![]() “Pharmacists are not necessarily attorneys with knowledge of the various state laws,” so they “can be confusing,” Alisa Vidulich, policy director for the Arthritis Foundation, said. In Tennessee, for example, a law is set to go into effect making abortion illegal after a fetal heartbeat is detected except in cases of “medical emergencies.” Patient advocates say that trigger laws banning abortion in some states may also have a chilling effect on medical care if it’s unclear whether health providers are protected to dispense treatment that may lead to pregnancy loss, but isn’t prescribed for that purpose. The Texas law includes mifepristone, misoprostol, and methotrexate under its description of an “abortion-inducing drug,” but also states that the restrictions don’t apply to drugs that may be known to cause an abortion but aren’t prescribed for that use. Methotrexate is only used in gynecology for ectopic pregnancies-in which the fetus forms outside the uterus and isn’t viable. Laws in states like Texas that restrict abortion care and list methotrexate as an abortion-inducing drug are prompting “confusion and caution in dispensing the medication,” said Steven Schultz, the Arthritis Foundation’s director of state legislative affairs. “They will end up with more significant joint pain, stiffness in the morning, problems functioning.” Methotrexate is “one of our gold standard, go-to drugs for the control of inflammatory arthritis in our patients,” according to Anisha Dua, a rheumatology professor at the Northwestern University Feinberg School of Medicine.ĭelays in getting it, even if temporary, can lead an arthritis patient to have a “disease flare,” Dua said. “I didn’t do a thing for the holiday weekend except trying to manage my new pain.” ![]() “I was late on my meds, so it was extra pain and I had lower energy,” said Crow, who was eventually able to get a new prescription from her doctor. Crow, who has inflammatory arthritis and a neuromuscular disease called myasthenia gravis, said in an interview that methotrexate has allowed her to resume simple, yet previously painful tasks like putting on her pants and rolling over in bed. Jennifer Crow, a 48-year-old writer in Tellico Plains, Tenn., got an automated call from her CVS pharmacy in early July that her prescription wouldn’t be refilled. The company said it encourages providers “to include their diagnosis on the prescriptions they write to help ensure patients have quick and easy access to medications.” ‘Confusion and Caution’ The Kentucky Board of Pharmacy has already issued recommendations to pharmacists and other health professionals, but trade groups say delayed access is certain to continue without additional efforts to reduce legal confusion.ĬVS Health said in a statement that before filling a prescription for methotrexate in some states, “we instruct our pharmacists to validate that the intended indication is not to terminate a pregnancy.” Individual state laws may vary-supporting the need for state-specific guides, patient advocates say. Guidance released Wednesday by the Department of Health and Human Services says pharmacists who refuse to fill methotrexate for inflammatory arthritis patients may be violating federal anti-sex discrimination laws. “There’s a real need out there for anyone from the governors to legislators to boards of medicine and boards of pharmacy to be as clear as possible in issuing guidance or revising laws to make sure that access to these medications is not affected,” Ganio said. ![]() Roughly 90% of rheumatoid arthritis patients use methotrexate at some point in their treatment, according to the Arthritis Foundation. But some states consider it an abortion-inducing drug, both because of its risks of miscarriage in pregnant individuals and use in gynecology to treat ectopic pregnancies. Methotrexate is FDA-approved to treat joint inflammation and improve mobility among patients with inflammatory arthritis, lupus, psoriasis, and other conditions. “What we’re seeing is an overreaction to the unknown of some of the laws or regulations that might restrict access,” said Michael Ganio, senior director of pharmacy practice and quality at the American Society of Health-System Pharmacists. Prescribers and advocacy groups say state medical and pharmacy boards need to clarify best practices for health professionals who fear legal repercussions for actions that go beyond abortion. ![]() Patient reports of delays or roadblocks in accessing methotrexate have risen on social media since the high court’s ruling triggered abortion bans in 22 states. Confusion over prescribing a common arthritis drug post- Roe is prompting demands for state guidance as pharmacies and providers grapple with the fallout of the US Supreme Court’s abortion ruling.
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