Why abortion bans impact access to medication for people with RA
With the decision Dobbs v. Jackson from the U.S. Supreme Court this summer, individual states were given increased power to restrict or ban abortions. One of the results of these strict abortion laws is that pharmacists have reportedly delayed or refused to fill common medications used to treat various chronic conditions such as rheumatoid arthritis, fearing that the medications could terminate a pregnancy.
A drug that has been central to some of these stories is mexthotrexate.
Methotrexate is prescribed approximately 90% of people with rheumatoid arthritis at some point during their treatment, reports the nonprofit patient organization Arthritis Foundation.
Following the Dobbs decision, the Arthritis Foundation issued a statement warn of potential medication disruptions and open a poll to learn more about the experiences of community members and said that several people have reported problems accessing medicines.
This month, a news outlet from Tucson, Arizona, reported that a teenage girl had been denied a refill of prescription medication due to fears it could cause the abortion of a hypothetical pregnancy.
Emma Thompson, 14, has been taking methotrexate for years to treat rheumatoid arthritis, an autoimmune disease that can cause widespread inflammation and debilitating joint damage.
But when her mother went to a local Walgreens to pick up the refill of this month’s medicine, the pharmacist at first refused to provide it to her. 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 ended up leaving with the meds that day, but I don’t know if they’ll be refilled next month,” she said. hello america. “I don’t know what the future holds right now, and not just for my daughter, but for every little girl who needs this medicine.”
Methotrexate is “classified as a disease-modifying anti-rheumatic drug, which means it can actually slow joint damage and disease progression over time, while reducing pain and swelling” , Anna Hyde, vice president of advocacy and access at the Arthritis Foundation, told Healthline.
Methotrexate is also used to reduce inflammation in other autoimmune diseases, such as psoriatic arthritis, juvenile idiopathic arthritis, Crohn’s disease, ulcerative colitis, and lupus.
In much higher doses, it can be used to treat an incomplete miscarriage or terminate an ectopic pregnancy, which is an unsustainable and life-threatening pregnancy that occurs outside of the uterus.
Due to methotrexate’s potential to terminate a pregnancy, some pharmacists may be reluctant to fill prescriptions for the drug in states that have restrictive abortion laws in place.
“New laws in various states require additional steps to dispense 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 legal and clinically appropriate prescriptions.”
Arizona state lawmakers recently passed a law banning most abortions after 15 weeks of pregnancy. Around the same time, the Arizona Court of Appeals halted enforcement of a near-total abortion ban that had been enacted after a lower court ruled that an 1864 law was valid.
The Arizona Medical Association is now asking the court to clarify the state’s abortion laws and what care health care providers can legally provide.
Thompson is not the only patient to report delays or disruptions in access to methotrexate, according to the Arthritis Foundation
“In total, we collected approximately 523 responses from patients across the country, including 16 indicating they had difficulty obtaining their medications since the Dobbs decision,” Hyde said. “These 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 also monitors disruptions in methotrexate access in people with Crohn’s disease or ulcerative colitis, two 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 extent of any disruption 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 drug interruptions for patients with inflammatory bowel disease are currently a widespread problem,” she added.
When access to methotrexate is delayed or interrupted, it can negatively affect patients who rely on this drug to control inflammation due to chronic conditions.
“Patients should follow the treatments prescribed by their healthcare professional, even when they don’t have symptoms, to prevent their disease from becoming active,” Wingate said. “Significant delays or refusal of treatment can increase disease activity, and the increased inflammation can make symptoms so severe that a patient may need to go to the emergency room, be hospitalized, or have need surgery.”
Even short-term delays can 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 abortifacient drugs, doctors and pharmacists can also struggle with uncertainty about when they can legally prescribe or dispense drugs such as methotrexate.
“Our members and patients are reporting that this uncertainty is disrupting care. Patients dependent on these drugs for reasons unrelated to pregnancy termination are reporting new challenges in accessing these and other drugs, and this puts the health of our patients at risk,” warned the American Medical Association, the American Pharmacists Association, the American Society of Health-System Pharmacists and National Association of Community Pharmacists in a
“Many healthcare professionals, including physicians and pharmacists, are unsure of their legal responsibility for prescribing and/or dispensing these drugs, whether used for abortion or other indications. “, adds the press release.
Several professional and patient organizations are now calling on lawmakers to protect access to methotrexate and other prescription drugs for people with chronic conditions.
Patients themselves can also take steps to limit or manage disruptions in access to medicines.
“We encourage patients to ask their providers to write the purpose of the prescription directly on it,” Hyde said. “This way, the pharmacist will be informed that the prescription is not for abortion.”
If a pharmacist refuses to fill a prescription for methotrexate or another drug, patients can 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 cannot access methotrexate or other medications to contact their prescribing physician first. Speak to your healthcare professional to help you access recommended treatment,” she recommended.
“We also urge patients with inflammatory bowel disease to contact the Crohn’s & Colitis Foundation by contacting our Irwin M. and Suzanne R. Rosenthal IBD Resource Center,” she continued. “The IBD Help Center can answer questions, provide resources to help you appeal drug denials, and connect you with our advocacy team.”
If necessary, patients can speak with their doctor to learn more about alternative treatment options.
Other drugs are available to treat autoimmune diseases such as rheumatoid arthritis and inflammatory bowel disease, but many of these drugs are more expensive than methotrexate.