Federal health officials reminded U.S. pharmacies on Wednesday that they must comply with federal civil rights laws in the decisions they make about supplying and dispensing medicine. This comes after multiple news reports of pharmacists refusing to fill some prescriptions for medications used for abortion, after the Supreme Court ruling overturning Roe v. Wade.
The guidance clarifies that pharmacists may not discriminate against pharmacy customers "with regard to supplying medications; making determinations regarding the suitability of a prescribed medication for a patient; or advising patients about medications and how to take them," according to a press release from the Department of Health and Human Services.
"We are committed to ensuring that everyone can access health care, free of discrimination," said HHS Secretary Xavier Becerra in the release. "This includes access to prescription medications for reproductive health and other types of care."
The guidance to pharmacies says an example of such discrimination would be if a pharmacist refused to dispense prescriptions for mifepristone and misoprostol to a patient who had a first-trimester miscarriage. These drugs are used "to assist with the passing of the miscarriage," according to HHS. But they are also used for medication abortions early in pregnancy — and such abortions are now banned in some states.
The Department aimed its guidance at the roughly 60,000 retail pharmacies in the U.S., reminding them that because they receive federal funding through several programs such as Medicare and Medicaid, they cannot discriminate based on race, color, national origin, sex, age, and disability; further they may not discriminate based on current pregnancy, past pregnancy, potential or intended pregnancy, and medical conditions related to pregnancy or childbirth.
Misoprostol is also used for stomach ulcers, so if pharmacy refused to stock that drug or dispense it to a patient with severe or chronic stomach ulcers, that could constitute discrimination based on disability, according to the guidance.
Another example in the guidance concerned contraception: if a pharmacy stocks contraception like condoms, but refuses to dispense hormonal forms of contraception such as the pill, that could constitute discrimination on the basis of sex.
HHS officials distributed to reporters a compilation of news stories about pharmacists refusing to fill doctors' prescriptions in states that have restricted abortion after the Supreme Court ruling on June 24, such as Louisiana, but also in states where abortion is still legal, like Virginia.
A doctor quoted in the New Orleans Times-Picayune said she prescribed Cytotec (the brand name for misoprostol) to make it easier to do an IUD insertion. The pharmacy called her to ask if the prescription was for an abortion. Even after she clarified, it still refused to dispense the drug.
HHS also shared news reports about pharmacies refusing to dispense methotrexate, a drug that is commonly used to treat cancer, rheumatoid arthritis, Crohn's, lupus, and other autoimmune diseases.
Methotrexate can also be used to end ectopic pregnancies, which are potentially fatal. Reports in the LA Times and other outlets, featured patients suffering from rheumatoid arthritis and lupus who were refused refills on their methotrexate prescriptions or had trouble getting them.
Senior health officials would not comment on those specific news reports or cases on Wednesday, but said the goal of the guidance was to provide clarity and support for pharmacists in their work. One official said the guidance made it clear that federal law obligations should come first, if there's a conflict with state laws. But she added that if there was a specific conflict with state law, that would have to be investigated in each case.
Patients who believe they were discriminated against at a pharmacy are encouraged to file a complaint at www.hhs.gov/ocr/complaints.
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