Autoimmune Patients Struggle with Access to Medicine in Anti-Abortion States

Methotrexate, originally developed as a chemotherapy agent, has been approved to treat leukemias, lymphomas, carcinomas, rheumatoid arthritis, juvenile arthritis, and severe psoriasis. However, some pharmacists are now reluctant to fill prescriptions of methotrexate after the Supreme Court’s decision to reverse Roe v. Wade. The medication millions rely on to treat these conditions has been restricted in certain states because of its less common off-label use in ending ectopic pregnancies.  

In states with severe anti-abortion “trigger laws,” administering any medication that could terminate a pregnancy has been declared illegal, leading pharmacies to take caution and, in some cases, avoid filling even the low doses of methotrexate used by autoimmune patients. Currently, laws that may impact the use of methotrexate exist in 13 states.  

The drug is a generic manufactured by several large pharmaceutical companies, including Pfizer, and though it isn’t prescribed for medication abortion, it is preferred to treat rare ectopic pregnancies.  “It’s one of the most common medications that I prescribe,” said Grant Schulert, MD, PhD, a pediatric rheumatology specialist at Cincinnati Children’s Hospital, in an interview with the LA Times. “It’s really a mainstay of our practice.” 

Around 2% of methotrexate prescriptions are filled by those seeking to end an ectopic pregnancy. Women's ability to end ectopic pregnancy early is an essential capability; without methotrexate, preserving reproductive health and treating autoimmune disorders may become more difficult.  

Alternatives to a $10 methotrexate regimen for autoimmune disorders include a more expensive class of biologics that can cost thousands of dollars. Stelara, made by Johnson & Johnson, is one example of a biologic used to treat autoimmune diseases like Crohn's disease or ulcerative colitis. An eight-week stint of Stelara is priced at $25,497.12. Benlysta is currently the only biologic available to treat lupus, a disease also treatable with methotrexate. The average retail price of Benlysta is $4,222.05.  

In response to post-Roe laws limiting access to medicine and reproductive healthcare, the Department of Health and Human Services (HHS) has announced investigations into pharmacies accused of denying women the medications they need. HHS also released guidance aimed at pharmacies that would deny access to necessary prescriptions: “As recipients of federal financial assistance, including Medicare and Medicaid payments, pharmacies are prohibited from discriminating on the basis of race, color, national origin, sex, age, and disability in their programs and activities under a range of federal civil rights laws.” 

HHS was firm in its direction concerning methotrexate use for reproductive health. “The course of treatment necessary to stabilize such emergency medical conditions is also under the purview of the physician. Stabilizing treatment could include interventions (e.g., abortion, removal of one or both fallopian tubes, anti-hypertensive therapy, methotrexate therapy, etc.), irrespective of any state laws or mandates that apply to specific procedures,” remarked HHS Secretary Xavier Becerra in an emergency letter to physicians.