The New Orleans Health Department has launched its investigation into whether Louisiana’s new law restricting two common pregnancy medications could harm women’s health or delay medical care.
The health department created a detailed form that can be filled out anonymously. It asks patients, doctors, pharmacists and others to submit detailed descriptions of any delays in care or pregnancy-related complications due to the law, which reclassifies misoprostol and mifepristone as Schedule IV controlled drugs.
The law requires the medications to be locked up in cabinets at hospitals and pharmacies. Doctors say this could delay access to the drugs during emergencies, like when women start bleeding out after giving birth or are miscarrying.
Dr. Jennifer Avegno, the director of the health department, said the form is a safe and secure way to track the law’s impacts in real time, from short delays in care to serious complications. The form will collect data and reports from across the state.
“If we just wait for someone to die we’re way too late,” Avegno said. “The goal is to identify issues as they happen, issues we haven’t even thought about yet, and see the real consequences of the law.”
“This is such uncharted territory, putting these drugs as scheduled drugs,” she added.
Forms are confidential
The only information the form requires is a zip code and a description of the event, and it asks whether someone is a medical provider, pharmacist, community member or “other.”
Avegno said the form was created to be HIPPA compliant, and it won’t be subject to public record requests. This could alleviate fears physicians could be investigated for making a report or providing care, Avegno said
The health department has sent the form to medical professional organizations, providers at New Orleans area hospitals and physicians who were among the nearly 300 who opposed the law in a letter last spring. Avegno also shared it with her personal network.
Drugs can induce abortions
Louisiana is the first state to list misoprostol and mifepristone as controlled substances.
Both have many uses, including treating miscarriages. Misoprostol is a frontline drug to stem massive blood loss when a woman starts bleeding out after giving birth. Some doctors have expressed that their greatest fear is that postpartum hemorrhages could worsen – or that women might die because of restrictions on misoprostol.
When taken together, or when misoprostol is taken alone, the drugs can also induce an abortion, which is why Louisiana’s Republican-controlled legislature, Gov. Jeff Landry, Attorney General Liz Murrill and Louisiana Right to Life said they need to be restricted.
Controlled dangerous substances must be kept in a locked cabinet in hospitals and pharmacies. They come with a sentence of up to 15 years in prison for anyone who possesses them without a valid prescription. The law does not criminalize pregnant women who have the drugs to give themselves abortions — an exemption that’s in line with Louisiana’s near-total abortion ban, which criminalizes those who provide abortions, not women who have them.
Reports already made
The New Orleans Health Department’s reporting form went live after Louisiana’s law took effect on Oct. 1, and Avegno said it has already received submissions. A few people have written in to say they used these drugs during pregnancy emergencies in the past and couldn't believe they were being restricted, she said.
In another case, reported by the Times-Picayune, a doctor prescribing misoprostol to a patient for an IUD insertion was denied by a health insurer, who said the drug needed prior authorizations.
“Which makes no sense,” Avegno said.
Prior authorization typically applies to brand-name drugs that are expensive or rare, and routinely used medications and even scheduled substances don't typically require prior authorizations, Avegno said.
The doctor said the insurance company asked if misoprostol was being prescribed for an abortion, although the doctor had already indicated it the medication was needed for an IUD. Avegno said she tried to talk to the insurer about it and was only told they were responding to a Louisiana “mandate,” without further explanation.
Louisiana Department of Health silent
On Sept. 26, Avegno sent a letter to the Louisiana Department of Health seeking more clarity on the law.
The letter asked LDH to clarify earlier guidance on how the medications can be stored that appears to conflict with state law. It also asks how physicians can ensure they aren’t accused of coercion when prescribing mifepristone or misoprostol to patients, since the restrictions were part of a larger law that established a new crime, “coerced criminal abortion by fraud,” when someone gives a pregnant woman the medications without her knowledge or consent.
The questions came out of a webinar the New Orleans Health Department held for health care providers and pharmacists to educate them on the new law.
Avegno said the LDH has not responded to the letter.