NC’s largest insurer will cover drugs for COVID-19 patients. State worries about supply.

North Carolina’s largest insurer said it will cover hydroxychloroquine and chloroquine — two drugs that are being investigated for treating the novel coronavirus — for people diagnosed with COVID-19.

However, Blue Cross Blue Shield North Carolina and other state regulators are closely monitoring prescriptions to ensure that those who need it for chronic conditions will still be able to receive it. While clinical trials are underway to assess whether the drugs are effective treatments for the new coronavirus, they have not been approved by the FDA for that use.

In North Carolina and nationally, pharmacists and patients have reported shortages and back orders on particular drugs — including hydroxychloroquine and chloroquine — due to doctors inappropriately prescribing medicine for themselves, their friends and their families.

“I’ve had three doctors calling today just wanting it for themselves or a family member. So of course we turn that down,” said North Carolina Pharmacy Board Vice President Ashley Duggins on Tuesday, adding that the requests were for “larger amounts.”

Blue Cross Blue Shield North Carolina said it has also noticed “a high number of prescriptions” for those drugs written for people without COVID-19 in what seems like “just in case” situations.

The surge in prescriptions has prompted regulatory agencies and the health insurance company to put measures in place so people who have long used the drugs for chronic illnesses such as lupus or rheumatoid arthritis can still get their regular prescriptions.

In an impromptu meeting Tuesday afternoon, the North Carolina Board of Pharmacy unanimously passed emergency rules that limit the amount of certain drugs a pharmacy can dispense for treating COVID-19 and disallow pharmacies to dispense those drugs in prevention or in anticipation of the novel coronavirus.

Blue Cross Blue Shield North Carolina said it would cover hydroxychloroquine and chloroquine “when prescribed at the doses being studied in ongoing clinical trials” and new prescriptions of the two drugs will require prior authorization.

“We are fully committed to making sure our members can access the care and medication they need during this public health emergency,” said a spokeswoman for Blue Cross Blue Shield North Carolina.

Not all health insurers are covering the drugs in the same way. According to reporting by BuzzFeed News, Kaiser Permanente, a major healthcare network in California, will no longer fill routine prescriptions for chloroquine since the drug is being used to treat the critically ill with the novel coronavirus.

President of North Carolina Medical Board, Bryant Murphy, issued an announcement on Wednesday addressing reports of inappropriate and “preemptive” prescribing by medical professionals.

“Prescribing in order to stockpile medication – whether for personal/family use or to assist patients – is not an acceptable medical practice,” he said. “Further, it is inconsistent with the ethics of the medical profession.”

He also reminded doctors and physician assistants that the “vast majority” of people infected by COVID-19 will experience mild illness and will not need prescription drugs of any kind.

Emergency drug preservation rule

On Tuesday, the N.C. Department of Health and Human Services and the N.C. Health Director asked that the Board of Pharmacy and Medical Board adopt the “COVID-19 Drug Preservation Rule.” The rule creates a list of seven “restricted drugs” that can only be given to those with a diagnosis “consistent with the evidence for its use.”

The medications on the list were identified by HHS as drugs that would be “potentially useful” for treating COVID-19, said board Executive Director Jay Campbell.

The restricted drugs — which include ones praised by President Donald Trump last week — are hydroxychloroquine, chloroquine, lopinavir-ritonavir, ribavirin, oseltamivir, darunavir and azithromycin.

“As we sit here today, there is no proof that any of them are effective in the treatment of COVID-19,” Campbell said.

If someone has a prescription for one of the drugs for COVID-19, that person must have a COVID-19 diagnosis and the pharmacist can only give a 14-day supply with no refill, according to the rules passed by the board. The drugs also cannot be dispensed for prevention or in anticipation of COVID-19.

The emergency rule does not apply to those who have a prescription from March 10 or earlier.

“Just like toilet paper, we don’t have as much drug in the supply chain to be able to manage and handle all the demand that’s out there,” said Stephen Eckel, associate dean of the UNC Eshelman School of Pharmacy.

Worrying about a prescription

People with lupus, an autoimmune chronic disease, have been particularly worried about shortages of hydroxychloroquine, which is also sold under the brand name Plaquenil.

The CEO and president of the North Carolina chapter of the Lupus Foundation, Jenny Prince, said that people with lupus have been concerned by rumors of shortages and sky-rocketing prices. The drug is also used to treat rheumatoid arthritis, malaria and other conditions.

Shearie Pearsall, vice chair of the local chapter of the Lupus Foundation, said she has taken hydroxychloroquine twice a day for several years. Pearsall is due for her 90-day refill on May 1, but she isn’t taking any chances. She has already requested the refill early, she said.

“I just want to make sure that when I need it, it’s there,” she said.

Pearsall said she already experiences joint pain and fatigue on a daily basis because of her lupus. But without her medication, she could have a flare-up and damage her kidneys and heart.

Mary Anne Dooley, a rheumatologist in Raleigh, has been similarly worried for her patients and has advised them to ask their pharmacists for a three- to four-month supply. The issue does not seem to be limited to North Carolina, she said.

“I think this is happening everywhere because Donald Trump said it on national TV,” she said.