Comprehensive medication guide to Mifepristone including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$30 copay for abortion use on most ACA-compliant plans in abortion-legal states; coverage varies by state and plan. Korlym requires prior authorization (Tier 5 specialty); copays range from $50–$300+ depending on plan and deductible stage.
Estimated Cash Pricing
$50–$200 via telehealth for abortion use; $300–$800 at in-person clinics. Korlym (Cushing's) exceeds $15,000 retail without insurance. Abortion funds and patient assistance programs may significantly reduce costs.
Medfinder Findability Score
40/100
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Mifepristone is a synthetic steroid with two FDA-approved uses. Under the brand name Mifeprex, it is used in combination with misoprostol for medical termination of pregnancy through 70 days (10 weeks) gestation — a regimen used in approximately two-thirds of all US abortions. Under the brand name Korlym, it is used to control hyperglycemia caused by excess cortisol in adults with endogenous Cushing's syndrome who have type 2 diabetes and have failed surgery or cannot have surgery.
Originally developed in France in the 1980s and known by its code name RU-486, mifepristone was approved by the FDA on September 28, 2000. A generic version (Mifepristone Tablets, 200 mg) was approved in 2019, and a second generic from Evita Solutions was approved in October 2025. Mifepristone is on the World Health Organization's List of Essential Medicines.
Mifepristone is subject to the FDA's Mifepristone Risk Evaluation and Mitigation Strategy (REMS) Program for the abortion indication, which requires prescribers and pharmacies to be certified before prescribing or dispensing the medication. This REMS is a major driver of access challenges.
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Mifepristone works as a hormone receptor blocker with a dose-dependent dual mechanism. At low doses (200 mg for abortion), it competitively binds to progesterone receptors — more tightly than progesterone itself — without activating them. This prevents progesterone from maintaining the uterine lining, causing the embryo to detach, the cervix to soften, and the uterus to become sensitive to prostaglandins. When misoprostol (a prostaglandin analog) is taken 24-48 hours later, it induces uterine contractions to expel the pregnancy.
At high doses (300-1200 mg for Cushing's syndrome as Korlym), mifepristone also blocks glucocorticoid receptors — the receptors cortisol uses to raise blood sugar. By blocking these receptors, mifepristone prevents cortisol from causing hyperglycemia, even though blood cortisol levels may rise further as the body compensates. Mifepristone is rapidly absorbed (peak levels at ~90 min), is 98% protein-bound, and is metabolized primarily by CYP3A4 with a terminal half-life of approximately 18 hours.
200 mg — tablet
Mifeprex — used for medical abortion (Day 1 of regimen, single oral dose)
300 mg — tablet
Korlym — used for Cushing's syndrome hyperglycemia (once daily with food, titrated up to 1200 mg/day)
Mifepristone is one of the most access-restricted prescription drugs in the United States. The FDA's REMS Program requires that both prescribers and pharmacies be certified before mifepristone can be prescribed or dispensed. Most retail pharmacies — including the majority of major chain locations — have not completed REMS certification. Research shows that since the 2023 REMS update allowing retail pharmacy dispensing, less than 2% of mifepristone prescriptions filled at retail have been at in-store pharmacies; most are filled through mail-order pharmacies connected to telehealth services.
Access is further complicated by state laws. As of June 2026, 13 states have total abortion bans. Many others have gestational limits, telehealth restrictions, or specific mifepristone dispensing requirements. The legal landscape is evolving rapidly — a May 2026 Fifth Circuit ruling that would have reimposed in-person dispensing was stayed by the Supreme Court, but further changes remain possible.
Finding a certified pharmacy that carries mifepristone in your area can be frustrating. medfinder calls pharmacies near you on your behalf to find out which ones can fill your mifepristone prescription, then texts you the results. This is significantly more efficient than calling pharmacies yourself.
For the abortion indication (Mifeprex), prescribers must be certified under the FDA's Mifepristone REMS Program. Certification requires completing and signing a Prescriber Agreement Form attesting to clinical qualifications. Mifepristone is not a federally controlled substance, so no DEA registration is required. However, state law may impose additional requirements in some states.
REMS-eligible prescriber types include:
Telehealth availability: In states where abortion is legal and telehealth prescribing is not specifically prohibited by state law, mifepristone can be prescribed via telehealth by REMS-certified providers and mailed through certified pharmacies. As of June 2026, the Supreme Court has stayed the Fifth Circuit ruling that would have eliminated telehealth prescribing — so telehealth access is currently preserved in states where it is legally permitted.
Mifepristone is NOT a federally scheduled controlled substance under the DEA. You do not need a DEA-controlled substance prescription, and pharmacies do not need a DEA registration specifically for mifepristone. However, mifepristone is subject to the FDA's Mifepristone REMS Program, which imposes certification requirements on both prescribers and dispensing pharmacies that are more restrictive than those for most non-controlled prescription drugs.
Notable exception: Louisiana has enacted a state law classifying mifepristone as a state-level controlled substance. In Louisiana, providers and pharmacies must comply with controlled substance regulations under state law. This law is being challenged in state court. Patients and providers in Louisiana should consult current state legal guidance. No other state has enacted a similar state-controlled substance designation as of June 2026, though legislative activity in other states may change this.
For medical abortion (Mifeprex + misoprostol):
For Cushing's syndrome (Korlym) — common side effects (≥20%):
Serious side effects — seek emergency care:
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Misoprostol (off-label)
Prostaglandin analog used alone for abortion when mifepristone is unavailable. ~80-85% effective vs ~98% for mifepristone combination. Available without REMS restrictions.
Recorlev (levoketoconazole)
FDA-approved steroidogenesis inhibitor for Cushing's syndrome. Reduces cortisol production (different mechanism than mifepristone). Approved 2021.
Ketoconazole (off-label)
Antifungal used off-label to reduce cortisol synthesis in Cushing's syndrome. Available in generic, more affordable than Korlym. Requires liver monitoring.
Pasireotide (Signifor)
FDA-approved somatostatin analog for Cushing's disease (pituitary-dependent). Injected twice daily. Works upstream of cortisol production.
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Warfarin / Anticoagulants
majorContraindicated — mifepristone causes bleeding; combination significantly increases hemorrhage risk.
Aspirin / NSAIDs
majorContraindicated for mifepristone abortion use — aspirin increases post-abortion bleeding risk by inhibiting platelet function.
Strong CYP3A4 Inhibitors (ketoconazole, itraconazole, clarithromycin)
majorIncrease mifepristone blood levels significantly; limit mifepristone dose to 300-900 mg/day if combination is necessary.
Strong CYP3A4 Inducers (rifampin, carbamazepine, St. John's Wort)
majorDecrease mifepristone blood levels, reducing effectiveness; do not use Korlym with strong CYP3A4 inducers.
Corticosteroids (prednisone, dexamethasone)
majorContraindicated with Korlym — mifepristone blocks glucocorticoid receptors, potentially causing severe worsening of conditions requiring corticosteroid therapy.
Simvastatin / Lovastatin
majorContraindicated with Korlym — mifepristone inhibits CYP3A4, causing dangerous elevation of statin levels with risk of rhabdomyolysis.
QT-prolonging drugs
moderateUse with caution — mifepristone can prolong QT interval; combining with other QT-prolonging agents increases arrhythmia risk.
Grapefruit juice
moderateAvoid with Korlym — inhibits CYP3A4, raising mifepristone blood levels and risk of adverse effects.
Mifepristone is a safe, effective, and FDA-approved medication with a more than 25-year track record. Its clinical utility is well-established — as a medical abortion option, it is used in approximately two-thirds of US abortions, and as Korlym, it fills an important niche for Cushing's syndrome patients who have failed surgical treatment. However, access remains a significant challenge due to the REMS program, state laws, and legal battles over dispensing requirements.
For patients, the most common obstacle is not the prescription — it's finding a certified pharmacy that can fill it. Most retail pharmacies are not REMS-certified, major chains have inconsistent participation, and the legal landscape can change quickly. Knowing your resources ahead of time makes a meaningful difference.
If you're struggling to find a pharmacy that carries mifepristone, medfinder can call pharmacies near you to identify which ones are REMS-certified and can fill your prescription — then texts you the results. It's a paid service designed to take the burden of pharmacy searching off your plate so you can focus on what matters.
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