On June 24, the Supreme Court issued its decision in Dobbs v. Jackson Women’s Health Organization. The consequences of overturning the 50-year-old precedent established in Roe v. Wade have been profound and swift. At least 24 states have, or will soon have, bans on abortion that could expose rheumatology professionals, pharmacists and, in some cases, patients to harsh criminal and civil penalties. With abortifacient drugs, such as methotrexate, facing more scrutiny, access issues have emerged for rheumatology professionals who depend on these drugs to treat patients with rheumatic disease.
Protecting Rheumatology Patients & Providers
Even as the effects of the decision unfold, it is clear that the ACR has an important role to play in the national discussion. We must work to ensure that patients with rheumatic disease have access to the medications and treatments they need and that rheumatology providers are able to care for their patients as they and their patients deem necessary.
As many of you know, the ACR has a full federal and state advocacy team on staff. We are already working on advocacy strategies to protect the interests of the rheumatology community. We also must work to ensure that the privacy expected in the provider/patient relationship remains intact. To that end, the ACR has created a new Access to Reproductive Health Care Task Force, which I’m leading.
The taskforce consists of rheumatology professionals from around the U.S. It will serve as a rapid response unit to address and provide information on emerging issues following the Dobbs decision. The taskforce has been charged with providing resources and guidance documents and holding a town hall to address many of the questions that members are asking right now. The work of the task force will serve as a foundation for the ACR to develop additional plans of action through relevant committees, including the Government Affairs Committee, the Committee on Rheumatologic Care and others.
As one of the first steps, the ACR will be reaching out to state boards of pharmacy, as well as governors, legislators and other policy makers, to ensure that medications patients use chronically to manage their diseases, even those that may be teratogenic, remain accessible to rheumatology patients and to ensure that safeguards are put in place to protect members of the rheumatology care team and patients from potential penalties when using these drugs to manage rheumatic diseases. Once we have more clarity on these issues, we will work to identify and develop long-term strategic approaches that ensure the provider/patient relationship remains at the center of rheumatology care.
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.
The ACR is working tirelessly to ensure that all rheumatology patients have equal access to the treatments they need and that our members can confidently provide those treatments without fear of legal consequences. You can aid this effort by reporting related access issues to [email protected].
Joseph Cantrell, JD, is the director of state affairs and community relations for the ACR.
Kenneth G. Saag, MD, MSc, is a professor of medicine and holds the Water’s endowed chair in the Division and the Department of Medicine at the University of Alabama at Birmingham (UAB). He is the division director of clinical immunology and rheumatology, and the director of the UAB Comprehensive Arthritis, Musculoskeletal, Bone, and Autoimmunity Center. He is also the ACR’s 85th president.