- With the U.S. Supreme Court’s Dobbs v. Jackson ruling, some states have implemented strict laws that have virtually banned abortion.
- One result is that some pharmacists have not filled prescriptions for medications that could potentially end a pregnancy, even if they are being prescribed for chronic conditions.
- The Arthritis Foundation issued a statement warning of potential medication disruptions due to these laws.
With the U.S. Supreme Court’s Dobbs v. Jackson ruling this summer, individual states have been granted increased power to restrict or ban abortions. One result of these strict abortion laws is that pharmacists have reportedly delayed or refused to fill common medications used to treat a variety of chronic conditions such as rheumatoid arthritis over concerns that the medications could end a pregnancy.
One drug that has been at the center of some of these stories is the drug mexthotrexate.
Methotrexate is prescribed to about 90% of people with rheumatoid arthritis at some point in their treatment, reports the non-profit patient organization Arthritis Foundation.
Following the Dobbs decision, the Arthritis Foundation issued a statement warning of potential medication disruptions and opened a survey to learn about community members’ experiences and said multiple people reported issues accessing medication.
This month, a news outlet in Tucson, Arizona, reported that a teenage girl had been denied a refill on prescription medication due to concerns that it could induce an abortion of a hypothetical pregnancy.
Fourteen-year-old Emma Thompson has been taking methotrexate for years to manage rheumatoid arthritis, an autoimmune condition that can cause widespread inflammation and debilitating joint damage.
But when her mother visited a local Walgreens to pick up this month’s refill of the drug, the pharmacist initially declined to provide it. Although the pharmacy eventually filled the prescription, Thompson’s mother worries about the potential for future medication disruptions in a state where abortion-inducing drugs are restricted.
“I did end up leaving with the medication that day, but I don’t know if it’s going to be filled next month,” she told Good Morning America. “I don’t know what the future holds right now, and not only for my daughter, but for every little girl that needs this medication.”
Methotrexate is “classified as a disease-modifying anti-rheumatic drug, which means it can actually slow joint damage and disease progression over time, along with reducing pain and swelling,” Anna Hyde, Vice President of Advocacy & Access at the Arthritis Foundation, told Healthline.
Methotrexate is also used to reduce inflammation in other autoimmune conditions, such as psoriatic arthritis, juvenile idiopathic arthritis, Crohn’s disease, ulcerative colitis, and lupus.
At much higher doses, it may be used to treat an incomplete miscarriage or end an ectopic pregnancy, which is a non-viable and potentially life-threatening pregnancy that occurs outside the uterus.
Due to methotrexate’s potential to end a pregnancy, some pharmacists may be reluctant to fill prescriptions for the drug in states that have implemented restrictive abortion laws.
“New laws in various states require additional steps for dispensing certain prescriptions and apply to all pharmacies, including Walgreens,” the pharmacy chain commented in a statement reported by Good Morning America. “In these states, our pharmacists work closely with prescribers as needed, to fill lawful, clinically appropriate prescriptions.”
State legislators in Arizona recently passed a law to prohibit most cases of abortion after 15 weeks of pregnancy. Around the same time, the Arizona Court of Appeals halted the enforcement of a near-total abortion ban that had been enacted after a lower court ruled that a law dating to 1864 was valid.
The Arizona Medical Association is now asking the court to provide clarity around the state’s abortion laws and the care that healthcare providers can legally provide.
Thompson is not the only patient to report delays or disruptions in methotrexate access, according to the Arthritis Foundation
“In total, we’ve garnered approximately 523 responses from patients across the country, with 16 indicating having trouble getting their medication since the Dobbs decision,” said Hyde. “Those 16 responses were from states that have abortion restrictions or bans in place, including Arizona, Idaho, Missouri, South Carolina, Utah, Tennessee, and Texas.”
The Crohn’s & Colitis Foundation has also been monitoring disruptions to methotrexate access among people with Crohn’s disease or ulcerative colitis, which are both forms of inflammatory bowel disease.
“We are aware of cases that have been publicly recorded, and the Crohn’s & Colitis Foundation is closely monitoring the issue to determine the scope of any disruptions and to support patients who may have been denied access,” Laura Wingate, Executive Vice President of Education, Support, & Advocacy at the Crohn’s & Colitis Foundation, told Healthline.
“Our ongoing conversations with medical providers and patients do not immediately indicate that such medication disruptions for inflammatory bowel disease patients are currently a widespread issue,” she added.
When methotrexate access is delayed or disrupted, it may negatively affect patients who rely on this medication to keep inflammation from chronic conditions in check.
“Patients should take prescribed treatments as directed by their healthcare professional, even when they do not have symptoms, to prevent their disease from becoming active,” Wingate said. “Significant delays or denial of treatment may increase disease activity, and the increased inflammation can cause symptoms to become so bad a patient may need to visit the emergency room, be hospitalization, or require surgery.”
Even short-term delays may negatively affect patients and their families by contributing to stress, uncertainty, and increased challenges in disease management.
Due to a lack of clarity in the wording of laws that restrict abortion-inducing drugs, physicians and pharmacists may also struggle with uncertainty over when they can legally prescribe or dispense medications such as methotrexate.
“Our members and our patients report that this uncertainty is disrupting care. Patients who rely on these medications for reasons unrelated to pregnancy termination report new challenges in accessing these and other medications, and it is placing our patients’ health at risk,” warned the American Medical Association, American Pharmacists Association, American Society of Health-System Pharmacists, and National Community Pharmacists Association in a
“Many health care professionals, including physicians and pharmacists, are uncertain of their legal liability related to prescribing and/or dispensing these medications regardless of whether they are being used for an abortion or another indication,” the statement added.
Multiple professional and patient organizations are now calling on lawmakers to protect access to methotrexate and other medications prescribed to people with chronic conditions.
Patients themselves may also take steps to limit or manage disruptions to medication access.
“We’ve been encouraging patients to ask their providers to write the purpose of the prescription directly on it,” said Hyde. “That way, the pharmacist will be informed that the prescription isn’t for abortion.”
If a pharmacist refuses to fill a prescription for methotrexate or another drug, patients may try sending the prescription to another pharmacy or consider mail-order prescription delivery.
If they can’t get a prescription filled, Wingate encourages them to contact their doctor.
“We urge patients who are unable to access methotrexate or other medications to first contact their prescribing physicians. Talk to your healthcare professional about helping you get access to the recommended therapy,” she recommended.
“We also urge inflammatory bowel disease patients to contact the Crohn’s & Colitis Foundation by contacting our Irwin M. and Suzanne R. Rosenthal IBD Resource Center (IBD Help Center),” she continued. “The IBD Help Center can answer questions, provide resources to help appeal denials of medications, and connect you with our advocacy team.”
If necessary, patients can talk with their doctor to learn about alternative treatment options.
Other medications are available to treat autoimmune conditions such as rheumatoid arthritis and inflammatory bowel disease, but many of those medication are more expensive than methotrexate.