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COVID-19 Quantity Limits Policy

April 2, 2020

PAI and its PBM partner, OptumRx, have developed a new Quantity Limit policy to provide clinical guidance for prescribing hydroxychloroquine/chloroquine related to COVID-19 treatment.

Background

In response to the United States COVID-19 outbreak, PAI is following guidance issued by the Centers for Disease Control and Prevention (CDC), as well as state and local public health departments, to support members’ needs.

Much attention has been focused on the use of hydroxychloroquine (brand name Plaquenil) and chloroquine in the treatment of moderate to severe COVID-19 illness. These medications are currently FDA-approved to treat conditions such as rheumatoid arthritis, systemic lupus erythematosus and malaria. Despite little clinical data supporting their use in treating COVID-19, both hydroxychloroquine and chloroquine are being prescribed and dispensed in large volumes, causing pockets of drug shortages around the country.

To manage inappropriate use, unnecessary utilization and “hoarding” of these drugs, effective March 31, 2020, PAI implemented the following quantity limit in an effort to minimize drug shortages for patients who depend on these medications.   

Quantity Limit Policy Specifics

  1. Hydroxychloroquine will be limited to 30 tablets within a 90-day time period.
  2. Patients who have utilization history of at least a 60-day supply total within the past 120 days will be allowed to bypass the quantity limit. The 120-day “look back” period ensures members have established history on the medication. While this is being put in as a system edit, we are also attempting to identify members currently taking hydroxychloroquine and chloroquine in order to grandfather them and bypass the quantity limit proactively.
  3. Chloroquine will be limited to 30 tablets within a 90-day time period.
  4. Members newly starting on hydroxychloroquine for rheumatoid arthritis or systemic lupus will be able to request quantities beyond 30 tablets through a manual override process.
  5. PAI will continue to review and determine the need for the quantity limit to remain in place.