Following Supreme Court Reversal of Roe v. Wade, Some Patients Fear Limited Access to Methotrexate

Due to its potential use as an abortifacient, some experts are warning that patient access to the common drug methotrexate could be limited following the recent Supreme Court decision to overturn Roe v. Wade, declaring that there is no federal right to abortion.

Methotrexate is commonly prescribed to treat patients with rheumatoid arthritis, as well as a range of other related conditions and some cancers.¹ However, it can also be used to induce abortion in combination with misoprostol until 7 weeks gestation.²

Because of this potential use, patients in states that are limiting or banning abortion access are reporting difficulty filling methotrexate prescriptions, according to a press release by the Arthritis Foundation.

For example, a law in Texas limiting access to abortion drugs includes methotrexate on the list of abortion-inducing drugs. Under the law, pharmacists in the state can refuse to fill prescriptions for misoprostol and methotrexate. As a result, liability concerns are making many health care providers reluctant to prescribe or fill those prescriptions, according to an article published in BMJ.²

Some anti-abortion laws do threaten legal action against health care providers who prescribe or provide abortion-inducing medications.³

“This is a terrible situation since so many patients depend on methotrexate,” Donald Miller, PharmD, a professor and chair of the pharmacy practice department at North Dakota State University, said in the press release from the Arthritis Foundation. “It’s very sad that pharmacists must protect themselves from going to jail for filling a prescription.”³

Methotrexate can be critical for patients with inflammatory conditions and, at higher doses, for patients with cancer. In some cases, such as juvenile idiopathic arthritis, it can be a crucial drug that works to get the disease into remission so that the child can live pain-free, according to the Arthritis Foundation.³

In the case of abortions, methotrexate can be used after a miscarriage or to end an ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus. Women experiencing an ectopic pregnancy or incomplete miscarriage require full tissue clearance from the uterus with either medication or surgery.³

Furthermore, methotrexate is not pregnancy-safe and can cause severe birth defects, such as spina bifida. Because of this, some patients who become pregnant while taking the drug may decide to terminate the pregnancy, which could become extremely difficult in states that have actively banned or restricted abortion.³

“In anticipation of [the Supreme Court] ruling, more than 20 states passed laws (also known as ‘trigger laws’) intended to criminalize abortions, with at least 6 additional states’ laws going into effect since the decision,” read the statement from the Arthritis Foundation. “Many of these state laws specifically list certain medications as ‘abortion-inducing drugs,’ which bans their use without necessarily distinguishing by condition or diagnosis.”³

For patients who do require methotrexate in states that have limited access to it, the Arthritis Foundation provided several recommendations. First, patients could ask the provider to write the purpose of the prescription on it, providing the pharmacy with assurance that the prescription is not for abortion.

The diagnosis code should also be included for documentation. Mail-order prescription delivery or alternative medications could also be an option, according to the press release.³

“The [Supreme Court] decision has definitely complicated a lot of issues around drugs like methotrexate,” Ron Lanton III, Esq, partner at Lanton Law, told Pharmacy Times in an email. “Access will now likely depend on where you live and how medicine is regulated in your respective state. However, according to the Department of Justice, ‘States may not ban drugs based on disagreement with the FDA’s expert judgment about its safety and efficacy.’ We will likely see legal challenges involving the Supremacy Clause of the Constitution.”

REFERENCES

1. Arthritis Foundation Statement on Methotrexate Access. News release. Arthritis Foundation; Accessed July 12, 2022. https://www.arthritis.org/about-us/news-and-updates/statement-on-methotrexate-access
2. Mahase, E. US anti-abortion laws may restrict access to vital drug for autoimmune diseases, patient groups warn. The BMJ; July 6, 2022. Accessed July 12, 2022. https://www.bmj.com/content/378/bmj.o1677
3. New Barrier to Methotrexate for Arthritis Patients. News release. Arthritis Foundation; Accessed June 30, 2022. Accessed July 12, 2022. https://www.arthritis.org/about-us/news-and-updates/new-barrier-to-methotrexate-for-arthritis-patients