We knew the Roe v. Wade reversal would have detrimental effects on Women's healthcare. Many didn't consider the ripple effects outside of abortion care.

I have no doubt that my rheum will go to bat for me against UHC. Any good doctor would (doesn't mean they should have to).

But the barriers of access to care for rheumatological conditions (which more often affect women than men) have been increased in a post-roe world.

Virginia has even introduced a potential bill that would further limit access to drugs that could induce abortion.

https://lis.virginia.gov/cgi-bin/legp604.exe?221+ful+SB710

So then my question becomes what happens in a scenario where patients can't get access to drugs required in step-therapy by their insurance providers?

Am I stuck on a treatment that is no longer working?

Do I pay thousands out of pocket for a treatment that has been standard of care for almost 3 years?

• Can be used to induce abortion for ectopic pregnancies

and most importantly to insurance

• is much cheaper than biologics.

No wonder my prior auth was denied!

My main concern regards my 3rd point. I live in Virginia, where there are reports of patients already struggling to get access to MTX.

https://www.cnn.com/2022/07/22/health/abortion-law-medications-methotrexate

Side note, some may ask why we decided to go to another TNFi instead of added Methotrexate to begin with. Due to previously mentioned increase in axial symptoms, we decided we'd have better results if we got that back under control first, and could add MTX if needed.

All this brings me back to my original thoughts about MTX, which start with

• Has low evidence for relief of axial symptoms
• Is no longer recommended as first treatment for PsA or SpA

...

"Only you and your doctor can decide what medical care you need."

It's almost as if they don't believe cost (especially of biologics) is a barrier to treatment. Take a look at the average prices for Avsola with GoodRX

https://www.goodrx.com/avsola