Examining the Impact of the Roe v Wade Decision on Medication Access

When the United States Supreme Court overturned Roe v Wade on June 24, 2022, access to abortion for millions of individuals was immediately restricted or completely revoked. However, an additional consequence of this decision is the difficulty that some patients have reported facing in filling their methotrexate prescriptions.

Methotrexate is a first-line therapy for rheumatoid arthritis and can also be used to treat other conditions. At higher doses, methotrexate is also an abortifacient and can be used to treat miscarriage and ectopic pregnancy. In a presentation¹ at ACR Convergence 2022, Kristin Wipfler, PhD, biobank director at FORWARD, the National Databank for Rheumatic Diseases, shared the results of a survey of patients who completed a survey about post-Roe v Wade medication access. Currently, the scope and severity of this medication access issue are unknown.

Survey participants received a description of the Supreme Court decision and were asked about their experiences accessing medications and whether they had attempted to refill a methotrexate prescription since June 24, 2022. Each participant’s state of residence was categorized by abortion legality status.

A total of 1706 participants responded to the survey (mean age, 67.2 ± 11.1 years; 84.6% women; 93.3% White). Diagnoses included rheumatoid arthritis (67.2%), osteoarthritis (12.5%), systemic lupus erythematosus (5.3%), psoriatic arthritis (3.5%), fibromyalgia (3.5%), or ankylosing spondylitis (1.4%). Across the total cohort, 42.5% of patients lived in a state where abortion was legal or protected; 32.2% lived in a state described as hostile to abortion, where abortion rights were at risk; and 25.3% lived in a state where abortion access had been banned or was severely limited. Among the total participants, 396 reported that they attempted to fill a methotrexate prescription since June 24, 2022, 6% of whom reported experiencing a barrier to medication access. An additional respondent reported restricted access to a prescription for hydroxychloroquine (n = 24).

Most respondents (63%) who reported experiencing a barrier to medication access indicated that the issue was a delay in prescription refilling by their pharmacy. Three patients said their pharmacist asked “excessive questions” about pregnancy, and 2 patients said their pharmacy refused to fill their medication. Another 2 patients indicated that their health care provider asked excessive questions about pregnancy, and 2 patients said their health care provider delayed writing a prescription for their medication.

Of the 24 patients who experienced an issue, 11 provided additional information to investigators. Five patient responses demonstrated that the current barriers were “overtly a result of the Supreme Court’s decision”—being told directly that medication access issues were due to pregnancy risk or concerns related to abortion. The remaining 6 patient responses indicated barriers that were “suggestive of being a consequence of the decision”— that is, reporting unexpected delays or refusals to fill the medication without a clear explanation or reasoning.

Limitations of this research include the participant sociodemographic characteristics (predominantly White, older than child-bearing age, educated, and insured). The authors noted that impacts of this ruling “may be more severe” in higher-risk populations.

“Within 2 months of the Supreme Court’s overturn of Roe v Wade, 1 in 17 individuals who tried to fill a methotrexate prescription experienced an unexpected barrier,” Wipfler and colleagues said. “Most issues experienced were delays by pharmacies seeking to confirm the purpose of the prescription with the patient’s health care provider. To reduce or avoid these delays, we recommend that health care providers prescribing methotrexate or other medications that are teratogenic or abortifacient include the patient’s diagnosis on the prescription.”

Reference

1. Wipfler K, Cornish A, Schumacher R, Shaw Y, Katz P, Michaud K. Impact on access to methotrexate in the post-Roe era. Presented at: American College of Rheumatology Convergence 2022; November 10-14, 2022; Philadelphia, PA. Abstract L09.