Many U.S. states have implemented bans or restrictions on abortion, including those conducted via medication, following the Supreme Court’s decision to overturn Roe v. Wade.
But some medications that cause abortion may also be used to treat other health conditions.
Methotrexate is a medication that can be used to end a pregnancy. But in recent weeks, some people on social media (here and here) have shared stories of pharmacies refusing to fill prescriptions for methotrexate, which they say is a medication that can also treat diseases such as rheumatoid arthritis and cancer.
Is methotrexate, which can end a pregnancy, also used to treat certain diseases?
Yes, methotrexate, which can end a pregnancy, is also used to treat certain diseases such as rheumatoid arthritis, lupus and cancer.
WHAT WE FOUND
Methotrexate is a drug commonly used to treat inflammatory conditions and certain autoimmune diseases. Those diseases include psoriasis (an autoimmune skin disease that causes red, scaly patches to form on some areas of the body), rheumatoid arthritis (an autoimmune and inflammatory disease that causes painful swelling of the joints), and certain cancers of breast, lungs, neck and head, among others, according to the National Library of Medicine.
According to the Arthritis Foundation, researchers first developed the drug in the 1940s and it later won approval from the U.S. Food and Drug Administration (FDA) for treating rheumatoid arthritis – which affects more than 1.3 million Americans – in 1988. It is now “one of the most effective and commonly used medications” in rheumatoid arthritis treatment, the American College of Rheumatology (ACR) says.
Methotrexate is also the most common drug used to treat ectopic pregnancy, a potentially life-threatening condition that occurs when a fertilized egg implants and grows outside of the uterus, according to the American College of Obstetricians and Gynecologists. The drug can be used in combination with another drug called misoprostol as an abortion medication, though this is rare, the Mayo Clinic says.
The drug can cause birth defects if used while a person is pregnant, according to the Mayo Clinic. Doctors may give people a pregnancy test before they start using the medication to make sure they aren’t pregnant.
Rheumatologists, who treat conditions like rheumatoid arthritis and lupus, have expressed concerns about barriers to prescribing methotrexate to patients after the Supreme Court’s decision to overturn Roe v. Wade. This comes as medications that can induce abortion are facing increased scrutiny and restrictions in many states.
“This is a particular problem because methotrexate is a first-line treatment for many rheumatic disease patients. Many payers and pharmacy benefit managers require patients to try methotrexate as a first step in their plan’s step therapy protocol; only after failing to respond to methotrexate can patients receive other therapies,” the ACR said in a statement on July 13.
Patients who can’t access methotrexate may have to pay for treatments out-of-pocket or “be put on more expensive therapies,” and in some cases their insurer may not cover other treatment options at all, the ACR added.
The Arthritis Foundation also said in a statement that arthritis patients are “reporting difficulty” accessing methotrexate after the Supreme’s Court’s reversal of Roe v. Wade.
“At least one state — Texas — allows pharmacists to refuse to fill prescriptions for misoprostol and methotrexate, which together can be used for medical abortions. Already there are reports that people in Texas who miscarry or take methotrexate for arthritis have trouble getting their prescriptions filled,” the Arthritis Foundation said on June 30.
Other medical organizations are also working to help ensure that patients who need methotrexate can get the drug.
The Lupus Foundation of America said on July 2 that “methotrexate is an important part of lupus care,” adding that it is “aware of reports that some people are having difficulty” accessing the drug in the wake of the Supreme Court decision.
In a statement shared via Twitter on June 30, the Crohn's & Colitis Foundation said it is “proactively investigating” how abortion restrictions will impact methotrexate access.
How to report methotrexate access issues
The ACR is asking patients and rheumatologists to report methotrexate access issues by emailing email@example.com. The Arthritis Foundation says patients experiencing trouble getting their methotrexate prescription filled can contact the organization by calling 1-800-283-7800.
Lupus patients experiencing challenges in accessing methotrexate can email firstname.lastname@example.org.
Patients with inflammatory bowel diseases can also reach out to the Chron’s and Colitis Foundation’s advocacy team by emailing email@example.com if they have been denied access to methotrexate.
Donald Miller, PharmD, professor and chair of the pharmacy practice department at North Dakota State University in Fargo, also offered some tips shared by the Arthritis Foundation for those experiencing difficulty in getting their medication.
“One thing to do immediately is ask your doctor to write the purpose of the prescription on it,” Miller said. “This should provide the pharmacy with assurance that the prescription isn’t for abortion.”
Patients can also ask their doctor for a letter of medical necessity, consider mail-order prescription delivery for methotrexate, or file a complaint with the pharmacy or their state’s Board of Pharmacy if they believe their rights have been violated, according to the Arthritis Foundation.