fmcMAB | mifepristone + misoprostol

Provider Education

• Video CME | RHAP Protocol

Pregnancy Consult

• dotFMCPREGCONSULT

• Provide Options Counseling
  (initially and continually).

• Establish GA (LMP +/- US) -
  available at FMC up to 11,6.

• Confirm IUP.
  MAB NUS (no-ultrasound) exception rather than rule, but dotFMCMABNUS available to evaluate.

• Confirm patient prefers fmcMAB to referral.

Mifepristone administration

• Arrange with MAB Provider (list in Epic) prn.

• Can be same or different day as workup.

• MUST BE A SEPARATE ENCOUNTER if Self-Pay Package use.

MAB CPT: S0199 Self-Pay Charge Code: 601042

Financial Considerations

• Discuss ASAP if uninsured
  Self-Pay $200 BUT covered by most insurance.

• Contact FMC BH
  for ANY suggestion of financial need.
  
  👆Cobalt Abortion Fund

Faculty Role

• Review this page with provider, as far ahead of mifepristone visit as possible.

• Discuss the clinical scenario in a reproductive justice framework, including coercion, options counseling, patient autonomy and structural factors reducing it.

• Facilitate precise history taking and dating.

• Confirm IUP or appropriate use of MABNUS checklist.

• Support the team: reception, nursing, BH, provider.

• Ensure completion of paperwork.

• Vet follow-up plan and promote OWNERSHIP.

Contraception & Sexual Activity

• Acknowledge risk of coercion from encouraging (vs offering) contraception in this context.

• Combination hormonal contraception (oral, patch, ring) may begin per convenience starting day after misoprostol, even w/ bleeding.

• Depo appropriate, but ideal timing unclear and admin on the day of MAB has theoretical implications for efficacy.

• Nexplanon or IUD can take place at a follow-up visit if desired and a bridge method can be prescribed until that time.

• Patients considering tubal ligation should be referred as appropriate to avoid delays, w/ bridge method prn.

• Patients may begin to have vaginal sex with or without barrier contraception after 72 hours.

LARC Statement of Principles