Abortion restrictions may affect access to Methotrexate

SAfter starting methotrexate in February, Jennifer Crow noticed a dramatic improvement in her arthritis pain. Since then, she takes the medication weekly. So her stomach dropped on July 1, when she received an automated call from her pharmacy saying her methotrexate refill for the month had not been approved.

Crow, 48 and living in Tennessee, was baffled by the disruption, until she saw on social media that The others reporting similar denials. Methotrexate — in high doses used as a chemotherapy drug — is sometimes prescribed for abortions, complicating its use in states that restrict access to subsequent abortions Roe v. Wade overturned.

Crow eventually received her medication after her doctor re-processed the refill request, but she said that temporarily not doing so would cause her pain and fatigue to flare up — and makes her worry about the future. Although neither Crow’s doctor nor her pharmacy explicitly said that methotrexate’s link to the abortion affected her prescription, she felt the timing was questionable. Her home state of Tennessee now bans most abortions after about six weeks and is set to be performed A near-total abortion ban next month.

Crow hopes that, in the future, pharmacies will have a clearer policy on how to handle non-abortion-related methotrexate prescriptions. But otherwise, “we will become test cases,” she said. “That still worries me.”

Methotrexate is an antimetabolite, a group of drugs that block certain cellular functions, usually given by mouth or by injection. It has been approved by the U.S. Food and Drug Administration to treat certain cancers, but it is also commonly used for conditions including lupus, arthritis, and psoriasis. Doctors also use it to end an ectopic pregnancy, in which a fertilized egg grows outside the uterus, resulting in a non-viable pregnancy and the risk of life-threatening complications. pregnant. Methotrexate ends pregnancy by stopping cells from dividing.

Although methotrexate is not one of the drugs commonly used in an elective medical abortion—These drugs are mifepristone and misoprostol-it can used for that purpose. Pregnant women are advised not to take methotrexate because it can cause serious harm to the unborn baby.

Some states, like Texas, whose law specifically lists methotrexate as an abortifacient, places restrictions on its use. However, Texas law notes that such drugs prescribed for reasons unrelated to abortion are exempt from those regulations.

Other states have similar distinctions. In Kentucky, the “trigger” law banned nearly all abortions in the state after Roe v. Wade was overturned, even though that policy is currently binding in court. But on July 1, the Kentucky Pharmaceutical Board emailed pharmacists and pharmacy interns in the state to remind them that, under Kentucky law, “if a pharmacist receives a prescription and it doesn’t say ‘to initiate an abortion,’ they might assume it’s not for abortion,” explains chief executive Christopher Harlow. medication such as methotrexate normally, if there is no indication that it is intended for an abortion.

Harlow said the board has not received any reports of patients being denied prescriptions. But other organizations say they have.

“We have heard of a small number of cases where patients were completely rejected [prescriptions] simply because they are of childbearing age,” says Steven Newmark, policy director of the Global Healthy Living Foundation, a nonprofit that supports people with chronic conditions. Other patients have been told they “need to go back to the doctor, or the pharmacist has to check with the doctor, or the doctor is more wary and reluctant” to prescribe drugs such as methotrexate, Newmark speak.

Michael Murphy, state government affairs adviser at the American Pharmacists Association, said pharmacists may be reluctant to prescribe methotrexate if they practice in states where providers may be responsible. legal or financial responsibility to perform abortion services. Laws vary widely from state to state, and many leave enough gray areas that it’s not always clear when or how someone can be held accountable.

However, it is also unclear how many patients are denied methotrexate one numbers of the Everyone yes share their experiences on social networks. Certain health groups — including Lupus Foundation of America, Arthritis Foundationand American College of Rheumatology—Recently posted statements regarding reported access issues and asking patients to contact them if they have problems.

Murphy said reports of patients being denied methotrexate are anecdotal, so it’s difficult to know how common they are. However, he said, “any report of patients not being able to receive medication and maintain their continuity of care is very concerning to us as pharmacists.”

Newmark says he hopes states will commit to maintaining access to these drugs, hopefully before it becomes a widespread problem. “If things are not fixed quickly,” he said, “it will require more action.”

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