Prescription Access & Legal Challenges
Teratogenic drugs, specifically methotrexate, have faced particularly intense scrutiny. This is a particular problem because methotrexate is a first-line treatment for many rheumatic disease patients. Many payers and pharmacy benefit managers require patients to try methotrexate as a first step in their plan’s step therapy protocol; only after failing to respond to methotrexate can patients receive other therapies. Without access to methotrexate, patients with rheumatic diseases may be forced to pay for treatment out of their own pockets or be put on more expensive therapies, such as biologics; in some cases, they may be left with no treatment options covered by their insurer.
To monitor disruptions to methotrexate access, we are asking patients and members of the rheumatology care team to report access issues to the ACR at [email protected]. We are working closely with our partners at the Arthritis Foundation and other patient groups, with the Coalition of State Rheumatology Organizations and with other specialty societies to try to ascertain the scope of the disruptions patients are facing. Although we still do not know how widespread these problems are, it is clear that access problems do exist.
Even as access issues are an immediate concern, helping ACR members navigate what could be a legal minefield is also a top priority. Some states are moving at a rapid pace to certify trigger laws that could put patients and care professionals in legal jeopardy. At the same time, legal challenges are being mounted and injunctions have been issued in several states that prevent trigger laws from going into effect immediately. The legal landscape is rapidly evolving, and this evolution will continue for quite some time, which makes giving definitive answers at the moment all the more challenging.
Finally, it is important to point out the unique challenges the Dobbs decision poses for patients with rheumatic disease who are women, who are likely to bear the brunt of the unintended consequences that state abortion bans may have on the management of their conditions. Men are unlikely to encounter the same challenges as women when attempting to fill a prescription for methotrexate.
In states where abortion has been or will soon be criminalized, female patients with rheumatic disease should not be assumed guilty of trying to induce a medical abortion and forced to plead their innocence at the pharmacy counter when filling a prescription such as methotrexate.
