Methotrexate Access

Methotrexate is a common drug prescribed to people with inflammatory forms of arthritis and other autoimmune diseases. In an autoimmune disease, a person's immune system mistakes healthy cells for foreign substances. It then attacks the healthy cells, which causes the damaging effects and symptoms of the disease.

Methotrexate is often the first-line treatment for conditions such as:¹

• Rheumatoid arthritis (RA)
• Psoriasis
• Psoriatic arthritis
• Lupus
• Ankylosing spondylitis (AS)
• Axial spondyloarthritis
• Juvenile idiopathic arthritis (JIA)

The drug has been used for a long time and is known to be generally safe and effective. In much higher doses, the drug is used to treat certain cancers.²

Methotrexate and arthritis

Methotrexate is essential for some people who take it either by itself or with other drugs. Some single drugs, like biologics, do not control RA well enough. In those cases, methotrexate can help reduce inflammation and keep the disease under control.^1,2

Methotrexate can be life-changing for children with JIA. The drug can put the disease into remission so that the child can live a pain-free life.^1,2

Methotrexate access

On June 24, 2022, the U.S. Supreme Court issued a decision that overturned Roe v. Wade. This decision made the right to abortion no longer federally protected.²

The court's ruling means that states can now make their own decisions about if, when, and how abortion can legally occur. This includes both surgical abortion and medical abortion. In medical abortions, medicines (typically mifepristone and misoprostol) are used to end a pregnancy.²

This ruling affects some other healthcare decisions, too. One of these decisions is whether to take certain medications, such as methotrexate, to treat an inflammatory condition.²

Why is access being denied?

Methotrexate is a vital treatment for many people with chronic health conditions, but the drug is also prescribed to treat early pregnancy loss. This type of loss includes miscarriage and ectopic pregnancy. An ectopic pregnancy happens when a fertilized egg implants outside the uterus.^1,2

Methotrexate is used in much higher doses for medical abortions than for arthritis treatment. For example, a person with RA may receive a maximum of 25 mg per week. A medical abortion, on the other hand, requires 3 times that dose.¹

After the Supreme Court overturned Roe v. Wade, at least one state (Texas) began to allow pharmacists to refuse to fill prescriptions for any medicine that could be used to cause a medical abortion.¹

Methotrexate is also not safe to take during pregnancy. Taking methotrexate can lead to severe birth defects, including spina bifida. Some people who become pregnant while taking methotrexate may want to end their pregnancy so they can continue to take the drug to treat their disease. The Supreme Court's decision means that the state they live in can define the terms around their access to abortion.¹

How can you access your medications?

If you are having trouble getting your medications, there is help available. The Arthritis Foundation has a toll-free helpline staffed by a licensed clinical social worker and trained staff. Call them at 1-800-283-7800. You can remain anonymous if you want to.^1,2

Other ways you may be able to access methotrexate include:¹

• Ask your doctor to write the reason why you need the drug on the prescription. The pharmacy can then see that you need it for a medical reason other than ending a pregnancy.
• Try filling your prescription at a different pharmacy.
• Try using a mail-order pharmacy to fill your prescription.
• Talk to your doctor about other drug options for your condition.
• File a complaint with your state’s Board of Pharmacy if you feel your rights have been violated.