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.

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. 

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.”

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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. 

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.