A few weeks after the Supreme Court’s June 24 ruling repealed the nationwide abortion rights created by Roe v. Wade, pharmacy chain Walgreens sent Annie England Noblen a letter, telling her that her monthly prescription of methotrexate had been postponed.
Noblen, a 40-year-old college teacher in rural areas MissouriShe had no trouble getting a monthly prescription of methotrexate for rheumatoid arthritis. So she went to Walgreens to find out why, and stood in line with other customers while she waited for an explanation.
When her turn finally came, she informed the Noblen pharmacist – in front of other clients behind her – that she could not release the drug until she received confirmation from the Noblen doctor that she would not use it to perform an abortion.
Since the Supreme Court overturned federal abortion rights, many states have enacted laws that severely restrict access to abortion, affecting not only pregnant women but also other patients as well as health care providers.
As a result, many pharmacies and doctors have been forced to deny and delay patients’ access to essential medications — such as methotrexate — that can be used to help perform an abortion.
Noblen is one of 5 million users of methotrexate throughout the United States and one of many autoimmune patients in the country. Although she eventually got a prescription, Knobeln and other patients now have to contend with monthly breach of privacy at pharmacies asking about their reproductive options as well as the possibility of being completely denied the drug in the future due to the restriction. laws.
For 60 years, methotrexate has been considered an inexpensive standard treatment for nearly 60% For patients with rheumatoid arthritis. It is also widely used to treat other autoimmune diseases, including Crohn’s disease, lupus, and psoriasis. 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 about 100,000 occurring annually, ectopic pregnancies are fatal to fetuses and can seriously jeopardize maternal health. Therefore, the only treatment is an abortion, and methotrexate is usually combined with other medications to perform the procedure.
The versatility of methotrexate prompted the World Health Organization to do so class It is an “essential medicine”. However, the Roe v Wade reversal has significantly impeded access to the drug – even for patients who are not pregnant and simply need the drug to treat other conditions.
Several health organizations have confirmed reports of women being denied methotrexate since the repeal of federal abortion rights.
The drug has been described as an “important part” of disease care and is dedicated to combating it, the Lupus Foundation of America He said: “We are aware of reports that some people are having difficulty accessing methotrexate in the wake of the Supreme Court ruling. [in June]. “
Similarly, the American College of Rheumatology He said It is aware of the “emerging concerns surrounding access to sought-after treatments such as #MTX [methotrexate] After the recent Supreme Court decision in the Dobbs case that led to the reversal of Roe v. Wade.
In Missouri, abortion is strictly prohibited with limited exceptions to save the life of a pregnant woman or to prevent serious risks to that person’s physical health. As a result, for someone like Noblen, being denied access to her monthly doses of methotrexate in Missouri—even if only temporarily—was and continues to be extremely harmful.
Noblen and others methotrexate helps reduce pain and swelling in their hands and shoulder joints that sometimes becomes so painful that it interferes with their ability to wear clothes or drive to work.
“If I wasn’t taking it, I don’t know how I would be able to function,” Knobeln told the Guardian.
After her pharmacy got confirmation from her doctor that she wouldn’t use the drug to induce an abortion, Nobelin was finally able to get her July prescription. In August, Knobeln went to the pharmacy again, expecting the process to be smoother this time. However, to her surprise, she was asked to consult a pharmacist before obtaining the medication and to ensure that she was not pregnant and did not intend to become pregnant while on the medication.
Noblen told the pharmacist that it was none of their business. Then the pharmacist told Noblen that she wouldn’t be able to get her medication if she didn’t answer the question.
“I will have to answer [that] “Every month before they would consider giving me the drug,” Knobeln said.
In addition, another problem that Noblen and many others face is likely to force them to spend $14,000 a month without insurance on Humira as a name brand alternative. They are concerned about prosecution by their own countries.
Nobelan said she is on birth control but is concerned about considering whether she is still pregnant.
In that case, she said she would have an abortion in Illinois, which protects abortion rights. But would she be prosecuted for lying because she would have told the pharmacist that she did not intend to become pregnant?
“I feel like I don’t have any control over my body,” Noblen said. “My body belongs to Missouri.”
Jennifer Crowe, 48, of Tennessee, faced similar problems after the Supreme Court struck down federal abortion safeguards. On July 1, Crowe, who has arthritis, received an automated call from CVS Pharmacy, informing her that a refill had been refused.
The call came during Friday evening over the weekend. As a result, Crowe was left without her weekly dose of methotrexate.
Before she started using methotrexate, Crowe’s joints became too stiff and painful to move without pain in the morning, greatly limiting her ability to move.
“Methotrexate has given me back my independence,” she told the Guardian. “I knew without it, I’d be back in limited motion and a lot of pain.”
After four days, the pain and stiffness began to return. She also began to panic, unsure if she would ever be able to get her medication because she and medical providers in Georgia were in two states that implemented abortion bans after Dobbs’ decision.
She couldn’t understand why she was in this position, given that she had had a hysterectomy years earlier. Eventually, Crowe discovered that CVS refused to refill it because the chain asked pharmacists to refuse to fill prescriptions for methotrexate unless they indicated a diagnosis unrelated to the miscarriage, a practice that Crowe found “invasive and unnecessary.”
Crowe, like Noblen, eventually got a new prescription. But since her treatment disorder, she has experienced increased pain and decreased ability to move.
“Dobbs’ decision has unintended consequences, and as a middle-aged woman without a uterus, I didn’t think it would affect my care,” she said.
Complicating matters: Methotrexate isn’t the only essential drug many are now struggling to access, despite US Health and Human Services Section guidance regarding laws prohibiting pharmacies from rejecting patients who have prescriptions for drugs that may terminate pregnancy.
People who take misoprostol — which prevents stomach ulcers relative to those who take aspirin, ibuprofen or naproxen — also face barriers to access because the drug can also be combined with other medications to induce abortions, said Stephen Newmark, chief legal officer with the Global Healthy Living Foundation. . Newmark added that such disruptions not only lead to “serious health consequences,” but violate patients’ treatment preferences.
However, methotrexate clearly demonstrates the uncertainty caused by the Rho reversal. Texas lawmakers have deemed it a crime to dispense methotrexate there to a pregnant woman in the past seven weeks and use the drug to terminate a pregnancy.
it was there Reports Doctors say that some pharmacies refuse to carry methotrexate and certain other essential medicines altogether. Some doctors have refused to prescribe these drugs to patients who might become pregnant, citing concerns about prosecution.
In a statement shared by many pharmacy organizations across the country, pharmacists and health care providers expressed Paying attention to “state laws that limit patients’ access to medically necessary medications and prevent physicians and pharmacists from using their professional judgments.”
The statement went on to call for clear guidance from state boards of medicine and pharmacy, agencies, and other decision makers.
For Rachel Riboshi, an expert in reproductive health law and dean of Temple University Law School, the bigger problem is obvious.
“The biggest problem is confusion,” said Riboshi.