SJennifer Crow saw a marked improvement in the pain of her inflammatory arthritis symptoms shortly after starting methotrexate treatment in February. Since then, she’s taken the drug weekly. So her stomach dropped on July 1, when she got an automated call from her pharmacy saying her methotrexate refill for the month hadn’t been approved.
Crow, 48, lives in Tennessee and was distraught by the disruption until she saw it on social media. other people were reporting similar denials. Methotrexate—which in high doses is used as a chemotherapy drug—is sometimes prescribed to induce abortions, complicating its use in states that have restricted abortion access in the aftermath of Roe v. Wade being overturned.
Crow eventually did get her medication after her doctor re-processed the refill request, but she says temporarily going without it caused her pain and fatigue to flare up—and made her nervous about the future. While neither Crow’s doctor nor her pharmacy explicitly said that methotrexate’s link to abortion affected her prescription, she feels the timing is suspicious. Tennessee, her home state forbids abortions within six weeks. It is preparing to ban abortions in its entirety next month.
Crow believes that pharmacies will be able to have more clear policies regarding non-abortion-related prescriptions of methotrexate. But if not, “we’re going to be test cases,” she says. “That still worries me.”
Methotrexate, an antimetabolite is a drug which suppresses certain cell functions. It is commonly administered by injectable or orally. It’s approved by the U.S. Food and Drug Administration to treat some cancers, but it’s also commonly used for conditions including lupus, arthritis, and psoriasis. It is also used by doctors to stop ectopic pregnancy. This occurs when a fertilized egg is born outside of the uterus. The unviable pregnancy can cause serious complications. Methotrexate stops cells from growing and ends pregnancy.
While methotrexate is not one of the drugs typically used in an elective medication abortion—those drugs are mifepristone and misoprostol—it can be used for that purpose. It is not recommended to use methotrexate if you are pregnant.
Texas is one of the states that have specific laws which specifically identify methotrexate (as an abortion-inducing medication) and place restrictions on its usage. Texas’ law does note, however, that such drugs are prescribed for non-abortion-related reasons that are exempt from those regulations.
Similar distinctions are made in other states. In Kentucky, a “trigger” law banned nearly all abortions in the state after Roe v. Wade Although the policy was overturned it is still being enforced in court. But on July 1, the Kentucky Board of Pharmacy emailed pharmacists and pharmacy interns in the state to remind them that, under Kentucky state law, “if a pharmacist receives a prescription and it doesn’t say, ‘for the induction of abortion,’ they can assume that it’s not for abortion,” explains executive director Christopher Harlow. This means pharmacists may fill prescriptions for drugs like methotrexate normally, if there’s no indication that it’s meant for abortion.
Harlow claims that the board has never received reports about patients not being able to get prescriptions. However, other organizations have reported that they received reports of patients being denied prescriptions.
“We have heard of a handful of cases of patients being completely denied [prescriptions] simply because they’re of childbearing age,” says Steven Newmark, director of policy at the Global Healthy Living Foundation, a nonprofit that supports people with chronic illnesses. Other patients have been told they “need to go back to their doctor, or the pharmacist has to check with the doctor, or the doctor is being wary and more reluctant” to prescribe drugs like methotrexate, Newmark says.
Michael Murphy, American Pharmacists Association’s advisor on state government affairs, said that pharmacists might be more reluctant to fill prescriptions for methotrexate if they are practicing in states where abortion providers could be legally and financially held liable. Laws vary quite a bit from state to state, and many leave enough gray area that it’s not always obvious when or how someone could be liable.
It’s also not clear how many patients have been denied methotrexate, though a numberThis is peopleHave shared their experiencesSocial media. Several health groups—including the Lupus Foundation of America, Arthritis FoundationPlease see the following: American College of Rheumatology—recently posted statements about reported access issues and told patients to contact them if they ran into problems.
Murphy says reports of patients being denied methotrexate are anecdotal, so it’s hard to get a handle on how common they are. But, he says, “any reports of patients not being able to receive their medications and maintain that continuity of their care is very concerning for us as pharmacists.”
Newmark hopes that states will make a commitment to keep these drugs available, so it doesn’t become a major problem. “If things don’t get remedied quickly,” he says, “it’s going to require more action.”
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