Guidance for COVID-19 drug prescribing

DENVER (March 26, 2020) - The Colorado State Board of Pharmacy, the Colorado Medical Board and the Colorado Nursing Board are concerned about the inappropriate prescribing of hydroxychloroquine, chloroquine, azithromycin, Kaletra, and potentially other medications, often in large quantities with a high number of refills, to respond to the COVID-19 pandemic.

The Boards are hearing of instances where abnormally high quantities of these drugs are being dispensed/prescribed in situations that don’t merit the drug, or quantities do not warrant the indication. These actions are causing a shortage of these drugs for people who need them for legitimate medical reasons.

The drugs are commonly used to treat malaria, lupus, rheumatoid arthritis and other conditions. According to the Centers for Disease Control, there are no US Food and Drug Administration (FDA)-approved drugs specifically for the treatment of patients with COVID-19. 

There is, at this date, only anecdotal evidence of their potential usefulness. Public health authorities are working to obtain better data on their potential – and most appropriate use in the pandemic.

Here are recommendations, first distributed by The American Society of Health-System Pharmacists (ASHP) to its membership, which may serve as a general guide for healthcare professionals regarding the receipt and dispensing of prescriptions for hydroxychloroquine, which can be applied to other COVID-19 investigative medications.

1. Continue to fill prescriptions for existing patients who are being prescribed these medications for FDA-approved indications on chronic therapy.
2. For new prescriptions, prescribers should be cognizant that hydroxychloroquine use in COVID-19 patients is not the standard of care. Pharmacists should verify and document diagnosis with the prescriber or prescriber’s agent and limit to a 30-day supply of medication with the drug frequently on back order at this time for prescriptions with an FDA-approved indication.
3. Due to limited supply, reserve hydroxychloroquine for patients with known autoimmune disorders and those ill enough to be hospitalized for COVID-19.

Please note that the Colorado State Board of Pharmacy, the Colorado Medical Board and the Colorado Nursing Board have the authority to discipline their corresponding licensees who fail to meet their corresponding generally accepted standards of practice.

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