A Lafayette woman had to have a uterine polyp removed in order to become pregnant. A woman from northwest Louisiana and a woman from New Orleans requested long-term contraception.
What do these three women have in common? They all required misoprostol to soften their cervix before undergoing routine medical procedures and faced difficulty filling their prescriptions.
A new law reclassifying misoprostol and mifepristone as controlled hazardous substances went into effect in Louisiana on October 1st. These drugs have been reclassified because they can be used for medication abortion, but they have several other prescription uses. Misoprostol is often used before medical procedures to soften the cervix and when a woman bleeds heavily after giving birth.
The new designation requires health care facilities and pharmacies to store medicines safely and to closely record dispensing and use.
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In May, Gov. Jeff Landry approved a bill from state Sen. Thomas Pressley, R-Shreveport, to reclassify the drug. Since then, doctors have expressed concerns that the law could lead to: delay in care For patients both in the hospital and in outpatient procedures.
Misoprostol is already I was separated from the postpartum hemorrhage cart. In Louisiana, he was locked in a medical cabinet outside his hospital room.
A New Orleans-area obstetrician-gynecologist was interviewed Friday. illuminator About her experience with the patient earlier in the day, starting the night before. She asked that her name not be used because her employer did not give her permission to speak to reporters.
“I sent her for a hysteroscopy to have it removed. [a uterine] polyp. But in preparation, she had to take a drug called misoprostol to dilate her cervix so that the surgery could be done more safely and comfortably,” the doctor said.
The patient was traveling from Lafayette for a minimally invasive medical procedure, and the doctor asked for a prescription for misoprostol several days before the procedure. But when the patient went to pick up the medication at a local pharmacy on Thursday night, he was told the prescription could not be filled.
“She’s just trying to undergo this procedure to get pregnant,” the doctor said indignantly. “They told her they were no longer carrying any of the drugs. She was very upset.”
Independent Pharmacy Changes Protocol
Reached for comment Friday, a Lafayette drugstore pharmacist said he hasn’t regularly stocked misoprostol in 10 years because he doesn’t see much demand for it at his small, independent drugstore. He explained. When they pick up a prescription for misoprostol, they often only pick up one or two pills of the drug, usually from a large local pharmacy.
However, when the pharmacist tried to do that in this case, he was told that the drug was a controlled substance and given the way the drug was counted, that was no longer an option.
The profession’s state regulatory agency, the Louisiana Board of Pharmacy, cited the new law in a report. July newsletterand state health departments. Submitted guidelines Pharmacies will be notified of the new law in early September. A Lafayette pharmacist admitted he didn’t know they existed until this week.
of illuminator For security reasons, this article does not identify pharmacists or small businesses.
“Sometimes pharmacies borrow money from each other, but because it’s a controlled substance, you can’t do that,” said the Lafayette pharmacist. “It needs to be replaced with the exact same drug.”
The pharmacist said this meant he would no longer accept prescriptions for misoprostol because they were so rarely filled that it didn’t make economic sense.
The gynecologist sent the prescription to a Walmart pharmacist in the New Orleans area Friday morning, thinking it might be easier to get it at a chain pharmacy. But when patients showed up, they were told the drug was not available.
“She said, ‘This is ridiculous,'” the doctor said. “She’s had to drive to all these places. She’s chasing it.”
The doctor then called fellow obstetricians and gynecologists in the area and asked if there was a particular pharmacy that had recently been used to fill a prescription for misoprostol. She ended up at a local CVS that had the medication in stock. The patient’s procedure was postponed until later in the day, as the doctor said he was fortunate to have had flexibility in his schedule to accommodate the change.
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But the doctor said she was frustrated by the time she, her staff and patients had to spend searching for drugs that were on the World Health Organization’s core list of essential medicines.
Louisiana is the only state to designate misoprostol and mifepristone as controlled dangerous substances, a designation most commonly used for highly addictive painkillers.
“This is having a huge impact on our practice,” she said. She plans to discuss with employers whether protocols need to be adjusted to store medications on-site.
Major pharmacies claim they have not changed their policies.
A pharmacist at a New Orleans-area Walmart where a patient was unable to get a misoprostol prescription filled said late Friday afternoon that the drug was currently out of stock but could be purchased from another pharmacy with the correct diagnosis code. He told Illuminator that he could order and have it delivered. It usually takes one day.
Corporate representatives for Walmart did not respond to requests for comment.
CVS spokeswoman Amy Thibault said Louisiana’s new regulations do not affect the pharmacy chain’s handling of targeted drugs.
“State law does not affect the supply of misoprostol or how the drug is stocked,” Thibault said.
A Walgreens spokesperson said the company had no issues with misoprostol supplies at any of its stores in Louisiana.
Fraser Engerman said there has been “no change in policy” since the new law took effect. “Inventory is based on sales at each store. If your store has low inventory, you can also order and have it delivered to your store the next day.”
‘Women are not safe in Louisiana’: New Orleans leaders call for repeal of pregnancy drug law
Dr. Nicole Freehill, a New Orleans obstetrician and gynecologist, said misoprostol was difficult to obtain right after the U.S. Supreme Court overturned it. Roe vs. Wade In June 2022, elective abortion will be effectively abolished in Louisiana.
““While we encountered some immediate backlash… things improved over time and we worked directly with pharmacists to reassure them that we were not prescribing for ‘illegal’ use,” Freehill said. said in a text message. “I fear this new law will undo much of that work.”
On Sept. 30, Dr. Freehill told patients scheduled to have an intrauterine device (IUD) inserted that day before the new law goes into effect on Oct. 1, in case of confusion. He said he recommended that they fill out the form. But when Freehill sent the prescription to the pharmacy, she said the patient’s insurance company asked for prior authorization.
“Prior authorization is another level set up by insurance companies, often due to the cost of the drug or service, typically brand-name drugs or imaging tests like MRI,” Freehill said. “I’ve never seen anything about misoprostol, and neither have the pharmacists I talked to.”
Freehill said patients were able to obtain prescriptions, but had to pay for them out of pocket so they didn’t have to wait for prior authorization. reported Please report this issue to the New Orleans Health Department. City Health Director Dr. Jennifer Avegno said. Impact study To determine whether new laws are leading to delays or difficulties in care.
Dr. Avegno called the new state law “a poorly thought out, medically and scientifically baseless law,” and said the state has heard stories of outpatient access to misoprostol being “delayed and denied.” He said he had heard from patients and medical workers inside. She said the reasons behind the barriers they face are varied and include pharmacies no longer carrying medicines and prescriptions taking longer to process.
“As hundreds of medical professionals have warned for months, this could impede women’s ability to undergo routine procedures, cope with miscarriage, and even receive fertility treatment. Avegno said.
“It’s really frustrating.”
An obstetrician in northwestern Louisiana, who requested anonymity because the hospital did not give him permission to speak to reporters, said some patients last week were having trouble procuring misoprostol.
“There wasn’t a single pharmacy.” [my area] This is to prepare misoprostol for IUD insertion,” the doctor said.
The OB explained that prior to May, there was no problem submitting a prescription for misoprostol the day before surgery. She submitted the prescription in question on Tuesday for treatment the next day.
Doctors criticize Louisiana Department of Health guidance on misoprostol, calling it ‘useless’
“Typically, pharmacies will have the medication available the next day or make adjustments until the dose is available,” she explained, noting that in her experience, pharmacists can often reliably deliver overnight.
The doctor said the patient was able to fill a prescription for the accompanying Valium, but the four local pharmacies he called told him they didn’t have misoprostol in stock. The doctor said a family-run pharmacy told patients it no longer carried the drug. The patient ultimately underwent surgery without the use of misoprostol.
The doctor said he had his staff check five pharmacies in the area, but none had immediate access. Only two people offered to order drugs.
The doctor said he is currently considering measures to keep misoprostol in the exam room so patients can dispense it themselves several hours before surgery.
“I counsel these patients about the pain they may experience when inserting an IUD and offer ways to reduce it, so it’s really frustrating when I can’t meet my contract terms,” says the doctor. said.
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