Not here, not now: a mystery caller study of availability of mifepristone in community pharmacies in Alberta, Canada.

Objectives: This study assessed same-day availability, dispensing practices, and information provision for mifepristone in Alberta pharmacies.

Study design: Cross-sectional data from 1620 pharmacies (>99% response) were collected from pharmacy respondents using a mystery caller approach (January to October 2024). Using a standardized script, team members inquired about mifepristone availability, Alberta's coverage plan, and dispensing. Outcomes included (1) same-day stock availability, (2) willingness to order, (3) refusal to order, and (4) conscientious objection. Accuracy of cost information and adherence to regulatory standards were assessed. Geographic patterns and associations with the deprivation index of pharmacy location were explored.

Results: Same-day dispensing was available at 12.9% pharmacies, and 76.2% offered to order it, with delivery times estimated from the next day to 10 days. A small number of pharmacies (n = 86, 5.3%) did not offer to order with no reason given; conscientious objection was reported by 90 pharmacies (5.6%), of which only 10.0% (n = 9) provided onward referrals. Awareness of Alberta's universal coverage for mifepristone was low; 71.1% of respondents incorrectly stated that uninsured patients must pay out of pocket. Mifepristone was less often in stock in Alberta's two major cities; pharmacies in high-deprivation areas were less likely to have mifepristone in stock and more often expressed conscientious objection.

Conclusion: Same-day mifepristone availability in Alberta pharmacies is limited, and adherence to referral standards among objectors is poor. Awareness of universal coverage is suboptimal, raising concern about overcharging. Enhancing access may require collaboration between abortion providers and pharmacies, increased communication about coverage policies, and innovative solutions related to dispensing.

Implications: Limited same-day access to mifepristone, compounded by poor adherence to regulatory standards and low awareness of public coverage, highlights equity gaps in abortion care across Alberta, Canada. Targeted policy reforms and pharmacist education are needed to improve timely, reliable access, particularly for socioeconomically disadvantaged communities.