PHOENIX — On May 20, Gov. Doug Ducey sent mixed messages when he said he would not rescind his order denying access to hydroxychloroquine and denied that he was prohibiting the use of it.
“Of course,” Ducey claimed in a press conference, “Arizonans can access needed pharmaceuticals and health care and medicine.”
However, his executive order of April 2, specifically states, “Prophylactic prescriptions for the prevention of COVID-19 are strictly prohibited unless peer-reviewed evidence citing prophylactic effectiveness becomes available.”
Trisa Guzman Glover, the governor’s director of boards and commissions told Capitol Media Services, “It is limited to the diagnosis or the suspected positive for COVID-19 so that we’re not running into shortages for those individuals who are taking it for other reasons.’’
Clearly the prophylactic use of hydroxychloroquine is prohibited in Arizona just as it is in New York and Ohio.
A review by the National Alliance of State Pharmacy Associations (NASPA) shows that other “red states” unlike Arizona, leave the prescribing decisions up to physicians and the dispensing decisions up to pharmacists:
|Alabama||3/25/2020||Pharmacists should use their professional judgement when filling prescriptions for hydroxychloroquine and chloroquine.|
|Arizona||4/2/2020||The following is required when filling hydroxychloroquine and chloroquine: • The prescription must be presented with a diagnosis code for COVID-19 from the prescriber.|
• For a phoned-in prescription, the pharmacist must document a diagnosis code for COVID-19.
• The prescription is limited to no more than a 14-day supply.
• No refills may be permitted unless a new prescription is furnished.
• Prophylactic prescriptions for the prevention of COVID-19 are strictly prohibited unless peer-reviewed evidence citing prophylactic effectiveness becomes available.
• This section does NOT apply to patients that are taking hydroxychloroquine and/or chloroquine for treatment other than COVID-19 (i.e. autoimmune disease) or to prescriptions written prior to April 2, 2020.
|Arkansas||3/21/2020||Pharmacists should exercise caution, keeping in mind that there are no FDA approved treatments for COVID19 at this time; monitor supplies of hydroxychloroquine and chloroquine; and encourage prescribers to note indication (lupus, etc) on prescription when sending to pharmacy.|
|Mississippi||3/24/2020||Pharmacists should exercise caution dispensing hydroxychloroquine and chloroquine in a community setting. Pharmacists should use their professional judgment when dispensing these medications for non-FDA approved indications and are allowed to deny prescriptions if neccessary.|
|New York||3/23/2020||No pharmacist shall dispense hydroxychloroquine or chloroquine except when written as prescribed for an FDA-approved indication; or as part of a state approved clinical trial related to COVID-19 for a patient who has tested positive for COVID-19, with such test result documented as part of the prescription. No other experimental or prophylactic use shall be permitted, and any permitted prescription is limited to one 14-day prescription with no refills.|
|Ohio||3/22/2020||Unless otherwise approved by the board’s executive director, no prescription for chloroquine or hydroxychloroquine may be dispensed by a pharmacist or sold at retail by a licensed terminal distributor of dangerous drugs unless all the following apply:|
(1) The prescription bears a written diagnosis code from the prescriber; and
(2) If written for a COVID-19 diagnosis, the diagnosis has been confirmed by a positive test result, which is documented on the prescription and both of the following apply:
(a) The prescription is limited to no more than a fourteen-day supply; and
(b) No refills may be permitted unless a new prescription is furnished.
Prescriptions for either presumptive positive patients or prophylactic use of chloroquine or hydroxychloroquine related to COVID-19 is strictly prohibited unless otherwise approved by the board’s executive director in consultation with the board president, at which time a resolution shall be issued.
|South Dakota||3/25/2020||From the Joint Statement of the American Medical Association, American Pharmacists Association, and American Society of Health-System Pharmacists on Inappropriate Ordering, Prescribing or Dispensing of Medications to Treat COVID-19 (referenced on the South Dakota BOP website): “We collectively support state and federal requirements that direct a prescription must be written only for a legitimate medical purpose. We also strongly support a pharmacist’s professional responsibility to make reasonable inquiries to a prescriber to resolve any questions about a prescription. If a prescription is not for a legitimate medical purpose, it should not be written, and it should not be dispensed. That determination can and should be made on a case-by-case basis, and physicians, pharmacists and other members of the healthcare team are more than capable of working together and resolving questions.”|
|Tennessee||3/26/2020||“We want providers and pharmacists to act with their best discretion to ensure patients continue to receive appropriate treatment in times of shortages. We discourage inappropriate prescribing or hoarding of this medication for prophylaxis or treatment of COVID-19, which may limit access for patients that require these medications for therapy for approved indications.”|
In late April, the Association of American Physicians and Surgeons let Ducey know in a letter that treating COVID-19 patients with the anti-malaria drugs chloroquine (CQ) and hydroxychloroquine (HCQ, Plaquenil®) seems to be working in response to his April 2
At the time, the physicians told Ducey, “To date, the total number of reported patients treated with HCQ, with or without zinc and the widely used antibiotic azithromycin, is 2,333, writes AAPS, in observational data from China, France, South Korea, Algeria, and the U.S. Of these, 2,137 or 91.6 percent improved clinically. There were 63 deaths, all but 11 in a single retrospective report from the Veterans Administration where the patients were severely ill.”