Weeks after the Supreme Court’s June 24 ruling overturning the nation’s right to abortion established by Roe v Wade, pharmacy chain Walgreens sent a message to Annie England Noblin, informing her that her monthly prescription of methotrexate was suspended.
Noblin, a 40-year-old college teacher in rural Missouri, has never had trouble getting her monthly methotrexate prescription for her rheumatoid arthritis. So she went to her local Walgreens to find out why, standing in line with other customers waiting for an explanation.
When it was finally her turn, a pharmacist informed Noblin – in front of the other customers behind her – that she could not release the drug until she received confirmation from Noblin’s doctor that Noblin would not use it. not to abort.
Since the Supreme Court’s elimination of the federal right to abortion, many states have enacted laws that severely restrict access to abortion, affecting not only pregnant women but also other patients as well as providers. health care.
As a result, many pharmacies and doctors have been forced to deny and delay patients’ access to essential drugs – such as methotrexate – which can be used to help induce abortion.
Noblin is one of 5 million methotrexate users in the United States and one of many autoimmune patients in the country. Although she finally received her prescription, Noblin and other patients are now forced to wrestle with both a monthly invasion of privacy at pharmacies that interrogate them about their reproductive choices as well as the possibility of be completely denied the drug in the future due to restrictive measures. laws.
For 60 years, methotrexate has been considered an inexpensive standard treatment for almost 60% of patients with rheumatoid arthritis. It is also widely used to treat other autoimmune diseases, including Crohn’s disease, lupus, and psoriasis. And, because it inhibits certain cellular functions, it has been used to treat a variety of cancers, including leukemia, breast cancer, lung cancer, and lymphoma.
But methotrexate also treats ectopic pregnancies, in which a fertilized egg implants outside the uterus. Although rare, with only around 100,000 pregnancies annually, ectopic pregnancies are fatal to fetuses and can seriously compromise the health of mothers. Therefore, the only treatment is abortion, and methotrexate is usually combined with other drugs to perform the procedure.
The versatility of methotrexate has prompted the World Health Organization to classify it as an “essential medicine”. Yet the Roe v Wade reversal has dramatically delayed access to the drug, even for patients who are not pregnant and simply need the drug to treat other conditions.
Many health organizations have confirmed reports that women have been denied methotrexate since the federal abortion law was abolished.
Calling the drug “an important part” of care for the disease it is dedicated to fighting, the Lupus Foundation of America said“We are aware of reports that some people are having difficulty accessing methotrexate following the Supreme Court’s decision [in June].”
Similarly, the American College of Rheumatology said that he was aware of “emerging concerns about access to necessary treatments such as #MTX [methotrexate] after the Supreme Court’s recent decision in the Dobbs case which led to the overturning of Roe v Wade.
In Missouri, abortion is completely prohibited with limited exceptions to save the life of the pregnant person or to prevent a serious risk to that person’s physical health. As a result, for someone like Noblin to be barred from having access in Missouri to his monthly doses of methotrexate – even temporarily – was and still is very damaging.
Methotrexate helps Noblin and others relieve pain as well as swelling in the hands and shoulder joints that sometimes becomes so excruciating that it prevents them from getting dressed or driving to work.
“If I didn’t take it,” Noblin told the Guardian, “I don’t know how I’d be able to function.”
After her pharmacy got confirmation from her doctor that she would not use the drug to induce an abortion, Noblin was finally able to get her prescription for July. In August, Noblin returned to the pharmacy, expecting the process to be smoother this time around. However, to her surprise, she had to consult a pharmacist before getting the drug and confirm that she was not pregnant and did not intend to become pregnant while taking the drug. .
Noblin told the pharmacist it was none of their business. The pharmacist then told Noblin that she couldn’t get her medicine if she didn’t answer the question.
“I’m going to have to answer [that] every month before they even considered giving me the drug,” Noblin said.
Additionally, another problem that Noblin and many others face is potentially being forced to spend $14,000 a month without insurance on Humira as a branded alternative. And they worry about lawsuits from their states.
Noblin said she is on birth control but worries about whether she still gets pregnant.
If so, she said she would have an abortion in Illinois, which has protected abortion rights. But would she expose herself to prosecution, accused of lying because she allegedly told a pharmacist that she had no intention of getting pregnant?
“It’s like I have no control over my own body,” Noblin said. “My body belongs to Missouri.”
Jennifer Crow, a 48-year-old woman from Tennessee, faced similar issues after the Supreme Court struck down federal abortion protections. On July 1, Crow, who suffers from inflammatory arthritis, received a robocall from her CVS pharmacy, informing her that her renewal had been declined.
The call came on a Friday evening over a holiday weekend. As a result, Crow found herself without her weekly dose of methotrexate.
Prior to starting methotrexate, Crow’s joints became too stiff and painful for her to move without pain in the morning, severely limiting her mobility.
“Methotrexate gave me back my independence,” she told the Guardian. “I knew that without it I would go back to reduced mobility and a lot of pain.”
Four days later the pain and stiffness started to come back. She also began to panic, not knowing if she would ever be able to get her medication because she and her Georgia-based medical providers were both in states that implemented abortion bans after the Dobbs decision. .
She couldn’t understand why she was in this position, given that she had had a hysterectomy years earlier. Eventually, Crow discovered that CVS had refused its renewal because the chain had asked pharmacists to refuse to fill prescriptions for methotrexate unless they indicated a diagnosis unrelated to abortion, a practice that Crow finds “invasive. and useless”.
Crow, like Noblin, eventually got her prescription renewed. But since her treatment was discontinued, she has struggled with increased pain and reduced mobility.
“The Dobbs decision has many unintended consequences, and as a middle-aged woman without a uterus, I didn’t think it would affect my care,” she said.
To complicate matters: Methotrexate is not the only life-saving drug that many are struggling to access, despite US Department of Health and Human Services guidelines on laws prohibiting pharmacies from rejecting patients with prescriptions for drugs capable of terminating a pregnancy.
People on misoprostol – which prevents stomach ulcers for those taking aspirin, ibuprofen or naproxen – also face barriers to access because the drug can also be combined with other drugs to induce abortion, said Global Healthy Living Foundation legal director Steven Newmark. Such disruptions can not only lead to “serious health consequences,” but they violate patients’ treatment preferences, Newmark added.
Nevertheless, methotrexate clearly illustrates the uncertainty created by Roe’s inversion. Texas lawmakers have made it a crime there to dispense methotrexate to someone who is seven weeks pregnant and uses the drug to terminate a pregnancy.
Doctors have reported that some pharmacies refuse to sell methotrexate and other essential drugs altogether. And some doctors have refused to prescribe these drugs to patients who could become pregnant, citing concerns about lawsuits.
In a joint statement from several pharmaceutical organizations across the country, pharmacists and healthcare providers expressed concern about “state laws that limit patient access to medically necessary medications and prevent physicians and pharmacists to use their professional judgment.
The statement went on to call for clear guidance from state medical and pharmacy boards, agencies and other policy makers.
For Rachel Rebouché, reproductive health law expert and dean of the Temple University School of Law, the bigger problem is clear.
“The biggest problem is the confusion,” Rebouché said.