Post-Roe drug delays weigh on patients, providers

The post-Roe battlefield is spreading to pharmacies, where drugs that can cause fetal abnormalities or that have multiple uses that include ending pregnancies are being put through more scrutiny.

The big picture: Some patients with rheumatoid arthritis, lupus and stomach ulcers are facing delays getting critical treatments while providers verify the drugs' intended use to pharmacists and insurers.

• The concern is without more direction, providers could face criminal charges for helping provide abortion care.
• "There's a need for greater clarity and guidance to health care providers on how to navigate this landscape because patients are losing access to their medications and it's not right," E. Michael Murphy, advisor for state government affairs at the American Pharmacists Association, told Axios.

Driving the news: Much of the current focus is on methotrexate, an immunosuppressant used to treat some cancers and inflammatory diseases that also can cause miscarriages and is used to treat ectopic pregnancies.

• It's part of a cohort of drugs that might be classified as "abortion-inducing" by states that have banned abortion, leading to uncertainty about other uses.
• Rheumatologists say their patients are experiencing delays having prescriptions filled or refilled, regardless of whether or not the patient can even get pregnant.
• Some patients have lost access to their prescriptions completely, the LA Times reported.
• Doctors in some cases have called pharmacies directly or specified a diagnosis, instead of entering orders via computer, Madelaine Feldman, a Louisiana-based rheumatologist and president of the Coalition of State Rheumatology Organizations, told Axios.
• "I'd hate to see any kind of long-term interruption for patients who've been on methotrexate for years and lose control of their disease because there can be a rebound if you stop if abruptly," Feldman told Axios.
• Because methotrexate is typically administered intravenously in cancer clinics, oncologists to date have not reported delays, said Julie Gralow, chief medical officer at the American Society of Clinical Oncology.
• But oncologists are facing their own set of questions about treating pregnant women diagnosed with cancer, because necessary drugs can be toxic to a fetus, the New York Times reported.

Zoom in: At pharmacy counters, the new uncertainty extends to drugs that can cause fetal abnormalities, and whether they should be made available to women of childbearing age if they may not have an option to terminate their pregnancies.

• Many such medications are prescribed in tandem with contraception for patients who can get pregnant.
• Accutane, a powerful drug for severe acne that can cause birth defects, is only prescribed if patients pledge to be on two forms of birth control through a federal database, and patients must present negative pregnancy tests for refills.
• Patients on Reddit and in other forums are questioning whether the drug will be banned in some states, or what their options would be if they get pregnant during their course.

What they're saying: The Department of Health and Human Services this month told retail pharmacies they can't stop patients from accessing prescribed medication, and that such an action would be considered discrimination.

• However, experts argue that recently enacted abortion bans could potentially be interpreted as also restricting access to emergency contraception and IUDs.
• Physicians say they're warning their patients about the dangers that pregnancy could present while they are being treated with drugs like methotrexate or the hormone misoprostol, often prescribing contraception alongside these drugs for patients who could get pregnant.
• "There would be great harm to patients if contraceptives are not allowed when they are medically necessary," David Pariser, dermatologist and past president of the American Academy of Dermatology, told Axios.

What we're watching: In states with stringent abortion bans, health care providers feel in the dark about their liability in prescribing such drugs and are seeking clarity on what is allowed.

• The questions come as some states are limiting access to certain medications if a provider chooses not to prescribe them, citing religious or moral beliefs.
• A dozen states have laws that allow health care providers to refuse to provide contraception services, according to the Guttmacher Institute.

The bottom line: When providers can't prescribe the best treatment for a patient, they are left with prescribing "less clinically efficacious drugs or maybe more costly drugs," said Deepak Sisodiya, chief pharmacy officer at UCLA Health Pharmaceutical Services.