Patients being barred from medication no longer used for abortion post Roe
The Department of Health and Human Services announced it is investigating reports of women being denied vital medication for chronic medical conditions unrelated to abortion in states that have banned abortion after the Supreme Court overturned Roe v. Wade.
It will also be issuing guidance to 60,000 retail pharmacies, reminding them of their obligations under federal civil rights laws, the agency said.
"We are committed to ensuring that everyone can access health care, free of discrimination," HHS Secretary Xavier Becerra said in a statement Wednesday. "This includes access to prescription medications for reproductive health and other types of care."
One example of the fallout has been reports of several women diagnosed with an autoimmune disease in states with abortion bans that have reported not being able to obtain a medication called methotrexate from their pharmacies.
"I'm a 48-year-old woman without a uterus," Jennifer Crow from Tennessee, where there is a six-week abortion ban in place, told ABC News. "I didn't think the abortion ban would affect me."
She said she has been taking methotrexate for her inflammatory arthritis since April. On July 1, for the first time since getting her prescription, her pharmacy required her to call her doctor to access a refill she was already prescribed, she said.
Crow said she was without medication for three days until she could speak to her doctor after the long July Fourth holiday weekend. She said, "During those three days, the inflammation returned. I was immediately put back into a flare."
Crow said she's spoken to many other people on Twitter with chronic diseases requiring methotrexate treatment with similar experiences to hers. She said that "many of them reached out to their doctor preemptively. Many doctors said that they had a blanket hold on all methotrexate until it gets worked out."
Becky Schwartz, 28, who suffers from lupus, told Stat News her doctor in Virginia said he had to pause prescribing the medication by orders of the health system he worked for.
She told Stat News the medication was dramatically effective and she feared what would happen without it.
"Before I started taking it, I was not able to do much at all, I was pretty immobile," she said. "Within a month, I was feeling great. Not perfect, but I could take a shower unassisted."
"I have gotten some reports where children have been denied methotrexate for their juvenile arthritis until they've proven they're not pregnant," Dr. Cuoghi Edens, an assistant professor of internal medicine and pediatrics at University of Chicago Medicine told the Los Angeles Times. That included an 8-year-old, Edens said.
The pharmacy's reluctance to fill a standing prescription or a doctor's reluctance to prescribe it may be due to fear of legal retaliation via felony charges on providers for aiding or abetting abortions.
"The concern that physicians and pharmacists are experiencing is, 'Is there a legal implication based on the SCOTUS ruling for continuing to prescribe or fill prescriptions for methotrexate?'" Dr. Kenneth Saag, president of the American College of Rheumatology, told ABC News.
The American College of Rheumatology, the Arthritis Foundation, the Crohn's and Colitis Foundation and the advocacy group CreakyJoints have all issued statements since the recent decision in Dobbs v. Jackson Women's Health Organization opposing the restriction of methotrexate access and have developed educational materials, as well as offered avenues through helplines and email to help support those who are not able to obtain their treatment.
Methotrexate is no longer used for abortions.
Medication abortion is the use of a combination of hormonally-active drugs to evacuate the contents of the uterus. Before the FDA approval of mifepristone in 2016 for medication abortion, methotrexate was paired with misoprostol. The abortion process on this older regimen was less effective, more prone to causing adverse side effects and took a substantially longer time to complete.
Methotrexate is still used to treat ectopic pregnancies, which occur when the embryo implants outside of the uterus. These pregnancies are not viable in any circumstance and only pose a significant risk to the mother, including future infertility and death, according to the American College of Obstetricians and Gynecologists. A study found that deaths from ectopic pregnancy decreased from 1.15 to 0.50 per 100,000 from 1980 to 2007, presumably due to improved treatment options and guidelines.
The issue of methotrexate access in outpatient pharmacies makes some providers worried about the future of access in other health care settings.
"Methotrexate has been revolutionary in women's health care for ectopic pregnancies, as most ectopic pregnancies don't go to the OR anymore. My take-home is, what's next? Let people die from a ruptured ectopic if methotrexate is restricted? Do women then have to wait until ectopic pregnancies rupture so that they can then get a lifesaving procedure in the OR?" said Dr. Jacques Moritz, a board-certified OB-GYN.
When women who can become pregnant are prescribed methotrexate, there are already safeguards to prevent adverse events related to pregnancy.
The American Academy of Family Physicians strongly recommends that women using this medication must use birth control in the form of hormonal contraceptives, condoms and/or abstinence. If a woman is ready to become pregnant, the American Academy of Rheumatology recommends that methotrexate be stopped at least three months before conception.
For those already using methotrexate, it's not as simple as finding another medication.
Methotrexate is a drug that also works to suppress the immune system. This treatment can be essential for people diagnosed with cancer as part of a chemotherapy regimen, some autoimmune diseases such as lupus, rheumatoid arthritis, psoriasis and Crohn's disease, or for those who have received an organ transplant.
"These are chronically ill patients who spend oftentimes years from the first date of the onset of the illness through diagnosis through a trial-and-error period to get themselves onto a medication where they're able to live their lives," Steven Newmark, chief legal office and director of policy for CreakyJoints, told ABC News. "And to see any kind of impediment put in place is horrific to say the least."
Without access to this treatment, disease flares are more likely, which can prevent people from maintaining their daily responsibilities and negatively impact their quality of life.
Restricting methotrexate from women could mean that the standard of care will not be met for those experiencing a range of diseases beyond reproductive care in states where abortion is banned.
"In arthritis, women are disproportionately impacted by the disease, so it's more likely that you're going to see a woman show up to the pharmacy counter for a methotrexate prescription than a man. So, it's kind of like this double whammy in that there are a few layers to this particular issue," Anna Hyde, the vice president of advocacy and access, and Alisa Vidulich, the policy director for the Arthritis Foundation, told ABC News.
Alternative medications are not necessarily the answer.
Newmark told ABC News, "There are concerns that alternative medications, which is not always a proper one-to-one substitute, but even if you look at other medications, they may not be covered in the same manner by insurance and may be more expensive."
"It's a shame that other diseases are being affected by this," Moritz added. "The doctor-patient relationship is sacred and now it's being desecrated."
Dr. Jade Cobern contributed to this article and is a resident in preventive medicine and pediatrics in Baltimore, Maryland, and a member of the ABC News Medical Unit.
Dr. Erica Jalal is an internal medicine resident physician at George Washington University and a member of the ABC News Medical Unit.
