose a first test of shield laws and are likely to ultimately be decided by the Supreme Court.

The Texas suit against Carpenter was filed after a pregnant woman in the state developed bleeding and went to the hospital, according to court filings from the state. The filings assert that the “biological father of the unborn child” found medications that appeared to be prescribed by Carpenter.

“If an abusive partner were to find a package of abortion pills in the trash can, if it says Dr. XYZ, already you have someone to name in a lawsuit,” said Greer Donley, a law professor at the University of Pittsburgh who has advised state lawmakers on crafting shield laws. “If it doesn’t have it, it’s a critical piece of information. How do you know who prescribed the pills?”

Separately, legislators in Texas unsuccessfully sought to end telehealth prescriptions with a bill, which died in the legislature, that would have allowed anyone to sue people who prescribe or send abortion pills to Texans for at least $100,000. Louisiana lawmakers are poised to pass legislation that would create similar punishment structures, allowing the “biological father,” his parents, or the parents of the pregnant person to file civil suits against out-of-state abortion providers. 

Abortion rights supporters say that removing the doctor’s name from a prescription label would add security for those who rely on shield laws but are nervous about heightened efforts to target providers, a concern that has only grown since this weekend’s shootings of two Minnesota state lawmakers and their spouses. News outlets have reported that the suspected shooter, Vance Boelter, had a list of alleged targets in his car that included abortion providers.

“It goes a long way in ensuring that providers are protected at a time when we’ve seen increased violence and animus toward abortion providers and reproductive health providers generally,” said Lizzy Hinkley, senior state legislative counsel at the Center for Reproductive Rights, which worked to help pass such a bill in New York. “Anyone who has their name on a pill bottle will risk detection by hostile parties in states that have banned abortion.”

One California doctor who practices with telehealth practice A Safe Choice said he deliberately keeps a low profile. Only a few close friends know about his work providing abortions to people out-of-state. But through his organization, he hears almost once a week from other health care professionals who want to offer telehealth abortions to patients living under bans. He believes a bill like California’s could encourage even more to do so.

“Allowing the provision of services without the providers needing to put their name on the prescription labels will add an additional layer of security and confidence for the providers,” said the doctor, who asked that his name be withheld because of the ongoing legal threats against abortion providers. “This is a very important next step.”

The California bill could have an outsized impact. Most shield law prescriptions are filled by California-based pharmacies. That includes those called in by doctors who are practicing in other states, such as New York, but who don’t want to mail the pills themselves.

“There is no pharmacy in New York state that mails pills for us, so we have to rely on pharmacies in California,” said one physician in New York, who asked that her name be withheld because of the legal actions taken against Carpenter. “All the shield law providers across the country are waiting with bated breath for this bill to be passed.” 

New York has passed a law removing prescriber names from abortion medication labels created in the state, she said, but that hasn’t affected her. Because she calls prescriptions into a pharmacy in California the labels are subject to the Golden State’s laws — and as a result, her name is still listed on the bottle when she orders abortion pills for out-of-state patients. Her patients live in states all over the country.

“It’s very stressful. I wish we could get California to move a bit faster,” she said.

The California bill has been approved by the state’s lower chamber but is still awaiting Senate passage. It’s faced little resistance and has received support from the state’s attorney general and lieutenant governor. Gov. Gavin Newsom, who has built a public profile in part through vocal support of abortion protections, has not weighed in, and his office said he does not comment on pending legislation.

Still, there are legal questions about bills like California’s. Federal law requires that medication labels include the prescriber’s name — a stipulation that some argue could conflict with and possibly override the state-level protection. 

But these questions haven’t been raised regarding other similar laws. Some legal scholars argued that the federal statute is ambiguous, and that pharmacies could say the state law still satisfies federal requirement by including the name of a medical practice — as New York’s and Maine’s do — rather than of an individual prescribing doctor or nurse.

“If you have the address and the practice and you’re able to easily identify where the prescription came from, that’s the purpose of this rule,” said Rachel Rebouché, dean of the Temple University School of Law. “The issue is being able to, for safety reasons and for monitoring, understand that someone who has the authority to do this has done it. There’s no question that putting the name of the practice does that.”

The blue-state push comes as abortion opponents have stepped up their efforts not only in individual states, but in their quest for national restrictions on mifepristone, calling for the federal government to prohibit dispensing it through telehealth. 

That campaign has included building a body of research that they say highlights its potential risks — which runs against mainstream medical findings and that some researchers have said rely on “junk science.” 

While President Donald Trump has remained quiet on abortion, members of his administration have suggested openness to curbing access to medication. This month, Food and Drug Commissioner Marty Makary committed to having his agency review mifepristone’s approval, though it’s not clear what that would ultimately mean. Health and Human Services Secretary Robert F. Kennedy Jr. has also said he supports taking another look at the drug’s safety. 

“In light of the situation at the FDA, it is urgent to ensure that California clinicians and pharmacists can prescribe and deliver mifepristone to the patients who rely on us,” Dr. Kelly Pfeifer, a California-based doctor who also provides abortions in Kansas, said at a committee hearing for the state’s bill. “This bill will allow us to continue to treat our patients even if politicians in Washington act against the science to further limit mifepristone.”