July 14 (Reuters) – Annie England Noblin, a 40-year-old resident of rural Missouri, never had a problem filling her monthly prescription for methotrexate until this week.
On Monday, Noblin’s pharmacist said he could not give her the drug until he confirmed with Noblin’s doctor that the drug would not be used to induce an abortion.
Missouri now bans almost all abortions, and methotrexate can be used to terminate a pregnancy. It also happens to be one of the first drugs doctors prescribe to treat rheumatoid arthritis, which affects more than one million Americans.
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The pharmacy ended up filling the prescription, but Noblin said she would likely switch to another, more expensive drug if they refused to fill her prescription in the future.
“It’s maddening,” Noblin said. “It made me feel like I couldn’t be trusted with my prescribed medicine just because I have a uterus.”
Dozens of women in states including Texas, Alabama, Georgia, South Carolina and Tennessee have also had trouble getting their methotrexate, either because of problems at pharmacies or because they say their doctors stopped prescribing the drug, according to social media posts , reviewed by Reuters and the patient advocacy groups Global Healthy Living Foundation and Arthritis Foundation.
More than 30 countries have passed legislation that restricts access to drugs that can be used to terminate a pregnancy. In Texas, it is now a felony to give methotrexate to someone seven weeks pregnant who uses it to terminate the pregnancy. Indiana bans medical abortion — including methotrexate — starting at 10 weeks pregnant.
Six other state laws specifically mention methotrexate as an abortion-inducing drug, said Stephen Schultz, director of state legislative affairs for the Arthritis Foundation.
These laws have a “chilling effect” on doctors and pharmacists, often prompting them not to prescribe drugs that can also cause abortion for fear of legal repercussions, said Rachel Rebusch, a law professor at Temple University.
On Wednesday, the US government’s health agency instructed retail pharmacies that they are required to fill prescriptions under federal civil rights laws, calling the refusal of methotrexate possible discrimination. Read more
The government’s guidance highlights the broad potential impact of limiting such prescriptions, but may not be enough to overcome concerns about state bans.
“This goes some way to getting the word out that there are federal rules that can be enforced,” Rebusch said. “We’ll have to wait and see what the federal government is willing 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 Pharmacy Association, which represents 19,000 independent pharmacists, said in a statement.
Spokesmen for two of the largest U.S. drugstore chains, Walgreens Boots Alliance and CVS Health, say they are instructing their pharmacists to confirm that methotrexate will not be used to terminate a pregnancy before dispensing it to people in states that prohibit abortion in many circumstances.
FREQUENTLY PRESCRIBED DRUG
Methotrexate, a cheap generic drug made by more than half a dozen companies, is commonly prescribed to treat autoimmune diseases such as 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 terminate pregnancies, terminate miscarriages, or terminate life-threatening ectopic pregnancies.
About 500,000 prescriptions for methotrexate per month were written last year, according to pharmaceutical market research firm IQVIA ( IQV.N ).
Restrictions on medical abortion can be further legislated. Drugmaker GenBioPro is currently challenging a Mississippi law that requires patients to see a doctor in person to receive mifepristone, a drug used in medical abortion. Read more
Lawmakers who are not medically trained could open a “Pandora’s box” with far-reaching effects on other areas of medicine, said Michelle Goodwin, a professor of global health policy at the University of California, Irvine School of Law.
“For many women, we’re going to see that reduced access,” Noblin said. “In the end, it will cost us money and our dignity.”
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Reporting by Rose Horowitz in Washington; Editing by Caroline Hummer and Bill Berkrot
Our standards: The Thomson Reuters Trust Principles.
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