Ever noticed how all of those commercials on TV advertising drugs spend the last 30 seconds or so of the ad rapidly reading off all the warnings and potential side effects? Almost without fail, every single commercial warns: Do not take this medication if you are pregnant or could become pregnant. You see, all medications have potential risks and side effects - and one of the most common risks of medication is damage to a fetus or causing a spontaneous abortion (miscarriage) in pregnant women.
Shortly after the United States Supreme Court handed down the Dobbs opinion, overturning Roe V. Wade and allowing individual states to restrict reproductive healthcare, privacy and healthcare experts started sounding the alarm that the decision could lead to women of childbearing age being denied basic medical care that has nothing to do with pregnancy or reproductive organs. These experts pointed out that many medications affect a women’s ability to maintain a viable pregnancy and doctors and pharmacists who prescribe and fill such medication could theoretically be charged under the laws of some states with “providing an abortion” if a women suffers a miscarriage as a side effect of a drug. These experts pointed out that there was a very real danger that women would be forced to justify their medical conditions to pharmacists, resulting in violations of their privacy regarding their healthcare. Even worse, they predicted that some doctors and pharmacists would resist prescribing these medications in states with such restrictive laws.
Conservative pundits and pro-birth activists belittled these concerns, stating they were nothing more than pro-choice doctors and experts trying to panic women over something that could NEVER happen in this country. They assured us that no woman would ever be denied access to necessary medication nor forced to reveal her most personal and painful medical information to her pharmacists in order to receive healthcare.
Guess what? These conservative pundits and pro-birth activists were wrong. Not only COULD this nightmare scenario for women happen, it is ALREADY HAPPENING.
This week, CVS Health, one of the biggest pharmacy chains in the United States, announced that it is now requiring pharmacists in five states, Alabama, Arkansas, Idaho, Oklahoma, and Texas, to validate the intended use of certain prescriptions before filling them to women of childbearing age. They are asking doctors who write the prescriptions to provide the official diagnosis of each female patient to their pharmacists and will be quizzing these women as to their intended use of the medication before they will fill the prescription. Why? Because the medications in question (which provide necessary, life saving benefits to women and men with certain autoimmune diseases and some cancers) may cause a spontaneous abortion (miscarriage) in pregnant women.
So far, CVS has only identified two drugs for which they will require “validation” before dispensing to women of child-bearing age:
Methotrexate - a powerful immunosuppressant used to treat certain serious autoimmune diseases and certain cancers. Methotrexate treats cancer by slowing the growth of cancer cells. Methotrexate treats psoriasis by slowing the growth of skin cells to stop scales from forming. Methotrexate may treat rheumatoid arthritis, lupus, and other autoimmune diseases by decreasing the activity of the immune system. Methotrexate is so powerful, it is typically only prescribed to patients who have tried and not responded to other medications and therapies. Methotrexate may cause very serious, life-threatening side effects. Doctors usually only recommend it when there is no other viable treatment option. CVS is limiting the use of methotrexate to women of childbearing age because one of it’s many negative side effects is the risk of causing spontaneous abortion (miscarriage).
Misoprostol - used to prevent stomach ulcers in patients who frequently take NSAIDs. It is often prescribed to patients with autoimmune disorders or with conditions that cause chronic pain. NSAIDs such as aspirin, ibuprofen and naproxen are used to treat inflammation and pain, but they put patients at risk for developing dangerous stomach ulcers Misoprostol helps to decrease risk of serious ulcer complications such as bleeding. This medication protects the stomach lining by lowering the amount of acid that comes in contact with it. CVS is limiting the use of misoprostol to women of childbearing age because it can be used in combination with another drug (mifepristone) to end a pregnancy.
Again, these are the only two medications currently being targeted by CVS for required “justification” before they will fill doctors’ prescriptions for women. But I fear this is just the beginning. Many common (and necessary) medications increase the risk of spontaneous abortion in pregnant women. Some antibiotics (fluoroquinolones and sulfonamides) used to treat serious infections increase the risk of miscarriage. Some medications used to treat anxiety and panic disorders increase the risk of miscarriage. Many medication used to treat chronic pain and inflammation (including over the counter drugs like advil and motrin) are linked to higher risks for miscarriage. If CVS is limiting access to misoprostol and methotrexate to women now, what makes anyone think they won’t limit access to these other medications in the future?
Of course, the right-wing pundits and the pro-birth activists don’t think any of this is a big deal. After all, women can still get these medications. They just have to PROVE to their pharmacists that they aren’t pregnant first. So what’s the big deal?
Well, it’s a big deal for many reasons, starting with these:
Doctors prescribe medications to their patients based on medical FACTS. Doctors and patients have a relationship based on mutual trust. Doctors are trained medical professionals and should not have to justify their medical decisions to pharmacists - whose only medical training involves the mixture of chemicals to dispense drugs. Whether or not a woman is pregnant or has the ability to become pregnant should NOT be used by a PHARMACIST as the deciding factor as to whether or not she will receive necessary and often life-saving medications prescribed by her DOCTOR.
Women of childbearing age should not have to PROVE to pharmacists that they are not pregnant and/or don’t intend to become pregnant before being allowed access to necessary medications. How exactly will these women be forced to offer such proof? A note from their doctor? Will they be forced to take an over the counter pregnancy test in front of pharmacy employees? Will women like me, who are still in our childbearing years but have been sterilized, be required to start carrying around medical records confirming our tubal ligations just so we can pick up a prescription?
It is an incredibly harmful and humiliating invasion of women’s privacy to require them to disclose the intimate details of their private medical diagnosis to a pharmacist or pharmacy employee. It doesn’t matter if I am being prescribed a drug for pain, or because I have cancer, or because I suffer from anxiety or depression. It’s really none of the pharmacist’s business. All they need to know is that my PHYSICIAN has determined that I NEED the medication.
CVS, of course, has released a statement assuring their customers that they are still “dedicated” to “ensuring safe and timely access to medications and they are committed to supporting women's health care.”
Uh huh.
I doubt that is comforting to the women who live in the five states where they will now be forced to “validate” their need for their medication and “verify” that they aren’t pregnant and “disclose” their diagnosis to CVS employees in order to be allowed to access medical care.
I know it won’t be comforting to me if the Republican Party wins a super majority in the North Carolina General Assembly and makes it illegal for me to make my own healthcare decisions with my doctor.
Make no mistake.
This is right now about one pharmacy chain, two drugs, and five states.
But it is coming to many more pharmacy chains, many more drugs, and many more states soon. Women will be forced to either prove they aren’t pregnant and publicly disclose their private medical information or be denied necessary medications because they may increase the risk of miscarriage.
I suppose that’s to be expected though. A footnote in the opinion authored by Justice Alito in Dobbs quotes a CDC study that makes it clear that women in the United States have the responsibility to “ensure the domestic supply of infants.” I guess that responsibility trumps our right to receive appropriate medical treatment as prescribed by our doctor - and even to stay alive - without our pharmacists’ permission.
***Commentary by Cheryl Christy. Cheryl can be reached at moorevoicesnc@gmail.com
