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Cancer, arthritis patients struggling to get medicine after abortion ruling

Methotrexate and misoprostol treat a number of medical conditions but can impact pregnancy, so some doctors, pharmacies say no to a prescription

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Bottles of the drug misoprostol sit on a table at the West Alabama Women’s Center in Tuscaloosa, Ala.

Bottles of the drug misoprostol sit on a table at the West Alabama Women’s Center on Tuesday, March 15, 2022 in Tuscaloosa, Ala. Misoprostol is used for a number of purposes, including as the second step in a medication abortion.

Allen G. Breed, Associated Press

Cancer and arthritis drugs are caught up in some states’ tussle over abortion bans. And some patients find themselves unable to access the medication that’s been prescribed for everything from cancer pain to psoriasis, rheumatoid arthritis to lupus.

CNN reports that confusion has “spooked insurance providers and pharmacies and medical offices into restricting the use of methotrexate, even in states where abortion is legal.”

The drug is used for chronic inflammation and pain. CNN notes that about a half-million methotrexate prescriptions were written each month last year, citing pharmaceutical research firm IQVIA.

Methotrexate got caught up in the abortion debate because a very high dose can be prescribed off-label for miscarriage or ectopic pregnancy, in which a fertilized egg grows outside the womb. In an ectopic pregnancy, the fetus cannot be carried to term, and it is very dangerous for the woman, as well.

Methotrexate is not a drug prescribed for medical abortion, like mifepristone and misoprostol. But some states added it to the short list of drugs that lead to abortion. And even in states that have not banned abortion, some doctors and insurance companies are refusing to prescribe it, while some pharmacies are rejecting prescriptions for it. And some states have added methotrexate to the short list of drugs that lead to abortion.

Though methotrexate is on Texas’ list, Texas said it is exempt from the law when prescribed for other purposes.

Even misoprostol, which is used for a medical abortion, has other uses, such as a treatment for severe stomach ulcers.

Patients are warned that harm to a fetus can result from taking either drug and women are strongly cautioned against getting pregnant while using those medications.

According to The Washington Post, “Even if they can show their patients suffer from conditions such as rheumatoid arthritis, some doctors worry they could be prosecuted for prescribing such drugs to a patient with an unintended pregnancy. Such patients are also at greater risk because they can no longer seek abortions in their home states should they accidentally become pregnant while taking such drugs — no matter how grievous the injuries to the developing fetus.”

Some fear that limited access to other drugs could follow.

“If you are of childbearing age, are you going to be denied medication that could potentially interfere with pregnancy?” asked Traci Poole, a pharmacist and faculty member at Belmont University College of Pharmacy, in Nashville, according to the Post.

There are questions about the legality of denying women access to the medications they’ve been using to treat medical conditions and whether that violates federal protections against discrimination on the basis of sex or disability. As the Post and other articles note, women in higher numbers are treated for autoimmune diseases that may be prescribed methotrexate, compared to men. And women get pregnant.

Katie Glenn, state policy director for Susan B. Anthony Pro-Life America, an anti-abortion advocacy group, said that doctors and pharmacists are overly worried and should not fear prescribing medications for medical reasons — as long as abortion is not the intention.

“Intent is the key here,” Glenn told The Washington Post. “If you’re a rheumatologist, you’re not doing abortions. If you’ve never prescribed methotrexate for abortion, you’re free to continue prescribing it as you were.”

The Arthritis Foundation and American College of Rheumatology have each issued statements noting concern that patients may not be able to get the medication they need. Steven Schultz of the Arthritis Foundation told The Associated Press that the group is trying to assess the breadth of the problem and said those having trouble getting their medication should contact the foundation’s helpline.

Becky Schwartz told CNN that she takes methotrexate for lupus. Less than a week after the Supreme Court overturned Roe v. Wade, her doctor sent a letter saying that all prescriptions and refills of the drug were being suspended because of the court decision. Her rheumatologist said they’ll wean her off the drug, although she lives in Virginia, where abortion is still legal.

In Missouri, a woman picking up a prescription of methotrexate, which she’d been using for over a year, was told by the pharmacist she needed a “specific direction” from the doctor that it would not be used for an abortion.

Walgreens and CVS both require that extra step in states where abortion is restricted. But some pharmacies have reportedly stopped carrying medication at all to avoid the risk of problems, CNN said.

CVS spokesman Mike DeAngelis told The Associated Press the policy of verifying that prescriptions of either methotrexate or misoprostol will not be used to end a pregnancy was introduced in early July in Alabama, Arkansas, Idaho, Oklahoma and Texas.

He said that laws restricting the dispensing of medications that can be used for abortion forced CVS to take the action and noted some have criminal penalties. He said CVS will fill the prescriptions for ectopic pregnancies and miscarriages.

The Associated Press separately reported that some doctors are so concerned about their liability that they declined to treat ectopic pregnancies, although such a pregnancy is not viable and endangers the mother.