Vagina Bible Author Shares Florida CVS Refusal to Fill Rx for Pill Linked to Abortion

Most of the time, Dr. Jen Gunter supplies answers, not questions.

A Canadian-born OB/GYN who now practices in San Francisco, Gunter is the author of The Vagina Bible (2019) and The Menopause Manifesto (2021), whose plainspoken puncturing of the myths and misunderstandings regarding the female body and reproductive system catapulted her to the upper echelons of the best-seller lists. Gunter might be even more internet-famous for skewering the sucker-born-every-minute sales pitches of Hollywood actress Gwyneth Paltrow, who regales women with the wonders of steaming their vaginas and stuffing jade "eggs" into them at $66 a pop.

But she's still awaiting an answer to the question she posed from her Twitter account, @DrJenGunter, on the afternoon of April 25.

"Hi @cvspharmacy," reads the tweet, which Gunter also posted on her Instagram. "Can you explain why your pharmacy in Florida refused to fill this prescription for misoprostol?"

The query is accompanied by a highlighted partial screen grab of a doctor's prescription indicating that the order — a single 200-microgram tablet of misoprostol to be taken "per vagina the night prior to your procedure" related to a diagnosis of "stricture and stenosis of cervix uteri" — had been declined.

The reason: "FEDERAL JUDGE BANNED THIS MEDICATION RECENTLY."

Hi @cvspharmacy can you explain why your pharmacy in Florida refused to fill this prescription for misoprostol? pic.twitter.com/yIeeP9thE6

— Jennifer Gunter (@DrJenGunter) April 25, 2023

Reached by New Times, Gunter clarified in a text that "[t]his isn't my patient and I didn't write the prescription. A doctor just asked me to make it public. I know the person so I know it's valid. All I know is they tried to get this for their patient to help with a GYN procedure and a CVS employee refused."

"I can say he is a real doctor, and this is how we would write that prescription," she added.

"One Tablet Per Vagina"

The tweet is brief, and the screenshot incomplete, but there was a lot to unpack for the 4.5 million who've seen it.

First, and most glaring: The pharmacist's note almost certainly refers to a pending case in Texas that challenges the U.S. Food and Drug Administration's (FDA) approval in 2000 of mifepristone, half of a two-drug regimen doctors prescribe to induce so-called medication abortions. A Donald Trump-appointed federal judge revoked approval of mifepristone on April 7, but his order was put on hold, and two weeks later, the U.S. Supreme Court suspended the ruling until the Texas case is resolved.

In other words, the pharmacist may have been twice mistaken: Mifepristone is legal, and the rejected prescription isn't for mifepristone; it's for misoprostol — the other half of the two-drug regimen.

Other commenters were thrown off by the instructions to be passed along to the patient: "TAKE ONE TABLET PER VAGINA THE NIGHT PRIOR TO YOUR PROCEDURE." The confusion prompted the OB/GYN to add her own comment, in which she clarified that "one tablet per vagina" is the technical way of instructing the patient to insert the tablet into their vagina as opposed to, say, consuming it by mouth.
Then there was the diagnosis: "Stricture and stenosis of cervix uteri," a narrowing of the opening that connects the uterus with the vagina (the cervix), which can cause pain and other complications.

"I write this [prescription] weekly for preop on my hysteroscopies for cervical stenosis patients," a fellow OB/GYN commented beneath Gunter's tweet. "I have caught hell of late. I have to call every pharmacy and swear in blood that my post-menopausal patient with thickened endometrium isn't trying to abort. I am so tired of this."

Some patients shared that they too encountered resistance after being prescribed misoprostol for medical purposes other than abortion.

"I'm in Florida & was prescribed Misoprostol last week. I was grilled at Walgreens about it. I was able to get it, but everybody w/i earshot of the drive-thru knows more abt my vagina than they probably wanted to," one confided.

Wrote another: "I live in Tampa and they gave me a major hard time about this (for my endometrial biopsy!), it was infuriating."

And a third: "Texas here. Had misoprostol for IUD insertion last December. Was grilled by a tech at Walgreens about why I was filling it despite it being on the label and my doctor's office calling to clarify verbally what the two tabs were being used for. Ugh."

"Getting There Together"

As of 2016, according to the National Women's Law Center, 13 U.S. states had enacted laws or rules allowing pharmacists to decline to fill prescriptions on moral or religious grounds. Seven of those states permitted refusals but required that the patient be passed along to another pharmacist or their prescription transferred to another pharmacy. Six states specifically allowed refusals for religious or moral reasons with no strings attached. Eight states explicitly barred pharmacists from interfering with a patient's access to prescribed medication.

Under certain circumstances, pharmacists in Florida may — and may be required by law to — refuse to fill a prescription. Those regulations specify "controlled substances" and, in the case of Florida Statute 893, "drug abuse prevention and control."

Florida also provides some statutory protections for healthcare workers who refuse to participate in abortions, including a clause shielding them from liability for their refusal. And as New Times has previously reported, two similar bills pending in the Florida legislature would broaden those protections and go so far as to allow healthcare providers (including pharmacists) and insurers the right to deny a broad range of medical services to patients on the basis of moral, religious, and ethical beliefs.

Pending legislation would allow Florida pharmacists to deny prescriptions on the basis of moral, religious, and ethical beliefs.

tweet this

If the legislation passes, providers could deny healthcare services to a patient because of a "conscience-based objection" stemming from a "sincerely held" personal belief. Additionally, employers would be prohibited from punishing healthcare workers who cite such a "conscience-based objection" in refusing to perform abortions and countless other medical services.

The ACLU of Florida described the measure as "shocking in its breadth, vagueness, and government overreach into the private sector and regulated businesses."

In the wake of last year's Dobbs decision, Amy Thibault, director of external communications for CVS — whose Twitter bio reads, "Bringing heart. Prioritizing health. Getting there together." — confirmed to USA Today that the company policy balances pharmacists' rights with patients' rights.

"Under federal law, we must reasonably accommodate a religious conviction, and in certain states a moral or ethical conviction may prevent a pharmacist or pharmacy technician from dispensing specific medications," Thibault said in a statement.

USA Today noted, "Thibault said an objecting pharmacist must request an accommodation from CVS ahead of time and make arrangements to ensure patient care, either from a different pharmacist or elsewhere. Most states require that care providers who decline to provide services or prescriptions must find an alternate option for patients."

Under current Florida law, the patient whose misoprostol prescription was rejected may file a complaint with the state's Board of Pharmacy.

"Everyone Needs to Know This"

Several unstated truths lurk beneath the surface of the CVS pharmacist's alleged misattribution.

Though misoprostol has many other uses — including "priming" the cervix — doctors have known for years that administering it, alone or in combination with drugs other than mifepristone, is quite effective in inducing abortion.

Earlier this year, Slate's Christina Cauterucci spoke with Melissa Grant, chief operations officer at Carafem, which operates clinics in Atlanta, Nashville, Washington, D.C., and Chicago and also offers abortion medication via mail order. "We now find effectiveness rates with misoprostol by itself can be as high as 95 percent," Grant said. "Mifepristone and misoprostol are about 98 percent. So we're really talking about a small difference overall."

Gunter noted as much on her Substack blog, The Vagenda, last year.

"Mifepristone and misoprostol together is ideal, and while I think everyone should have that option, it may not be possible for everyone to access. So it is important that people know how effective misoprostol alone is and where they can get it." she wrote.
"There is no way any doctor or nurse or police lab can determine if you have taken it as long as you take it under your tongue or place the tablets against your cheek," added the OB/GYN. "Everyone needs to know this."

"Everyone needs to know this."

Gunter typed those words on May 5, 2022 — three days after the news site Politico leaked a draft of the U.S. Supreme Court's looming decision in Dobbs v. Jackson Women's Health Organization, which signaled the end of the federal guarantee to abortion that had endured since the court's 1973 ruling in Roe v. Wade.

Gunter's post was headlined, "Stop Talking About Coat Hangers and Start Talking About Misoprostol: Some thoughts on where we have been and where we go from here from an OB/GYN."

"The Prescription Has Been Filled"

Dr. Gunter was reluctant to elaborate on her April 25 tweet beyond confirming its authenticity and her relationship to the prescribing physician. She did, however, share the location of the CVS pharmacy that rejected the misoprostol prescription: 4890 Tamiami Trail East, just outside the Naples city limits.

A pharmacist who answered the phone there appeared to be familiar with the matter when asked about a recent prescription that had been refused. "The prescription has been filled," she said before declining to provide further information, referring the matter to CVS Health's corporate communications department.

"This was an isolated incident that was addressed and corrected on Tuesday [the same day Dr. Gunter's tweet was published]," the department's executive director, Mike DeAngelis, responded in an emailed statement. "We understand that the recent court decisions did not impact access to misoprostol and continue to dispense the medication as allowed by individual state law."