How Did the Roe v Wade Overturn Affect Methotrexate Access in Rheumatic Disease?

Within 2 months of the US Supreme Court’s decision to overturn Roe v Wade, 1 in 17 individuals who attempted to fill a methotrexate (MTX) prescription experienced an unexpected barrier, according to results of a survey presented at the American College of Rheumatology (ACR) Convergence 2022, held between November 10 and 14, in Philadelphia, Pennsylvania.

Participants enrolled in FORWARD, The National Database for Rheumatic Diseases, were sent a survey regarding post-Roe access to medication. They were asked to provide a description of the Supreme Court decision and whether they had experienced any problems accessing medication since June 24, 2022. In addition, they were asked if they had attempted to refill an MTX prescription during that time.

All participants’ responses were linked to their most recent semiannual questionnaire with regard to demographics, primary diagnosis, and patient-reported outcomes. Further, states of residence were categorized by the legality status of abortion.

Results of the survey showed that among a total of 1706 respondents, 396 reported attempting to fill an MTX prescription since June 24, 2022. Among these participants, 6% (n=23) reported experiencing a barrier to MTX access. One participant reported having restricted access to hydroxychloroquine as well.

Overall, 63% of the respondents who reported an issue indicated that they had experienced a delay in refilling their prescription by their pharmacy. Among the 24 individuals who experienced a barrier in filling their prescription, 11 responded to a request for follow-up for additional information. Of these individuals, 5 experienced barriers that were directly a result of the Roe v Wade decision (ie, the participants were told that the issue in filling the prescription was because of pregnancy risk/abortion-related concerns), whereas 6 experienced barriers that were suggestive of being a consequence of the decision (ie, unexpected delays/refusals without being provided with a clear explanation).

Survey respondents were predominantly White, older than childbearing age, educated, and had medical insurance. The researchers noted that the impact of the Roe v Wade overturn may be more severe in higher-risk populations. Most of the issues experienced by participants were delays by pharmacies seeking to confirm the reason for a prescription with the health care provider.

According to the study authors, “To reduce or avoid these delays, we recommend that health care providers prescribing [MTX] or other medications that are teratogenic or abortifacient include the patient’s diagnosis on the prescription.”