State abortion bans prevent women from getting essential drugs

Annie England Noblin’s 2.5mg methotrexate pills are displayed at her home in West Plains, Missouri, U.S. July 14, 2022. Annie England Noblin/Handout via REUTERS

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July 14 (Reuters) – Annie England Noblin, a 40-year-old resident of rural Missouri, had never had a problem filling her monthly methotrexate prescription until this week.

On Monday, Noblin’s pharmacist said she could not give her the drug until she confirmed with Noblin’s doctor that the drug would not be used to induce an abortion.

Missouri now bans nearly all abortions, and methotrexate can be used to terminate a pregnancy. It also happens to be one of the first drugs prescribed by doctors to treat rheumatoid arthritis, which affects more than one million Americans.

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The pharmacy eventually filled the prescription, but Noblin said she would likely switch to a different, more expensive medication in case she refused to fill her prescription in the future.

“It’s infuriating,” Noblin said. “It made me feel like I couldn’t be trusted with the medications I was prescribed just because I have a womb.”

Dozens of women in states like Texas, Alabama, Georgia, South Carolina and Tennessee have also had problems getting their methotrexate, either because of problems at pharmacies or because they say that their doctors suspended the prescription of the drug, according to social media posts reviewed by Reuters and patient advocacy groups the Global Healthy Living Foundation and the Arthritis Foundation.

More than 30 states have enacted laws that restrict access to drugs that can be used to terminate a pregnancy. In Texas, it is now a crime to dispense methotrexate to someone more than seven weeks pregnant who uses it to terminate a pregnancy. Indiana prohibits medical abortion – including methotrexate – from 10 weeks of pregnancy.

Six other state laws specifically mention methotrexate as an abortion-inducing drug, said Steven Schultz, director of state legislative affairs for the Arthritis Foundation.

These laws have a “chilling effect” on doctors and pharmacists, often causing them not to dispense drugs that can also cause an abortion for fear of legal repercussions, said Rachel Rebouche, a professor of law at Temple University.

On Wednesday, the US government health agency ordered retail pharmacies they are required to fill prescriptions under federal civil rights laws, calling the denial of methotrexate possible discrimination. Read more

Government guidance underscores the general potential impact of limiting such prescriptions, but may not be sufficient to override concerns about state bans.

“It helps send the message that there are federal rules that can be enforced,” Rebouche said. “We’ll have to wait and see what the federal government is prepared to do to make sure people have the information they need.”

Pharmacists are caught in the crossfire between conflicting federal and state regulations, the National Community Pharmacists Association, which represents 19,000 independent pharmacists, said in a statement.

Spokespersons for two of the largest U.S. drugstore chains Walgreens Boots Alliance and CVS Health say they are asking their pharmacists to confirm that methotrexate will not be used to terminate a pregnancy before distributing it to people in states that prohibit abortion in many circumstances.


Methotrexate, an inexpensive generic drug made by more than half a dozen companies, is commonly prescribed to treat autoimmune diseases like lupus and has been approved to treat rheumatoid arthritis for more than 30 years.

It is also used to treat cancer, and in much higher doses can end pregnancies, complete miscarriages, or end a life-threatening ectopic pregnancy.

About 500,000 methotrexate prescriptions per month have been written over the past year, according to pharmaceutical market research firm IQVIA (IQV.N).

Restrictions on medical abortion could be further enshrined in law. Drugmaker GenBioPro is currently challenging a Mississippi law that requires patients to see a doctor in person to obtain mifepristone, a drug used in medical abortion. Read more

Lawmakers without a medical background can open a “Pandora’s box,” with far-reaching effects on other areas of medicine, said Michele Goodwin, professor of global health policy at the University of California, Irvine School of Law.

“For a lot of women, we’re going to see this reduced access,” Noblin said. “At the end of the day, it will end up costing us money and costing us dignity.”

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Reporting by Rose Horowitch in Washington; Editing by Caroline Humer and Bill Berkrot

Our standards: The Thomson Reuters Trust Principles.

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