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COVID-19 Resource Center
April 02, 2020
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ACR, rheumatology societies call on governors to safeguard hydroxychloroquine supply chain

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More than 50 rheumatology societies, including the American College of Rheumatology, have urged U.S. governors to ensure judicious use of hydroxychloroquine and chloroquine for investigational COVID-19 purposes, given that these drugs are essential for many rheumatology patients.

In a letter addressed to all U.S. state governors, as well as lieutenant governors, insurance commissioners and pharmacy boards, the leaders of 53 rheumatology organizations petitioned that efforts should be made to ensure an adequate supply of hydroxychloroquine is available, with protections placed on “all aspects of the supply chain from manufacturer to wholesaler, wholesaler to pharmacy and final distribution to patients.”

“Our providers have extensive experience with the antimalarials, hydroxychloroquine and chloroquine, which are under investigation as potential treatments for the novel coronavirus,” the societies wrote in their letter. “Both medications have been successfully used to treat lupus and rheumatoid arthritis for decades. While we remain hopeful that these drugs will be proven effective against the scourge of COVID-19, we also need to ensure that rheumatology patients who depend on these medications have access to them during this crisis.”

They noted, “Hydroxychloroquine is critical to many rheumatology patients and — in the case of lupus — the only drug proven to reduce mortality.”

 
More than 50 rheumatology societies, including the American College of Rheumatology, have urged U.S. governors to ensure judicious use of hydroxychloroquine and chloroquine for investigational COVID-19 purposes.
Source: Adobe

According to letter, increased off-label use of these medications in patients with COVID-19 could lead to drug shortages for patients with rheumatologic diseases, an imminent threat that the societies hope to avoid by recommending that governors adhere to the following guidelines:

  • Ensure a supply of hydroxychloroquine for clinical trials in pre-exposure prophylaxis, post-exposure prophylaxis and therapy for COVID-19;
  • “Work with the state board of pharmacy to ensure that hydroxychloroquine prescriptions are filled when prescribed by a rheumatologist, a rheumatology professional, or for a patient with COVID-19 when the patient’s use of the drug is initiated and managed by an appropriate specialist;”
  • Relax restrictions on importing hydroxychloroquine for the duration of the pandemic;
  • Allow decisions about the distribution of hydroxychloroquine to be made locally and based on accurate epidemiological data; these decisions should not be made in an ad hoc manner by pharmacies;
  • “[Preventing] unreasonable price increases or cost sharing increases for these drugs” should be another action point for governors;
  • Limit refills of hydroxychloroquine to 30 days for patients who received a prescription before the pandemic;
  • Request that insurers exempt patients with rheumatologic diseases from prior authorization, step therapy protocols and other methods of managing drug use while shortages of hydroxychloroquine last to ensure that these patients can find alternative therapies when needed; and
  • Encourage clear, accurate communication with each state’s populace about hydroxychloroquine use, while discouraging unrestricted access to this drug for pre-exposure prophylaxis of COVID-19 without evidence.

Finally, the ACR and participating organizations encourage governors to prevent pharmacy-level restrictions in initiation of hydroxychloroquine in patients with SLE.

“We are in the midst of a public health crisis that is unprecedented in our lifetime. We understand the desire to find effective treatments as rapidly as possible,” the authors wrote. “As members of the broader health community, we share the same desire, but those desires are tempered by the concern we have for rheumatology patients and our overall commitment to ensure that the drugs used to treat any disease are safe and effective. We are happy to work with you and offer any assistance that we can during this difficult time.” – by Rob Volansky

For more information:       

Please view the full letter here: https://www.rheumatology.org/Portals/0/Files/State-level-HCQ-sign-on.pdf