New Barrier to Methotrexate for Arthritis Patients

By Linda Rath | June 30, 2022

The reversal of Roe v. Wade, the 1973 ruling that the right to abortion was protected under the constitutional right to privacy, is having unforeseen consequences for some people who take methotrexate for arthritis and those who prescribe it. In some states where laws banning or severely restricting abortion have already taken effect, some patients are reporting difficulty getting their prescriptions for methotrexate.

The Methotrexate Dilemma

Methotrexate is one of the most commonly prescribed drugs for inflammatory forms of arthritis. It’s often the first medication prescribed for rheumatoid arthritis , psoriasis, psoriatic arthritis , lupus and juvenile idiopathic arthritis (JIA). It’s also well established, with a long track record for safety and effectiveness.

Methotrexate is critical for those who take it either alone or in combination with another drug. If another drug alone, like a biologic, doesn’t adequately control the disease process, methotrexate can tamp down the inflammation and help keep the disease under control. In some cases, such as toddlers with JIA, methotrexate can be life-changing, getting the disease into remission so the child can live a full and pain-free life.

Unfortunately, arthritis patients who rely on methotrexate are reporting difficulty accessing it. That’s because in addition to treating arthritis and — in much higher doses — cancer, methotrexate may be used after a miscarriage or to end an ectopic pregnancy — a nonviable, sometimes life-threatening pregnancy that occurs when a fertilized egg implants outside the uterus. Women who experience an ectopic pregnancy or incomplete miscarriage need tissue cleared from the uterus with medication or surgery.

Another issue with methotrexate is that it’s not pregnancy-safe. It can cause severe birth defects, including spina bifida, and some patients who become pregnant while taking it may decide to terminate the pregnancy. The reversal of Roe makes this decision far more difficult, especially in states that have actively banned or restricted the procedure.

Much higher dosages of methotrexate are used for abortion than for arthritis. For example, a rheumatoid arthritis patient may get a maximum dose of 25 mg per week, whereas abortion requires three times that dose.

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.

“This is a terrible situation since so many patients depend on methotrexate,” says Donald Miller, PharmD, professor and chair of the pharmacy practice department at North Dakota State University in Fargo. “It’s very sad that pharmacists must protect themselves from going to jail for filling a prescription.”

Some anti-abortion laws hold the threat of legal action against health care providers who prescribe or provide these medications, making it more difficult for patients to receive them.

Health Secretary Xavier Becerra has vowed to increase access to reproductive services and medications. He maintains states can’t restrict access to medications that are approved and regulated by the Food and Drug Administration or their movement across state lines, but some legal experts say this is a tough case to make.

Your Options

Women who are concerned about their access to care can learn more about their rights from the Department of Health and Human Services . The American College of Rheumatology also has a Reproductive Health Initiative with additional information for health care professionals and arthritis patients.

Confusion about the new laws is swirling. In the meantime, if you have trouble getting your medication, these tips may help:

• “One thing to do immediately is ask your doctor to write the purpose of the prescription on it,” Miller says. “This should provide the pharmacy with assurance that the prescription isn’t for abortion.” Similarly, ask your doctor for a letter of medical necessity, confirming that you need the medication to treat your specific medication condition.
• If the pharmacy still turns you down, get your paper prescription back and send your prescription to a different pharmacy. Make sure the diagnosis code is included for documentation for insurance and to help protect against potential legal action. There may be other obstacles, such as a requirement to speak directly to the physician.
• Consider mail-order prescription delivery for your methotrexate.
• Discuss alternative medication options with your doctor.
• If you believe your rights have been violated, consider filing a complaint with the pharmacy or your state’s Board of Pharmacy.
• Finally, “contact your state legislators about the need to clarify anti-abortion laws to provide safe havens for these situations,” Miller says.

We Want to Hear from You

If you’re having trouble getting your medication, we want to know. We offer one-on-one support through our toll-free Helpline staffed by a licensed clinical social worker and trained staff. You may remain anonymous. We fully respect your right to privacy. And if you have experienced trouble getting your methotrexate prescription filled, please contact us at 1-800-283-7800.