After Roe v. Wade was overturned, the Biden administration enforced a rule in 2022 mandating that retail pharmacies receiving any federal funding had to carry and dispense mifepristone, misoprostol, and methotrexate—drugs used in medication abortions and, in the case of methotrexate, the treatment of ectopic pregnancies and autoimmune disorders such as rheumatoid arthritis and lupus—in order not to discriminate on the basis of sex and disability.
The Trump administration formally withdrew that rule on Tuesday, allowing pharmacists to refuse to stock or dispense misoprostol and methotrexate, despite their other uses.
Even under the Biden-era rule, pharmacists could still refuse to dispense the drug if they suspected or knew a pregnant person was past the date allowed in their state for a medication-induced abortion. Mifepristone was removed from the Biden rule in 2023, after a lawsuit involving anti-abortion litigators at the arch-conservative Alliance Defending Freedom (ADF) in a case that was subsequently dismissed.
I asked the two leading pharmacies in the United States—CVS and Walgreens—if they will continue to stock and dispense methotrexate. A spokesperson from CVS told me that “all our pharmacies continue to stock and dispense methotrexate where legally permissible.” Walgreens did not respond by the time of publication.
ADF, meanwhile, celebrated the win it couldn’t get in court, writing that “we are grateful to the Trump administration for rescinding Biden-era guidance that forced Americans to dispense abortion-inducing drugs against their conscience.”
Days prior to the Biden administration issuing the rule, NBC’s Today Show covered the challenges faced by patients with chronic illnesses in trying to get their lifesaving medication. With the rule rescinded—and coupled with efforts to criminalize abortion drugs in states like South Carolina, raising concerns that even sympathetic doctors will be scared to prescribe mifepristone, misoprostol, and methotrexate—their availability at smaller pharmacies is likely to drop.
That’s despite the fact that people who are able to conceive are supposed to take contraceptives while on methotrexate, which can cause fetal abnormalities, according to the American College of Rheumatology, meaning that their risk of getting pregnant—let alone pursuing an abortion—is in fact quite low.
Autoimmune disorders primarily affect women, who have also been the main target of abortion restrictions, underlying how treatment for both shows how women’s health is under attack. Research from KFF found that of reproductive-age women who have used methotrexate in the previous year, over 90 percent did so for reasons unrelated to pregnancy. According to the John Hopkins Arthritis Center, around 60 percent of rheumatoid arthritis patients currently are on or have been on methotrexate. It’s unclear how challenging filling methotrexate prescriptions for chronic illnesses remained under the Biden rule, but it will almost certainly become more difficult without it.
Without reliable access to treatment, autoimmune disorders can be very dangerous for those who have them. A 2018 brief report funded in part by the Lupus Foundation of America found that systemic lupus erythematous, one form of lupus, is tied for the top ten leading cause of death for women between the ages of 15 and 24. Among Black and Latina women, it’s the fifth leading cause of death for that age group.
