Post-Roe Prescription Restrictions Impact Women with Chronic Disease

November 22, 2022 - The Supreme Court’s decision in Hobbs v. Jackson Women’s Health allowing statewide abortion bans has led some clinicians and pharmacists to restrict access to certain drugs that help manage chronic conditions because they are also sometimes used in medication abortion. But according to a new Kaiser Family Foundation analysis, most of the people accessing these drugs are women who are not pregnant.

The KFF researchers indicated that these findings give credence to arguments from the Department of Health and Human Services that these prescription restrictions amount to discrimination on the basis of gender, which goes against section 1557 of the Affordable Care Act (ACA).

Clinicians and pharmacists in states with abortion bans began restricting prescriptions to certain drugs like methotrexate and misoprostol because those medications can induce abortion. However, those drugs are also commonly used to treat certain chronic conditions like Crohn’s disease, Lupus, and certain kinds of cancers.

“In these reports, pharmacists have denied or delayed filling prescriptions unless specific codes for non-pregnancy related conditions are given,” the KFF researchers wrote. “Some providers are also requesting patients take a pregnancy test to confirm a non-pregnant status before they will prescribe the medications.”

At best, these guardrails delay patient access to treatment and, at worst, might keep a patient from treatment altogether.

Through an analysis of prescription drug claims for 14,000 non-elderly beneficiaries of any gender, the researchers found that these rules are disproportionately impacting women who are not pregnant.

For example, 71 percent of the people getting a methotrexate prescription were women. Methotrexate can be used to terminate an ectopic pregnancy or an intrauterine pregnancy in the first trimester, but it’s also commonly used to treat some cancers, rheumatoid arthritis, moderate or severe eczema, and scleritis.

Of the women ages 18 to 49 with a methotrexate prescription, 92 percent were not pregnant in the study year (2019). Most of those women had an autoimmune disease and one in five had a cancer diagnosis in the past year, the researchers found.

Similar trends emerged when looking at misoprostol prescriptions. Misoprostol can be used to induce labor and manage early pregnancy loss. It can also be used in combination with mifepristone to terminate intrauterine pregnancy through 70 days of gestation.

But misoprostol is also used for cervical ripening, to manage abnormal bleeding, and to reduce the risk of gastric ulcers. Some clinicians also prescribe misoprostol in combination with diclofenac to treat rheumatoid arthritis and osteoarthritis.

Again, most of the people accessing this drug were women of childbearing age and who were not pregnant. Most of the non-pregnant women had a misoprostol prescription to prepare for getting an IUD. About a third got a misoprostol prescription because they had an abnormal bleeding diagnosis.

These findings show how abortion bans can impact patient health beyond actual abortion access. Even people who are not pregnant may be impacted by abortion bans, the researchers said, because tamping down on certain drug prescriptions could stymie chronic disease management.

“As abortion bans are implemented in states in the South and Midwest, reproductive-aged women with autoimmune diseases or cancer could see delays or denials in receiving medications like methotrexate and misoprostol, used to manage their chronic conditions,” the researchers wrote. “The abortion bans also have implications for the management of a broad range of conditions that impact women.”

The researchers acknowledged that healthcare providers may be reticent to prescribe these drugs in states with abortion bans lest they face legal consequence.

But this evidence that restrictions on methotrexate and misoprostol disproportionately impact women gives credence to the reminders from the Department of Health and Human Services that beneficiaries of federal funding (mostly via Medicare and Medicaid), pharmacies and healthcare organizations can’t discriminate on the basis of sex.

“The administration’s stance is that decisions to limit access to these medications could be discriminatory based on age, sex, and disability and could violate Section 1557 of the ACA,” the researchers concluded. “This is one of the many unanticipated consequences of the Supreme Court decision to overturn Roe v. Wade and states actions to ban abortion.”