Insurance and Medicaid

Private Insurance

Most of the commercial payers and State Medicaid programs across the country have developed reimbursement policies for Mifeprex*. In general, if surgical abortions are covered, the payer will most likely cover Mifeprex.

Since everyone has different coverage, it is important that you remind patients to check directly with their health insurance company to find out if Mifeprex is covered. For most patients, office visits and lab tests will be covered as will the medication. In addition, you may wish to remind patients that they are responsible for any copayments, deductibles or coinsurance that normally apply under their health insurance policy.

Medicaid

The federal Medicaid program will only provide funding for abortion in cases of rape or incest, or when the woman's life is in danger. However, some states go beyond the minimum coverage set by the federal guidelines, and fund abortions, including Mifeprex. The following states currently provide some coverage for abortion services.

Alaska	Illinois	Montana	Oregon
Arizona	Maryland	New Jersey	Vermont
California	Massachusetts	New Mexico	Washington
Connecticut	Minnesota	New York	West Virginia

Since it takes time to qualify for Medicaid, some women may be eligible for Emergency Medicaid. Emergency Medicaid covers pregnant women who do not have health insurance and who meet Medicaid income and asset limits. Emergency Medicaid may cover the cost of an abortion. Check with your state Medicaid program for more information on coverage and policies.

For information on reimbursement codes for Mifeprex click here.

IMPORTANT SAFETY INFORMATION

Serious and sometimes fatal infections and bleeding occur very rarely following spontaneous, surgical, and medical abortions, including following Mifeprex use. No causal relationship between the use of Mifeprex and misoprostol and these events has been established. A high index of suspicion is needed to rule out serious and rarely fatal infections (e.g. Clostridium sordellii) and sepsis that can present without fever, bacteremia or significant findings on a pelvic exam, with or without abdominal pain, but with leukocytosis with a marked left shift, tachycardia, hemoconcentration, and general malaise.

Cramping and bleeding are expected; bleeding may continue for 9-16 days. 5-8% of women will need a surgical procedure to end a pregnancy or stop heavy bleeding.

Patients should be counseled to seek immediate medical attention if they experience sustained fever (100.4° F or higher), severe abdominal pain, prolonged heavy vaginal bleeding, syncope or general malaise more than 24 hours after taking misoprostol.

Mifeprex should not be used in cases of confirmed or suspected ectopic pregnancy, as Mifeprex is not effective in terminating these pregnancies. Physicians may need to consider the possibility of a ruptured ectopic pregnancy, even if efforts were made to rule out an ectopic pregnancy, because an ectopic pregnancy may have been missed.