As abortion bans mount in states across the country in the wake of the Supreme Court’s overturning of Roe v. Wade, abortion seekers in states where the procedure is banned are increasingly turning to online telemedicine providers.
Cindy Adam is one of those providers—as well as the co-founder and chief executive officer of Choix, a virtual clinic which offers sliding-scale telemedicine abortion services to people in California, Colorado, Maine, New Mexico, Illinois and Virginia (with more states coming soon). Choix clinicians can also prescribe advance provision abortion medication, birth control, emergency contraception, and other reproductive health-related services.
“It really helps to alleviate the stress and the barriers that come with accessing such a highly stigmatized and politicized form of care, even in the states where abortion care remains legal,” Adam said of the service. “It puts that power to decide back into the hands of the person seeking care.”
In this Q&A, Adam answers all your pressing questions about telemedicine abortion, including:
- What do you need to do to get abortion pills, and what does the process of taking them look like, from start to finish?
- What is advanced provision abortion medication, and how can you get it?
- And more!
Watch the video here, or read the transcript below.
00:00:04 Allison Fine:
Hi, everybody. I’m Allison Fine, having the wonderful opportunity to talk to Cindy Adam today. Cindy is a nurse practitioner and the cofounder of Choix, which I love—an online clinic that provides access to reproductive healthcare, including abortion medication and birth control, emergency contraception, STI testing, urinary tract infection, everything people of reproductive age and capability need.
And Choix is amazing, because it’s all virtual, asynchronous, you type, they type, and solving a huge amount of problems in a beautiful way. And so, welcome, Cindy. Thank you for taking the time today.
00:00:55 Cindy Adam:
Thank you so much, Allison, really appreciate you having me on today.
00:00:58 Allison Fine:
So, Cindy, can you walk us through exactly how abortion care happens online with Choix?
00:01:05 Cindy Adam:
Absolutely. If someone is interested in seeking abortion care via telehealth with Choix, you’d go to CHOIXHealth.com, and you would complete an initial online medical questionnaire. It reviews only the most pertinent information about your medical history, so that our providers can determine whether or not abortion care via telehealth is a safe fit for them. What they’ll do is answer those questions, and then be prompted to create a patient portal account with us.
Within one business day, one of our fantastic nurse practitioners or midwives will review your questionnaire, and then follow up with either a regular text or an encrypted text, if that’s your preference, just to either confirm some of medical history and follow up, or just to approve you to proceed with care. After that, the next step is to complete some consent forms that are required as part of the process, and then, we send prescriptions to the address that you’ve signed up with for shipping.
And the final steps include some additional follow-ups with us, a medication check-in to ensure you’ve received your medications, a 72-hour follow-up, which is a way for us to check in, to assess your symptoms, to ensure the process is complete, and that folks are feeling stable and well, and then, the final check-up is around four to five weeks, where we confirm a negative pregnancy test or the return of a person’s normal menstrual cycle.
Providers are available along the way to check in with folks if they have any questions or concerns, and of course, we provide a plethora of educational materials and a video to help support people with any questions they might have.
00:02:37 Allison Fine:
Now, this is not a fly-by-night operation. You and your cofounders are all medical professionals. You have clinicians on staff, right? This is not, you didn’t just happen into this one day. When did this start, about two years ago, with Choix?
00:02:56 Cindy Adam:
Yes, our two-year anniversary is in a couple weeks. When we first opened our virtual doors, our amazing team of cofounders started Choix with Lauren Dubey, nurse practitioner. We studied together at UCSF, and Lauren worked for many years as a lead clinical trainer at Planned Parenthood before joining Choix full-time. Dr. Aisha Wagner, a fantastic family medicine doctor, who wears many hats, but has been part of those studies looking at the abortion care via telehealth model, is the medical director for TEACH, is one of our co-medical directors here for Choix, also contracts for Planned Parenthood, doing abortion care. And then, of course, my partner in all things, Mark Adam, who is our CTO.
00:03:43 Allison Fine:
So, tell me what states you’re working in right now, Cindy?
00:03:47 Cindy Adam:
We currently offer care in California, Colorado, Illinois, New Mexico, Maine and Virginia.
00:03:54 Allison Fine:
Okay. So, if someone from, say, Texas contacted you, what would happen?
00:04:02 Cindy Adam:
So, if anyone contacts us from a state where we are not licensed to provide care, what we do is provide them information about the process, and information about the types of questions that we are going to ask in our healthcare forms. So, we can essentially let them know what the clinical protocols and information is that’s required, so that that person might be able to understand if they need to have an ultrasound, and when would be the best times that would be to travel for care to one of the states that we serve.
We can only provide care in the states where we’re licensed to operate and provide care, but we can definitely help coordinate care and provide information for folks who are planning to travel, and we do it all the time, and more and more every day.
00:04:44 Allison Fine:
I mean, you really are not turning anybody away. What are the costs of the services, Cindy?
00:04:51 Cindy Adam:
We currently offer our care on a sliding scale. We felt that that was really important to help improve equity in telehealth, and we were offering our services at 289. That’s sort of our goal price in terms of being able to support our clinic, but we offer care as low as 175 to 350, if folks can give more to help to support the care of others, and we also work with abortion funds, amazing funds like ACCESS, and Chicago Abortion Fund, and more, to help get that cost down even more for folks, because we know even 175 is really too much for many.
00:05:23 Allison Fine:
Isn’t that something? So, tell me about your partnership with Honeybee Health. Why did you choose them and what do they do?
00:05:30 Cindy Adam:
Honeybee Health is a fantastic online pharmacy. They were one of the first pharmacies to offer mifepristone via mail, when the FDA at first modified the REMS and allowed temporarily for the mailing of the medication. Previously, there was an in-person dispensing requirement. And we have been working with Honeybee since 2021 to send medications to our patients. They are a fantastic partner in this care because they are able to get medications right to your door. You don’t have to go to a clinic or make an appointment in-person in order to access this care.
00:06:14 Allison Fine:
So, let’s just translate a bit for some folks who may not be familiar with the two medications and what the REMS are for abortion medication.
00:06:23 Cindy Adam:
Yes. So, the two medications in the FDA-approved medication abortion process, the first one is mifepristone. It’s one tablet that’s taken by mouth, and it is a progestin-blocker. So, that’s what stops the pregnancy from continuing. That medication has a special designation where it’s part of a REMS program, which is the risk-evaluation and mitigation strategy by the FDA. This designation is truly political. It is basically stated that a clinician must dispense this medication, and essentially, pharmacies couldn’t retail it or provide this medication to people at local pharmacies for pick-up.
You had to be in-person to pick it up. Mifepristone is extremely safe medication. It’s safer than Tylenol, and it is something that many people have been lobbying for a long time to get out of this REMS category. Most recently, so, at first in 2020, it was a federal district court ruling because of the pandemic that allowed for this temporary change in the REMS, and allowed for the mailing of mifepristone. And then, lots of bouncing back and forth in the courts, made it to the Supreme Court, went back to the FDA.
Finally, in December of 2021, they permanently modified the REMS and removed the in-person dispensing requirement, although I think many of us in the moment feel very strongly that they did not go far enough. They should have completely removed the REMS on mifepristone, but there was some change, and so, now we can work with Honeybee. And eventually, when the updated version of the REMS comes out, hopefully other pharmacies will be able to join in this space more easily and provide the medication.
00:08:16 Allison Fine:
So, just to connect all the dots for folks who are listening to this, Cindy, somebody can go online, maybe through DuckDuckGo, which is a, you know, a safe web browser, connect whenever they have time with one of your clinicians, go back and forth by text, make sure that they are healthy for this option, and get the prescription online, through Choix, that then goes to Honeybee Health online…
00:08:47 Cindy Adam:
That’s correct.
00:08:48 Allison Fine:
…and the medication is mailed to them. Women never have to move, right?
00:08:55 Cindy Adam:
Never have to leave their home.
00:08:57 Allison Fine:
Never have to leave their home, and so private. Now, you had a super-exciting announcement a couple of weeks ago that is just, I know it’s almost trite to say, but absolutely game-changing. Tell us about Advance Provision of Abortion Medication.
00:09:14 Cindy Adam:
Yes. So, we were really excited to recently begin to offer Advanced Provision of Medication Abortion, which is when we do a medical evaluation, and then provide a prescription for folks who want to have abortion medications on hand for as-needed future use. We offer the care very similarly to how you might access a medication abortion, you’re just not pregnant at the time, and we do the same sort of initial medical review, just to make sure that you’re not allergic to the medications that we plan to prescribe, and a review of your medical history.
We send the medications, along with our educational materials, folks sign the same consent forms, and then, should someone become pregnant in the future, should they decide that they want or need to have an abortion, they can come back to us for clinical care and support, and we’re there for them throughout the process.
00:10:09 Allison Fine:
It’s just so remarkable, and so brilliant, and so courageous of you all. This is, what you’re really saying is, get your pills now, put them in the medicine cabinet, put it in your shoe, put it in your purse, wherever you want to put it, and if you ever need them, there they are, right? And you don’t have to worry about going over 12 weeks. You don’t have to worry about not being able to afford them at the time, right? You’re going to provide pills to people before they need them, if and when they ever need them. I think that’s just brilliant. What’s been the response to this announcement?
00:10:47 Cindy Adam:
Yeah, exactly. We’ve had a lot of excitement over this expansion of access to care. We were very excited to join our colleagues who have been providing this care at Aid Access and other individual providers who have been doing this, and really paved the way. We felt that it was really important to join them in offering this care, because, you know, it really helps to alleviate the stress and the barriers that come with accessing such a highly-stigmatized and politicized form of care, even in the states where abortion care remains legal, because it really puts that power to decide back into the hands of the person seeking care.
They’re able to access that care when they need to, and they’ll have the clinical support that they deserve with Choix.
00:11:33 Allison Fine:
This is just fantastic. Now, Cindy, take out your crystal ball, tell us, where do we go from here for abortion care in this country?
00:11:41 Cindy Adam:
My goodness. You know, I have high hopes for everyone who has been working to get out the vote in November. I know that people have felt a lot of emotions around voting, just because they feel like sometimes that it doesn’t work, but the truth is, is that voting is more important now more than ever. And so, for the future of abortion care, and not just abortion care, but all of our reproductive freedoms and rights that we know we deserve and need, I think that’s really key.
In addition to that, really continuing to work and support the organizations at the forefront of this care, including the folks at PlanCPills.org, folks who are looking to access care, AbortionFinder.org, INeedAnA, and working with all of the different, really huge practical support groups. An often extremely important part of care for folks is really healthcare meeting, getting to be able to that clinic or to a state where you can access abortion care via telehealth, really looking to support, practical support.
So, whether that be, you know, looking at the folks at the Brigid Alliance, connecting with practical supports, the groups listed on INeedAnA.org, all amazing, amazing different organizations and people working in different ways to improve and provide access to abortion care on many different levels.
00:13:12 Allison Fine:
This is fantastic. Cindy Adam, nurse practitioner, co-founder of Choix, thank you so much for everything that you do.
00:13:21 Cindy Adam:
Thank you so much, Allison. I’m so lucky and so privileged to work with such an amazing group of people, and to be a part of this incredible community advancing access to care, so thank you so much for having me.
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