What women can do if methotrexate is refused RA drugs

“Are you pregnant or planning to be pregnant?” asked the pharmacist.

Novelist Annie Noblin, 40, of West Plains, Missouri, had come to pick up her methotrexate prescription for her rheumatoid arthritis (RA). There had never been a problem before. But since Roe vs. Wade had been reversed on June 24, 2022, things had changed. Missouri is in a trigger state, where strict anti-abortion laws have been “triggered.”

What does RA medication have to do with abortion?

Sometimes methotrexate is used off-label to terminate ectopic pregnancies, and its use during pregnancy can cause miscarriages or birth defects. Women with RA in states with restrictive abortion laws now find themselves in the crosshairs.

Invasive health issues, delays in refills

Noblin had received a text message earlier in the day that his prescription was on hold. After hours of not hearing anything, she finally went to the pharmacy where she was told her rheumatologist needed to confirm it was not going to be used for an abortion. And she had to reveal if she was pregnant or planning to be.

“I was livid,” she said. “It was so overwhelming. Why are my breeding plans anyone’s business? The pharmacist said she couldn’t give me the medicine until I responded. I then been compelled to disclose my private personal information.

“And now I’m going to have to do it every time I try to fill a prescription. Because I can’t stand the principle; I have to have this medicine,” she said, adding, “What if I get pregnant? Am I am I then responsible for what is happening?

What the anti-choice side says about the patient’s predicament

When asked to comment on this question, Laura Echevarria, director of communications and press officer for the National Committee for the Right to Life, replied by e-mail: “It is absurd. No law passed or proposed by the pro-life movement prohibits physicians from prescribing methotrexate for arthritis. … There are no pro-life laws designed to prevent the administration of drugs for the treatment of arthritis.

The concern over access to methotrexate is real

And even, Steven Newmark, director of policy and general counsel of the Global Health Living Foundation, confirms that access to methotrexate is becoming an issue in our post-deer world. “We heard from women in some states who had trigger laws as a result of the Dobbs decision, that they were denied access to their FDA [U.S. Food and Drug Administration]–approved medication for their chronic condition. Additional barriers were put in place in some cases or more questions were asked. In some cases, we have heard of people who have just been turned down outright.

Pharmacists are at the heart of the conflict

Some states are trying to clarify the issue. Kentucky Pharmacy Board issued the following state of emergency:

“Any prescription or medical prescription for a drug which is known to be capable of causing an abortion is presumed by a pharmacy to be for indications other than the termination of pregnancy. A pharmacy issuing such prescription or medical prescription is not required to verify that the prescription or medical prescription does not violate any provision of this Chapter or KRS Chapter 216B. »

But when contacted, Amy Thibault, senior director of external communications for CVS Pharmacy, replied via email: “Some state laws restrict the distribution of drugs for the purpose of inducing an abortion. These laws, some of which provide for criminal penalties, have forced us to require pharmacists in these states to validate that the intended indication is not to terminate a pregnancy before they can fill a prescription for methotrexate or misoprostol.

What is the pharmacist’s obligation?

The American Pharmacists Association (APHA) sounded the alarm in its July report statementsaying “Today, in response to the recent decision of the Supreme Court of the United States in Dobbs vs. Jackson women’s health organizationthe US Department of Health and Human Services [HHS] The Office for Civil Rights (OCR) has been freed tips [PDF] for pharmacies that sets out their obligations under federal civil rights laws, in conflict with some state laws, and raises concerns for pharmacies and pharmacists in our country.

What’s more, says the APHA, “the guidelines also remove a pharmacist’s professional judgment in making decisions about the suitability of a prescribed drug for a patient; or counseling patients on medications and how to take them. The implications of these guidelines may have widespread unintended consequences beyond reproductive health services.

The group of pharmacists calls for clear policies

Waiting, E. Michael Murphy, PharmD, adviser for state government affairs at APHA, said, “We have urged state and federal government policymakers to take action to ensure that patients maintain access to FDA-regulated drugs and to evidence-based patient care services. This is a complicated question because each state’s laws and regulations are different. We encourage our members to refer to state laws and regulations. … And we encourage policymakers to provide explicit guidance to healthcare professionals on how to navigate these confusing regulations.

Healthcare providers are also limited

“Physicians have been placed in an impossible situation trying to fulfill their ethical duties to put the health and well-being of patients first,” said American Medical Association (AMA) President Jack Resneck Jr. ., MD, when he provided testimony (PDF) to the Oversight and Investigations Subcommittee of the House Committee on Energy and Commerce, July 19, 2022. “We have only begun to assess the full impact of the Dobbs decision,” he said. he declared, adding: have more questions than answers.

In the meantime, says Thibault SVC encourages providers to include their diagnosis on the prescriptions they write so pharmacists know immediately what the drug is for.

What can prescription holders do? In the end, the law is on the side of the patients

Section 1557 of the Patient Protection and Affordable Care Act is a federal law that broadly prohibits sex discrimination in federally funded health programs and activities. HHS Civil Rights Office is responsible for enforcing this. “These guidelines indicate that, generally, pharmacies cannot refuse to dispense reproductive health-related medications, including but not limited to misoprostol and methotrexate,” explains Michelle Bankerdirector of reproductive rights and health litigation at the National Women’s Law Center.

The reason, she continues, “is that their refusal may constitute discrimination based on sex, which includes discrimination based on pregnancy. It would also include discrimination based on disability, including certain autoimmune diseases that methotrexate is used to treat.

Remember: Pharmacies Must Fill Drug Prescriptions

The banker adds that another nuance is that it is possible that, in certain limited circumstances, an individual’s pharmacist or pharmacy employee may invoke certain federal laws that allow this type of refusal on religious grounds, but these denial laws do not extend to the pharmacy itself. . If someone at the pharmacy refuses to fill a prescription, someone else at the pharmacy must fill it.

What to do if you are refused medication

Invoke Section 1557. Bring a copy of “Advice to the Nation’s Retail Pharmacies: Obligations Under Federal Civil Rights Laws to Ensure Access to Comprehensive Reproductive Health Care Services.” On page 3, he lists two examples of how refusal of methotrexate can constitute discrimination based on gender or disability. Noblin, for example, could use this to refuse to give out invasive personal information. If you are up to it, you can also file a complaint with the HHS Office for Civil Rights or take legal action against the discriminating party.

Other help options

The Arthritis Foundation recommends the following:

  • Contact its toll-free hotline for one-on-one support from licensed social workers and trained staff at 800-283-7800.
  • Ask your doctor to write the purpose of the prescription on it — this way the pharmacist will know that the prescription is not for abortion.
  • Patients can also try sending their prescription to another pharmacy, discussing mail order deliveries or other medication options with their doctor if they are having trouble.

Global Foundation for Healthy Living and CreakyJoints The Global Foundation for Healthy Living and Creaking joints, advocacy organizations, are encouraging people to reach out to their elected officials to let them know about the importance of this lifesaving drug. To share your story with CreakyJoints, tweet at @zoerothblatt.

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