How Overturning Roe v. Wade Strips Women of Maintenance Medication for Chronic Illness
Supreme Court justices did not think through how the Dobbs v. Jackson Women's Health Organization decision would intersect with our health care system beyond abortion access. I have psoriatic arthritis. Methotrexate is the go-to medication for people like me with PsA and other autoimmune diseases such as lupus, rheumatoid arthritis, Crohn's disease and more. Methotrexate is also prescribed to treat ectopic pregnancies.
Because of restrictive abortion laws in many states, access to and prescriptions for methotrexate have come into question. When I was prescribed methotrexate, my doctor specifically stressed that I should use two forms of birth control because while taking methotrexate, an unintended pregnancy would not be viable. Methotrexate strips the body of folic acid.
Herein lies the issue. Doctors who care for women of childbearing age who have autoimmune disease now have to think twice when treating them. The pharmacists who dispense methotrexate now have reason to be concerned about being charged with aiding and abetting an abortion in states like Texas.
However, insurance companies require methotrexate to be used as a first line of defense against many autoimmune diseases. When I was first diagnosed, my insurance required me to try methotrexate first prior to moving on to the newer biologic drugs that I take now. This is called "step therapy." Methotrexate is cheaper than biologics. My most recent statement was $12,461.97 for a one-month supply of my biologic injections. The American College of Rheumatology found in their 2020 patient survey that almost half (46%) of patients reported that their insurer subjected them to step therapy requirements. Insurance companies do not want to pay for more expensive medication if a less-expensive traditional one works well.
METHOTREXATE AND ABORTION
If an ectopic pregnancy is caught before it ruptures, methotrexate can halt the growth of the fertilized egg. It can also be used to help shrink the tissue following surgery. To be clear, an ectopic pregnancy is never viable. It happens when the fertilized egg grows outside the womb, in the fallopian tube or attached to an ovary. An ectopic pregnancy always ends in pregnancy loss. If left untreated, the pregnant person's life is in danger when it ruptures.
Women who routinely take methotrexate for chronic illnesses like autoimmune arthritis are now facing barriers to accessing their medication. Symptoms vary with each individual, but for me, leaving my psoriatic arthritis untreated means I can't walk. I can't sleep comfortably, and my feet swell painfully to the point where shoes are not an option. The pain is so much that I am bedridden. All of us have experienced full-blown active disease on our road to diagnosis. To expect a person to return to that in the name of being "pro-life" is unethical and heartbreaking.
Women should not have to worry about losing the medication that allows them to function in their daily lives along with losing their reproductive health care. Justice Clarence Thomas has already stated that access to contraception should be evaluated by the courts next. With methotrexate, access to contraceptives is vital. Access to an abortion if those contraception methods fail is also vital. A pregnancy is not viable when methotrexate is in the system. No one should suffer like that.
Women with chronic illness already live through so much. To find a medication that works for you in the face of illness saves your quality of life. To have it stripped away for fear of the perception that it is being used to terminate a pregnancy is cruel.
Our United States Supreme Court did not think this decision through. This pebble tossed into an ocean under the guise of "pro-life" will continue to ripple out to harm women, again and again and again.
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