The Supreme Court decision to overturn Roe v. Wade is causing a worrying side effect: Patients in states that have enacted abortion bans are reporting that pharmacies have refused to fill prescriptions for drugs that could impact a pregnancy if the patient was pregnant. In other words, patients are having trouble accessing critical medication just because they are women.
Pharmacists can refuse to dispense medication for a number of reasons, whether it’s because they’ve identified potentially harmful drug interactions or contraindications, suspect drug abuse, or because the prescription is missing important information. In some states, conscience clauses allow them to refuse to provide a drug because of their religious or personal beliefs. But in these recent post-Dobbs cases, reports suggest that individual pharmacists, pharmacy chains, and even some prescribers are worried about their own legal liability. “Abortion bans are written ambiguously,” says Dr. Benjamin Brown, an OB/GYN in Rhode Island and assistant professor at Brown University. “That can lead people to interpret them very broadly, which ultimately hurts people seeking care.”
While it’s unclear how common this phenomenon is, media reports say patients have had issues filling prescriptions for misoprostol, a drug that is part of the medical-abortion regimen but also can be used for routine gynecological procedures like IUD insertion, and methotrexate, a standard medication for autoimmune diseases like lupus or rheumatoid arthritis that is also used to treat ectopic pregnancy.
Pharmacies have refused to dispense methotrexate in Missouri and Texas, with one store in the latter state even denying the medication to an 8-year-old girl suffering from juvenile arthritis, the Los Angeles Times reported. Social-media users in Tennessee, Alabama, Georgia, and South Carolina have similarly recounted running into obstacles while trying to obtain the drug. There is so much confusion around abortion laws that a rheumatologist’s office in Virginia, a state where abortion remains legal up to viability, notified patients that it would stop prescribing methotrexate directly as a result of the Roe reversal, according to the Times.
Medical experts emphasize this should not be happening and that it sets a dangerous precedent. Pharmacists are among the most accessible health-care providers, says Dr. Danya Qato, an associate professor at the University of Maryland School of Pharmacy, and they have an obligation to “assure optimal outcomes for all patients.” Like abortion bans, refusing to fill prescriptions will likely disproportionately affect minority communities. “There are whole groups of people that if you put enough barriers in front of them, they just stop accessing care,” Qato says.
Medical experts can rattle off a whole list of routine medications that could be misconstrued as off-limits to women under these vague bans. “I can foresee scenarios in which people may be denied access to medication for which there is some data that, even if it is not an abortifacient, it may be harmful to a developing pregnancy,” Brown says. “And there is a very broad group of medications where that may be the case, whether it’s acne treatments or seizure medications.”
Common medications that could cause birth defects include the antibiotic ciprofloxacin (Cipro), the blood thinner warfarin, the antimalarial drug primaquine, or benzodiazepines like temazepam (Restoril), says Dr. Ashley Garling, an assistant professor at the University of Texas at Austin College of Pharmacy. Garling also points out that high-dose NSAID pain relievers, like Ibuprofen and naproxen, can potentially lead to pregnancy disruption. So far, she hasn’t heard of pharmacists refusing to fill prescriptions for any of those medications, although “with the tumultuous environment, it is hard to say.”
Pharmacy giants Walgreens and CVS have said they instructed their staff in states with abortion bans to confirm that methotrexate would not be used for aborting a pregnancy when they are dispensing the drug. All of the reports were concerning enough for the Department of Health and Human Services to warn pharmacies and health-care providers against such refusals because they could be a form of sex or disability discrimination. Notably, this warning included the use of misoprostol and mifepristone to help a patient pass a miscarriage. Yet a week after HHS issued its guidance, The New Republic reported that CVS had not updated its instructions, leaving pharmacists to sort out conflicting messages.
The situation is an enormous mess. But if you’re taking a potentially contentious medication, there are steps you can take to ensure you get the care you need.
Talk to a doctor
If a pharmacy is refusing to fill your prescription, call your doctor. “The first thing I would advise someone to do is to get in contact with the provider who prescribed the medication so that that person can advocate for them,” Brown says.
If your doctor is refusing to prescribe your medication, try to find a new provider. If you need a referral, call the relevant professional body, whether a state’s association or a national group like the American College of Obstetricians and Gynecologists (while you’re at it, report the office that refused you a prescription). “Almost every physician will be a member of one or, very frequently, multiple national organizations, state organizations, specialty organizations,” Brown says.
You can also try a patient-advocacy group, like the Arthritis Foundation, which has a toll-free hotline, including for people having issues with accessing methotrexate, that you can reach at 1-800-283-7800.
Make sure your prescription has the right diagnosis code and indication
CVS has said that for methotrexate or misoprostol prescriptions it has instructed pharmacists in “high-risk states” to “validate that the intended indication is not to terminate a pregnancy.” It also said it encourages providers “to include their diagnosis on the prescriptions they write to help ensure patients have quick and easy access to medications.”
It is not a given that your prescription will have a diagnosis code, which informs a pharmacist of your specific condition, or an indication, which specifies what the drug will be used for. If you run into issues, Garling recommends asking your doctor to resubmit a prescription with the relevant code and, ideally, the indication spelled out in the notes. To prevent a denial from happening in the first place, ask the provider to include the code and the clinical indication when issuing the prescription.
Advocate for yourself
“Patients should be vocal,” Qato said, and escalate as necessary. If one pharmacist denies you medication, ask for someone else at the same location. Go to the manager and then the district manager if the pharmacy is part of a broader chain. You can also call the company’s complaint line, bearing in mind that some chains have introduced corporate policies that may themselves be an obstacle.
Seek out alternatives
If you need your medication immediately, you may want to try another pharmacy. Make sure the new pharmacy has your medication in stock first, then tell them that you’d like to have your prescription transferred from the pharmacy that didn’t fill it.
You also could ask your doctor for several doses of medication to hold you over or try to get the medication at an urgent-care clinic or emergency room. The latter is not an ideal solution, Qato says, because it can be a hassle and there’s a risk doctors there may refuse the prescription as well. If nothing else works, discuss alternative treatments for the condition with your prescriber, Garling adds.
Report the denial
No matter how you go about getting your prescription filled, medical experts advise reporting your denial to an overseeing body or watchdog. If you’re getting refused at a pharmacy, call the state pharmacy board; HHS also encourages people to report denials on their complaints website. “Those reports are really valuable so that we can get a sense for how often this is happening and how we can help to make sure that people in the future don’t experience it,” Brown says.
Consider legal action
HHS’s guidance to pharmacies makes clear that it may constitute discrimination under federal civil-rights law if a medical provider or pharmacist denies you medication because you have the potential of being or becoming pregnant. According to Jess Braverman, legal director at the Minnesota nonprofit Gender Justice, it could also violate state discrimination laws.
“If a pharmacist just refuses to give someone medication prescribed by their doctor for pain relief during IUD insertion, I would absolutely say that’s a form of sex discrimination, especially if that’s not actually barred by any law,” Braverman says. Minnesota’s sex-discrimination law, for instance, includes discrimination based on pregnancy, childbirth, and related conditions. It’s not just a hypothetical debate: Gender Justice filed a lawsuit in 2019 on behalf of a woman who was refused emergency contraception by two pharmacies, and the case is now going to trial.
Braverman says you can seek out a civil-rights attorney or, depending on where you live, file a complaint with your state human-rights department or attorney general’s office. If your state offers no protection from pharmacy refusals, you can reach out to your local legislators.