Post-Roe, many autoimmune patients lose access to ‘gold standard’ drug

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Six days after the Supreme Court struck down the right to abortion, lupus patient Becky Schwarzgot an unexpected message from her rheumatologist.

“This is a notice to let you know that we are pausing all prescriptions and subsequent refills of methotrexate,” the message read. “This decision has been made in response to the reversal of Roe vs. Wade.”

Schwarz was stunned. Methotrexate is a cheap, common drug prescribed to millions of Americans. Like her, many have rheumatic illnesses. Others take it to treat inflammatory bowel disease, psoriasis or cancer.

Yet few are aware that it is used off-label to end ectopic pregnancies, or that it could be restricted by doctors or pharmacists even in states like Virginia that do not ban abortion.

The reasons are numerous, and muddy.

In Texas, dispensing methotrexate to someone who uses it to induce a miscarriage after 49 days of gestation is a felony; that makes pharmacists hesitant to fill such prescriptions for almost anyone with a uterus. A new total ban on abortion in Tennessee will effectively criminalize any medication that could disrupt pregnancy past the point of fertilization, with strict exceptions for a patient who will otherwise die. And in Virginia, confusion over rules about who is permitted to prescribe drugs “qualified as abortifacients” may be blocking access to the medication.

“That’s what was shocking to me,” said Schwarz, a 27-year-old who lives in Tysons Corner, Va. “In a state where I thought I was relatively protected regardless of what the Supreme Court decided, I found out I wasn’t.”

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