Policy (Criteria)

1. Individual is being prescribed this medication for any medically-accepted use not related to pregnancy termination; OR
2.  Individual is being prescribed this medication for medication-induced pregnancy termination; AND
   1. No fetal heartbeat has been detected; OR
   2. Fetal heartbeat has been detected; AND
      1. Abortion is being performed or induced on a pregnant woman due to a medical emergency or performed to prevent the death of the pregnant woman, prevent serious risk of a substantial and irreversible impairment of a major bodily function, not including psychological or emotional conditions, of the pregnant woman; OR
      2. There is presence of a fatal fetal anomaly; OR
      3. Probable gestational age is not more than twelve weeks and the pregnancy is the result of rape or incest

Approval duration:

Diagnosis other than pregnancy termination: 1 year

For medication-induced pregnancy termination: 1 month

References

1. Fetal Heartbeat and Protection from Abortion Act, A70, R88, S474, 125th Session (2023). https://www.scstatehouse.gov/sess125_2023-2024/bills/474.htm
2. DailyMed - CYTOTEC- misoprostol tablet. (2025). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4ab12da7-5731-4e06-bf1c-bc3f2e711f12