Louisiana
Some Louisiana patients struggle to fill reproductive care prescriptions under new drug law • Louisiana Illuminator
A Lafayette woman needed to get a uterine polyp removed so that she could get pregnant. A woman from northwest Louisiana and another from New Orleans wanted to take long-term birth control measures
What do these three women have in common? They all need misoprostol to soften their cervix before undergoing routine medical procedures, and they all faced challenges trying to fill their prescriptions.
A new law reclassifying misoprostol and mifepristone as controlled dangerous substances took effect Oct. 1 in Louisiana. The medications were reclassified because they can be used in medication abortions, but they have several other prescribed uses. Misoprostol is often used ahead of medical procedures to soften the cervix and when women bleed profusely after delivery.
The new designation requires medical facilities and pharmacies to securely store the drugs and closely record their dispensing and use.
GET THE MORNING HEADLINES.
In May, Gov. Jeff Landry approved a bill from state Sen. Thomas Pressly, a Shreveport Republican, to reclassify the drugs. Since then, doctors have voiced concerns that the law could lead to delays of care for patients, both in hospital settings and for outpatient procedures.
Misoprostol has already been pulled off of postpartum hemorrhage carts in Louisiana and locked away in medical cabinets outside of patient rooms.
A New Orleans-area OB-GYN spoke Friday with the Illuminator about an experience she had with a patient earlier in the day that began the night prior. She asked that her name not be used because her employer did not grant her permission to speak with a reporter.
“I had set her up for an office hysteroscopy to remove [a uterine] polyp. But in preparation for that, she needed to take a medication called misoprostol in order to help open her cervix up so that I could do the procedure more safely and more comfortably,” the doctor said.
The patient was traveling from Lafayette for a minimally invasive medical procedure, and the doctor called in a misoprostol prescription a few days ahead of the procedure. But when the patient went to pick it up Thursday night at her local pharmacy, she was informed her prescription couldn’t be filled.
“She’s just trying to get this procedure done in order to get pregnant,” the doctor said, exasperated. “They told her they do not carry the medication at all anymore. She was very upset.”
An independent pharmacy shifts protocol
Reached for comment Friday, a pharmacist at the Lafayette drug store explained he hasn’t regularly stocked misoprostol for a decade because his small independent drugstore does not see a lot of demand for the drug. When they receive a prescription for misoprostol, they usually get the medication – often just one or two pills – from a larger pharmacy nearby.
But when the pharmacist went to do that in this case, he was told the drug was a controlled substance, and this was no longer an option because of how the medication needs to be counted.
The Louisiana Board of Pharmacy, the profession’s state regulatory body, mentioned the new law in their July newsletter, and the state health department sent guidelines on the new law to pharmacies in early September. The Lafayette pharmacist admitted he had not been aware of them until this week.
The Illuminator is not identifying pharmacists or small businesses in this story for security reasons.
“Sometimes pharmacies may borrow from one another. But it being a controlled substance, you can’t do that,” the Lafayette pharmacist said. “You’d have to replace it with the exact same medication.”
The pharmacist said this means he will no longer fill misoprostol prescriptions, as it does not make sense for him economically because he rarely gets requests for it.
The OB-GYN sent the prescription Friday morning to a New Orleans-area Walmart pharmacist, suspecting it would be easier to access at a chain pharmacy. But when the patient showed up, she was told the medication was not available.
“She was like, ‘This is ridiculous,’”the doctor said. “She had to drive to all these places — she’s chasing it.”
The doctor then called fellow OB-GYNs in the area to find out if there were specific pharmacies they have used recently to fill misoprostol prescriptions. She eventually reached a local CVS that had the medication in stock. The patient’s procedure was delayed until later in the day because the doctor said she was fortunate to have flexibility in her schedule to accommodate the change.
Need to get in touch?
Have a news tip?
However, the doctor said she was frustrated that she, her staff and the patient had to dedicate time to hunting down the medication, which is on the World Health Organization’s core list of essential medicines.
Louisiana is the only state to designate misoprostol and mifepristone controlled dangerous substances, a designation most often used for highly addictive painkillers.
“This has such a huge impact on our practice,” she said. She plans to talk to her employer about whether or not they need to adjust their protocols to store the medication onsite.
Major pharmacies insist they haven’t changed policy
A pharmacist at the New Orleans-area Walmart where the patient was unable to get her misoprostol prescription filled told the Illuminator late Friday afternoon the medication was not currently in stock but could be ordered and delivered from another pharmacy with the correct diagnosis code — a process that usually takes a day.
Corporate representatives for Walmart did not respond to requests for comment.
Amy Thibault, a CVS spokeswoman, said Louisiana’s new regulations haven’t affected how the pharmacy chain handles the targeted drugs.
“There’s been no impact to misoprostol supply or how we stock the medication due to the state law,” Thibault said.
A Walgreens spokesman said the company has had no issues with the supply of misoprostol to any of its Louisiana stores.
“There has been no change in policy” since the new law took effect, Fraser Engerman said. “Stock is based on sales at each of our stores. If there is low volume at a store, it can be ordered for next-day delivery to the store.”
‘Women are not safe in Louisiana’: New Orleans leaders want pregnancy care drug law reversed
Dr. Nicole Freehill, New Orleans OB-GYN, said obtaining misoprostol was challenging immediately after the U.S. Supreme Court overturned Roe v. Wade in June 2022, effectively ending elective abortions in the state of Louisiana.
“We did encounter push back immediately after … but that improved over time and working with pharmacists directly to reassure them we were not prescribing it for ‘illegal’ uses,” Freehill said in a text message. “I am fearful this new law will destroy a lot of that work.”
On Sept. 30, Freehill said she encouraged a patient with an upcoming intrauterine device (IUD) insertion to fill her misoprostol prescription that day — before the new law took effect Oct. 1 — in case of any confusion. But when Freehill sent the prescription to a pharmacy, she said the patient’s insurance provider requested prior authorization.
“Prior authorization is another level an insurance company puts in place, often due to the cost of a medication or service, it’s usually for brand-name drugs or imaging like MRIs,” Freehill said. “I have never seen one for misoprostol, neither had the pharmacist that I talked to.”
The patient was able to obtain the prescription but had to pay out of pocket for it in order to avoid waiting for the prior authorization, said Freehill, who reported the issue to the New Orleans Health Department. City health director Dr. Jennifer Avegno is conducting an impact study on the new law to determine if it’s leading to care delays or difficulties.
Avegno described the new state law as a “poorly conceived, medically and scientifically baseless law” and said she’s heard from patients and providers across the state about outpatient access to misoprostol being “delayed and denied.” The reasons behind the barriers they face are varied and include pharmacies no longer carrying the medication as well as prolonged waits for prescriptions to be processed, she said.
“As hundreds of health care professionals have warned for months, this has disrupted women’s ability to have routine procedures, manage miscarriages, and even receive fertility treatments,” Avegno said.
‘It’s really frustrating’
An obstetrician in northwest Louisiana, who requested anonymity because her hospital did not give her permission to speak with a reporter, said she had a patient who faced challenges procuring misoprostol last week.
“I couldn’t get a single pharmacy in [my area] to dispense misoprostol for an IUD insertion,” the doctor said.
The OB explained that prior to May, she hadn’t had issues calling in misoprostol prescriptions the day before a procedure. She submitted the prescription in question Tuesday for a procedure the next day.
Doctors criticize misoprostol guidance from Louisiana Department of Health: ‘It’s not helpful’
“Usually the pharmacies would have the medicine the next day or make adjustments pending dosage availability,” she explained, saying that in her experience pharmacists can often get deliveries secured overnight.
The patient was able to fill her accompanying Valium prescription, according to her doctor, but four area pharmacies the patient called told her they did not have misoprostol in stock. One family-owned pharmacy told the patient they were no longer carrying it, her doctor said The patient ended up getting the procedure without misoprostol.
The doctor said she had her staff follow up with five pharmacies in the area and said none had it readily available. Only two offered to order the medication.
Now the doctor said she is considering steps to keep misoprostol in her office so that she can dispense it to patients herself, hours ahead of a procedure.
“I counsel these patients on the pain they might experience with IUD insertion and offer them ways to mitigate it. So it’s really frustrating when I can’t hold up my end of the bargain,” the physician said.
YOU MAKE OUR WORK POSSIBLE.
If you’ve experienced challenges seeking reproductive health care in Louisiana, particularly if you are in a rural area, we’d love to hear from you. Please fill out this secure form or contact our reporter at lorenaoneil.64 on Signal, an encrypted messaging app.
As we will do throughout this football season, HawgBeat went behind enemy lines to gain insight on the Louisiana Tech Bulldogs with BleedTechBlue Publisher Ben Carlisle.
Louisiana Tech has been on a bit of a roller-coaster this season, as it defeated a team like Western Kentucky (7-3 record) and nearly beat NC State on the road, but the Bulldogs lost Tulsa, FIU and Sam Houston.
Under Cumbie’s leadership, Louisiana Tech has accumulated a 10-24 (7-16 CUSA) overall record in three seasons. This year, the Bulldogs boast the No. 104 total offense (344.4 YPG) and No. 61 passing offense (232.2 YPG) in the country.
Here is what Carlisle had to say about Saturday’s matchup, which is set to kick off at 3 p.m. CT at Razorback Stadium in Fayetteville…
Louisiana
Louisiana lawmakers search for ways to pay for Landry’s proposed income tax cut • Louisiana Illuminator
Gov. Jeff Landry’s ambitious plan to overhaul Louisiana’s tax structure has largely been pared down to a more modest goal – cutting state income taxes.
Lawmakers are working on a way to make sure the state can pay for that desired tax reduction while not having to make damaging cuts to areas such as health care and higher education.
Options include raising the state sales tax rate higher than it is now, retaining a higher corporate income tax rate than proposed or settling on an income tax cut that is smaller than Landry originally pitched weeks ago.
The governor wanted to move to a flat personal income tax rate of 3% – the highest rate currently is 4.25% – but it will cost the state more than $1 billion annually. Landry’s income tax plan also leaves the state approximately $700 million short of what is needed to cover the costs of government, according to senators.
Through his Revenue Secretary Richard Nelson, the governor had originally crafted a proposal that would exchange a broader base of tax collections for lower personal income and corporate taxes. Nelson said Louisiana would be able to pay for across-the-board personal income and corporate tax rate cuts totaling billions of dollars as long as the state scrapped generous business tax breaks and applied the sales tax to a greater range of products.
The governor has struggled to get lawmakers to fully embrace the trade off, however.
Legislators have eagerly voted for bills to cut corporate and personal income taxes but stalled on proposals to help make up for that lost revenue.
Landry’s tax package started to unravel last week when the Louisiana House of Representatives refused to vote for legislation that would extend the sales tax to more services, such as lawn care, home repair and dog grooming. YOU MAKE OUR WORK POSSIBLE.
“Obviously, the services bill in its original form was a little over $500 million, which would equate to about a half a point on the personal income tax,” House Speaker Phillip Devillier, R-Eunice, said.
This week, the Senate declined to fully roll back some of the state’s expensive business incentive programs, such as its movie and television tax credits and historic preservation tax breaks that collectively cost the state hundreds of millions of dollars annually.
A plan to eliminate a state inventory tax credit, which covers taxes businesses pay to local governments, has been delayed until 2026, and a proposal to increase a tax on heavy machinery and equipment used by industrial employers has also been scrapped.
If he doesn’t find a way to make up for that money, Landry runs the risk of revisiting the same political problems that plagued former Gov. Bobby Jindal.
Jindal also cut income taxes without replacing the lost revenue or finding a permanent way to cut government spending. His policy led to chronic budget problems for years and made the former governor deeply unpopular when he left office.
Senate leaders appear to be pushing for a higher state sales tax rate to help fill the hole left by the personal income tax cut.
It was scheduled to automatically drop from 4.45% to 4% in July, though Landry had already pitched keeping the extra 0.45% permanently as a way to cover the corporate and personal income tax reductions. Now, lawmakers are considering an even higher rate to cover the state’s expenses; 5% has been floated for a few days.
“This isn’t a tax-lowering session. This is a tax-reorganization session,” Rep. Michael Echols, R-Monroe, said Wednesday. GET THE MORNING HEADLINES.
Louisiana already has one of the highest average sales tax rates in the country, and that levy is a larger burden on poor people who have to pay the same rate as the wealthy. Very low-income households don’t pay income tax and won’t necessarily see benefits from cuts Landry and lawmakers make in that arena.
“As soon as you start to increase the sales tax more, the plan becomes more regressive,” said Rep. Matthew Willard, D-New Orleans, leader of the House Democratic Caucus.
Several Republicans and Democrats in the House also weren’t enthusiastic about the sales tax portion of the original tax plan and might not want to vote for a 5% rate. A bill to keep the state sales tax at 4.4% barely passed the House, with just two votes to spare last week.
“That would be the top number we need for sales,” Sen. Franklin Foil, R-Baton Rouge said Wednesday morning. “We don’t necessarily have the votes to do that yet. We need to get a tally of where things stand.”
Lafayette Sen. Gerald Boudreaux, head of the Senate Democratic Caucus, said his party doesn’t want a higher sales tax rate, but Democrats also fear government programs they champion, like social services, will be targeted if they don’t support the proposal.
“We want to make sure the things that are important to us will be funded, right?” Boudreaux said Wednesday before he and other Democratic senators headed off to a meeting with Landry.
Rep. Jack McFarland, R-Jonesboro, was bullish on the legislators’ willingness to raise the sales tax to 5%.
“I think it can get there. It’s an easier path for that than it is for broadening the base,” he said.
If lawmakers aren’t willing to raise the sales tax more, legislators could look to retain more of the current corporate income tax rate, but they’ve already pulled back on an original plan to cut that tax dramatically.
Landry initially pitched replacing the graduated corporate tax rate that tops out at 7.5% with a flat 3%. But the senators moved that levy back up to 6% earlier this week to claw back some revenue. A further increase might be unlikely given pressure from business lobbyists.
Corporate taxes are also a notoriously unstable source of tax revenue. In part because sizable tax credits can be applied in any budget cycle, corporate tax collections have ranged from $193 million to $1.6 billion annually over the past 10 years, according to the Public Affairs Research Council of Louisiana.
Legislators could also increase the personal income tax rate from 3% but seem very reluctant to do so. If it does go up, they would try to keep it to a small adjustment, like up to 3.1% or 3.2%.
“My belief is the personal income tax will, probably will, stay at 3(%),” said Foil, who heads the Senate committee that oversees tax policy.
The Arkansas Razorbacks (5-5, 3-4 SEC) will look to secure bowl eligibility Saturday against Louisiana Tech (4-6, 3-4 CUSA) at Donald W. Reynolds Razorback Stadium in Fayetteville.
Hailing from Ruston, Louisiana, the Bulldogs will bring the nation’s No. 12 total defense with them to Fayetteville fresh off an upset win over Western Kentucky, which was leading the Conference USA standings prior to last Saturday.
“We’re catching them when I think they’re playing their best football,” Arkansas head coach Sam Pittman said Monday. “They deliver some problems. The structure of their defense. They’re a 3-3-5 but it’s different because they have a robber, a rover — a guy basically who’s hard to get to to block. Who is a really, really good player. The (Kolbe) Fields kid.
“So offensively, they’re running the ball a lot better than they have all year. Not throwing it quite as much as what they did earlier in the year. Bu the transfer from Coffeyville (Omiri Wiggins) is a hard runner. Their line is playing well. They’ve got a lot of speed at wideout. So I think they’re going to come in with a lot of confidence, obviously, after their win last week. We’re excited to have them here and on senior day for us. But we know that was a big win for them last week and they’ll come in with a lot of confidence I’m sure.”
Arkansas is statistically better than the Bulldogs in generally every major offensive category, but the Louisiana Tech defense is stingy. Former Razorback Zach Zimos has logged nearly 500 snaps on the year at linebacker, which is a position he switched to after being a safety with the Razorbacks.
“He’d hit you,” Pittman said. “When he hit you, you got stuck. Certainly playing a different position than we had him here. But I like Zach, I always have. I’m happy for him. I think he’s one of the leaders over there. He’s played a lot of ball. I’m just really happy for him and he’s doing a good job. He’ll hit you, now, so we’ll have to figure that out.”
The Razorbacks will be trying to bounce back from a 20-10 loss to Texas that set them back to a .500 record on the season. A win over the Bulldogs would make Arkansas bowl eligible after the Hogs missed the postseason last year.
“This game, winning, if we can win, it will allow us to play not just another one but another one after that,” Pittman said. “And we just have to continue to improve. So I think that’s what we’ll talk about a little bit more than even what Louisiana Tech has been able to do lately.”
HawgBeat has also compared both teams’ grades from Pro Football Focus, which is a football analytics website that provides grades for each individual player and full teams after analyzing each game for all Football Bowl Subdivision (FBS) teams. Grades are given from 0-100, with the higher the grade signifying better performance.
Here’s a look at how both teams stack up based on stats from this year and high school star ratings:
Offense
Louisiana Tech || Arkansas
Scoring: 21.9 (109th) | 30.7 (45th)
Total yards: 344.4 (104th) | 458.3 (11th)
Passing: 232.2 (61st) | 278.0 (20th)
Rushing: 112.2 (115th) | 180.3 (80th)
Third downs: 41.7% (57th) | 47.3% (15th)
Sacks allowed/game: 3.3 (122nd) | 3.1 (117th)
Turnovers: 19 (118th) | 17 (98th)
Defense
Louisiana Tech || Arkansas
Scoring: 21.1 (35th) | 25.7 (75th)
Total yards: 302.3 (12th) | 380.2 (80th)
Passing: 187.3 (26th) | 257.2 (116th)
Rushing: 115.0 (29th) | 123.0 (38th)
Third downs: 36.0% (57th) | 37.0% (59th)
Sacks/game: 1.8 (78th) | 2.1 (57th)
Turnovers forced: 13 (68th) | 12 (85th)
Missouri Attorney General plans to sue Jackson County over youth gun ban ordinance
What’s At Stake For No. 1 NDSU at No. 4 USD & No. 9 Montana at No. 2 Montana State?
Wisconsin and Nebraska are both seeking bowl eligibility and an end to their losing streaks
Vanderbilt Commodores Face Unbeaten Nevada in Charleston Classic Opener
Child care in N.H. can be even more expensive than housing, food, and health care – The Boston Globe
Colorado Rockies game no. 116 thread: Zac Gallen vs José Ureña
See it: Tesla crashes into Columbus convention center at 70 mph
Fox News Politics: Georgia the whole day through
Why Marjorie Taylor Greene was ‘kicked out’ of the Freedom Caucus according to Rep. Buck
Death of missing Oregon girl found in stream ruled homicide
Ted Cruz urges White House to halt $1.25B in 'digital equity' funds
UK imposes sanctions on Isabel dos Santos, Ukrainian oligarch Firtash
This year's FAFSA is officially open. Early review says it's 'a piece of cake'
Read the Verdict in the Civil Case Against Amber Guyger
Democrat Tammy Baldwin details recipe for running in a swing state after victory in Trump-won Wisconsin
-
News1 week agoHerbert Smith Freehills to merge with US-based law firm Kramer Levin
-
Business1 week ago
Column: OpenAI just scored a huge victory in a copyright case … or did it?
-
Health1 week agoBird flu leaves teen in critical condition after country's first reported case
-
Business5 days agoColumn: Molly White's message for journalists going freelance — be ready for the pitfalls
-
World1 week agoSarah Palin, NY Times Have Explored Settlement, as Judge Sets Defamation Retrial
-
Politics4 days agoTrump taps FCC member Brendan Carr to lead agency: 'Warrior for Free Speech'
-
Science2 days agoTrump nominates Dr. Oz to head Medicare and Medicaid and help take on 'illness industrial complex'
-
/cdn.vox-cdn.com/uploads/chorus_asset/file/25739950/247386_Elon_Musk_Open_AI_CVirginia.jpg "Inside Elon Musk’s messy breakup with OpenAI")
Technology3 days agoInside Elon Musk’s messy breakup with OpenAI
