A 14-year-old girl was denied arthritis medication as part of Arizona’s abortion ban

For years, Deborah Power, a rheumatologist in Tucson, prescribed methotrexate to manage her 14-year-old patient’s rheumatoid arthritis. But just two days after the state’s abortion ban took effect last month, a pharmacy refused the teenager’s renewal.

The reason: At a higher dose, methotrexate – a drug used to treat certain cancers, arthritis and a host of autoimmune diseases – can also cause abortions and terminate ectopic pregnancies, although this may not be its most common use, Power told the Washington Post.

Emma Thompson was finally able to get her prescription filled, but the delay highlights the medical complications some patients face in states with strict abortion rules. Although drugs are not prescribed to terminate a pregnancy, the June reversal of Roe vs. Wade has thrown pharmacists, patients and doctors into a “constant juggling act,” Power said, balancing medical care with changing policies and potential legal ramifications.

“I don’t think everyone understands what the ramifications of such a broad and sweeping anti-abortion law are and how many other women are affected by it,” she added. “For example, how can we decide that women cannot have this medicine that men can have? It is gender discriminatory. And how can you make a law that does not allow me to provide quality care to my patients? »

Abortion ban complicates access to drugs for cancer, arthritis and even ulcers

Throughout Emma’s life, rheumatoid arthritis – an inflammatory disease that causes the body’s immune system to attack healthy tissue in joints – has resulted in prolonged hospital stays, clinical trials and simply ” too much pain to have a normal life,” said her mother, Kaitlin Préble. For 10 years, her daughter’s doctors experimented with different doses of methotrexate, finally hitting the right amount about a year ago that allows Emma to thrive, go to school and “just be a normal teenager,” Preble said.

All of that seemed to be in jeopardy on September 25, when Preble checked her Walgreens app to see if Emma’s prescriptions were ready. Instead of a green light saying they could be picked up, a message popped up saying his methotrexate refill had been declined.

“It didn’t even give the reason,” Preble said. “He just said I had to call my doctor.”

Still, Preble said she had a clue that the state’s new abortion ban — which dates back to the 19th century and bans the procedure except to save the pregnant woman life – had something to do with it. Her suspicions were confirmed the next day, when Preble went to the pharmacy “and made a big deal inside,” she said.

Arizona is one of several Republican-controlled states that point to a century-old law as justification for reducing access to abortions. (Video: Julie Yoon, Joshua Carroll/The Washington Post)

At first, no one explained why her daughter was unable to get a drug that was “crucial to her health,” Preble said. Then she pressed a pharmacy technician for answers.

“The pharmacist said she denied it because Emma was 14,” which is considered childbearing age, Preble said. “The pharmacy technician then asked, ‘Well, have you looked at his story? She’s been on this medicine for a long time,” and the pharmacist said, “No,” which I think was very important. »

All the while, Preble was shaking and crying: “I understand that pharmacists are afraid because they don’t want to assume anything. But it is extremely unfair to put a child through this unpredictable situation. And we shouldn’t have to go through all those steps to get a drug.

In a statement to The Post, a spokesperson for Walgreens said that while the company cannot discuss individual patients, “new laws in various states require additional steps to dispense certain prescriptions and apply to all pharmacies, including Walgreens”.

“In these states, our pharmacists work closely with prescribers as needed, to fill legal and clinically appropriate prescriptions,” the spokesperson said. “We provide ongoing education and information to help our pharmacists understand the latest requirements in their field.”

Patients across the country are facing similar situations as more drugs are reviewed. Many drugs are teratogens or drugs that can cause fetal abnormalities and miscarriages if taken by a pregnant woman. In some cases, women must prove they are taking birth control or submit pregnancy tests to pharmacies to fill prescriptions for drugs that can end pregnancies, The Post previously reported.

With regard to methotrexate – which is used or has been used by nearly 60% of patients with rheumatoid arthritis – medical groups have previously said there are growing difficulties in accessing the drug. In Texas, for example, pharmacists are allowed to refuse to fill prescriptions for misoprostol and methotrexate under the state’s “heartbeat bill.” The American College of Rheumatology in July urged pharmacists across the country to provide the drugs “without delay and assuming they are not used to terminate a pregnancy”.

“Methotrexate must remain accessible to people with rheumatic diseases, and legal safeguards must protect rheumatology professionals, pharmacists and patients from potential legal penalties,” the medical group said in a statement.

Federal authorities warn pharmacists against refusing abortion drugs

The new laws have also affected patients with other conditions, such as Crohn’s disease and ulcerative colitis. In August, the Crohn’s & Colitis Foundation said it “vehemently opposes” policies that prevent patients from accessing approved treatments.

“The decision on the most appropriate therapy for their condition should be made as a shared decision between a patient and their healthcare professional, based on medical evidence,” the organization wrote in a statement. statement.

Although her daughter’s next refill isn’t due for a month, Preble said she’s already dreading the possibility of another denial.

“These laws are just too extreme and don’t take into account all the different scenarios people face,” she said.

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