Medical orgs sound alarm over reports U.S. patients can't get Methotrexate for arthritis, lupus, cancer

Medical associations and patient advocacy groups are raising concerns about reports from women across several U.S. states who have reported being denied access to methotrexate to treat chronic medical conditions, because the drug can potentially induce abortion. The apparent restrictions come on the heels of the U.S. Supreme Court’s overturning of the Roe v. Wade ruling and the newer Dobbs v. Jackson Women’s Health Organization ruling. Methotrexate is listed on the World Health Organization’s (WHO) list of essential drugs. The drug is used for numerous conditions including rheumatoid arthritis, axial spondyloarthritis, ankylosing spondylitis, psoriatic arthritis, lupus, Sjogren’s vasculitis, juvenile idiopathic arthritis and other related conditions. It is also used to treat leukemia, certain types of breast, skin, lung and uterus cancers, as well as severe psoriasis. Crohn’s disease, ulcerative colitis and others are on the list too. Methotrexate may adversely affect a fetus because of its effect on cells that reproduce quickly—making the drug useful in fighting some cancers. A caution from the Crohn’s and Colitis Foundation stated methotrexate should be avoided by pregnant women, but adds “the drug can be passed in semen and that men should also avoid it for several months before family planning.” While it is difficult to say how many women this affects, or who the decision-makers are in terms of restricting access, several U.S. medical associations say they have heard from patients who are suddenly unable to get methotrexate prescriptions. Statements have been issued by the American Pharmacists Association (APhA), the American Association for Cancer Research (AACR), American College of Obstetricians and Gynecologists (ACOG), the U.S. Arthritis Foundation, the Crohn’s and Colitis Foundation and the Sjögren’s Foundation. Some are asking for details from patients about access issues for advocacy purposes. Read: QUIZ: The latest on monkeypox prevention "It is critical that patients be able to access needed medications as prescribed by their doctors in the context of their unique, individual health conditions," Dr. Jen Villavicencio, an obstetrician-gynecologist and spokesperson for ACOG told the Medical Post. "Prescribing medications that may have a negative impact on a potential pregnancy is not uncommon and something doctors and healthcare professionals are familiar with." An Arthritis Foundation statement said “In some states where laws banning or severely restricting abortion have already taken effect, some arthritis patients are reporting difficulty filling their methotrexate prescriptions . . .. The Arthritis Foundation supports unencumbered access to and coverage of FDA-approved drugs for managing arthritis in alignment with scientific and clinical guidelines, as well as evidence-based medical recommendations.” When asked how this issue is affecting U.S. doctors and patient care, the American Medical Association sent this commented, “The U.S. Supreme Court ruling in the Dobbs case and states’ efforts to ban, curtail and/or criminalize abortions have raised multiple legal and ethical issues in America’s healthcare delivery system. Further complicating the situation are ongoing federal and state developments responding to the post-Dobbs landscape. The AMA is monitoring the fast-moving developments and gathering information, but during this unsettled period the AMA is not yet able to provide reliable and credible answers to your questions at this time.” Twitter is abuzz On social media, patients and physicians alike are making public the troubles they're facing, with some of the most vocal stating they are from Texas, Tennessee, Ohio and Virginia. Becky, one Twitter user from Virginia tweeted on June 30, “I’ve never had an abortion but my access to healthcare has changed because Roe was overturned. I have #Lupus which is an inflammatory autoimmune disease that causes my immune system to attack my organs, joints, skin, and muscles. I take #Methotrexate as one of my treatments.” The tweet garnered close to 41,000 likes, and her story was featured in Newsweek. Becky also tweeted a copy of a form-letter from her rheumatologists’ office which, in part, stated: “This is a notice to let you know that we are pausing all prescriptions and subsequent refills of Methotrexate. This decision has been made in response to the reversal of Roe v Wade. I am incredibly sorry for the inconvenience and complications that this will cause. We are working as quickly as possible to come up with policies and practices that would allow us to continue prescribing medications qualified and used as abortifacients to those who use it for other medical purposes.”Indeed, some pharmacies won’t dispense the drug, as Cheryl Crow, a reporter for Arthritis Life tweeted “Pharmacists in some states have been refusing to fill the methotrexate prescription for patients with rheumatoid arthritis and ankylosing spondylitis in light of the recent Roe v Wade overturn.” Read: How common are primary psycho dermatologic conditions? Dr. Jennifer Gunter, a Canadian born obstetrician, now in California, was blunt “A hospital that refuses to offer methotrexate for ectopic pregnancy should lose their accreditation.” It appears Methotrexate isn’t the only drug being denied to female patients of reproductive age, with some reporting harder access to Mistoprostol, used to treat gastric ulcers. E. Michael Murphy, PharmD, a spokesperson for the APhA told the Medical Post the association is closely monitoring the issue. “We are also looking into issues related to access to other medications that may be included in the definition of ‘abortion-inducing drug’… Uncertainty in financial and criminally liability for health care professionals in certain states’ laws and regulations is jeopardizing continuity of care and access medications proven to be safe and effective by the FDA for indications including, arthritis, cancer, and others,” he said. Murphy noted that Kentucky’s Board of Pharmacy took action to protect patient access to these medications by publishing an emergency directive which in part said, “Any prescription or medical order for a drug that is known to possibly cause an abortion shall be presumed by a pharmacy to be for indications other than for the termination of a pregnancy.” Read: Risk for myocarditis, pericarditis may depend on which mRNA vaccine is used

Medical orgs sound alarm over reports U.S. patients can't get Methotrexate for arthritis, lupus, cancer

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