At times over the last 2.5 years, patients with autoimmune diseases have had an unfair and needlessly difficult time accessing some of the specific medications they require to treat their illnesses. Two of the mainstays for many of these patients are hydroxychloroquine (Plaquenil) and methotrexate (MTX).
The first blow came when Trump touted hydroxychloroquine as a cure for COVID — without any evidence. There was a run on the medication, and patients with rheumatoid arthritis or other autoimmune diseases were unable to get their prescriptions filled.
The other commonly used medication to reduce the progression of these diseases (these drugs are known as DMARDs, or disease-modifying antirheumatic drugs) is MTX. In much higher doses, methotrexate has also been used for decades in treating cancer.
Most autoimmune diseases affect women of all ages far more than men. Examples are rheumatoid arthritis, lupus, Sjögren syndrome, and Crohn's disease.
Now, by reversing Roe v Wade, SCOTUS has hurt women, not only by limiting access to abortion but also by predictable fallout from this decision. As a result of state "trigger laws" enacted to criminalize abortions as soon as SCOTUS dealt this widely anticipated blow, 30 states have restricted access to medications that might also end a pregnancy, intentionally or otherwise.
Texas, vying to be a leader in repressing both women and the vote, has made it a felony "to dispense methotrexate to someone more than 7 weeks pregnant who uses it to end a pregnancy." Texas also allows pharmacists to refuse to fill prescriptions for MTX or misoprostol, which (among other things) is used for abortions. Pharmacists in many states can also deny care based on their personal religious beliefs.
Physicians and pharmacists may also be confused by the new regulations and loathe to risk financial or criminal charges by overzealous prosecutors. (For example, Indiana Attorney General Todd Rokita is targeting Caitlin Bernard, MD, for performing a medical abortion on a 10-year-old girl who was raped, saying, "We're going to fight this to the end, including looking at her licensure," and trashing her on Fox television. Bernard did everything legally.
And Tennessee is trying to outdo Texas by criminalizing any medication that can disrupt a pregnancy after fertilization.
MTX is a relatively inexpensive drug used for a variety of conditions. (Cost varies from around $10 with GoodRx to around $130 retail per month). As mentioned, it is a first-line DMARD to stop the progression of rheumatoid arthritis and is used to treat cancer. It's also used to treat ectopic pregnancies that have not yet ruptured. According to the American College of Obstetricians and Gynecologists (ACOG), MTX stops cells from growing, and the woman's body then absorbs the pregnancy over weeks.
In an ectopic pregnancy, the fertilized egg implants in the fallopian tube rather than the uterus. If untreated, it will rupture, often killing the woman and the early fetus. But some states want to prohibit treatment of an ectopic pregnancy, sentencing a woman to almost certain death from internal bleeding and shock. These laws impose huge ethical and legal risks for physicians.
If taken during pregnancy, however, MTX can cause severe birth defects, so women who accidentally become pregnant while taking it for other conditions may want an abortion — which now will be extremely difficult or impossible to get.
Because the nuances of the new laws in many states are unclear, the end result is that women, even in states that do not ban abortion, like Virginia, may be refused a prescription that they've previously received without any problem.
It's appalling that even children are denied access to the MTX that they need to control their disease.
The only (small and temporizing) saving grace in this is that the US Department of Health and Human Services just directed pharmacies that if they "receive federal funding through several programs such as Medicare and Medicaid, they cannot discriminate based on race, color, national origin, sex, age, and disability; further, they may not discriminate based on current pregnancy, past pregnancy, potential or intended pregnancy, and medical conditions related to pregnancy or childbirth."
It's unclear what sort of penalty pharmacists might incur in this battle between states' rights and the feds. When this conflict ends up going to the Supremes, it's pretty clear this regime — which already reversed decades of precedents with the Dobbs decision — will side with the states. And, of course, separation of Church and State has gone out the window with this rabid court, now led by religious zealots, wanting to reshape the country to abide by its Christian beliefs.
Heaven help us with this court. Get out the vote as if your life depended on it — it most certainly does now.
Patients who believe they were discriminated against at a pharmacy are encouraged to file a complaint here.
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She survived 25 years in solo practice in rural Cumberland, Maryland, and now works part-time. She especially loves writing about ethical issues and advocating for social justice. Follow her at drjudystone.com or on Twitter @drjudystone.
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Cite this: Judy Stone. Abortion Laws Deny Treatments Needed for Autoimmune Disease - Medscape - Jul 21, 2022.