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State Action on Hydroxychloroquine and Chloroquine Access

Hydroxychloroquine (HCQ) and chloroquine (CQ), two medications used widely by people with lupus, are currently being investigated as potential treatments for the coronavirus (COVID-19).

As a result, people with lupus nationwide are experiencing difficulties accessing these medications, which are so critical to fighting the disease.

The Lupus Foundation of America is working tirelessly to ensure that people with lupus are able to access these medications, and is partnering with the Arthritis Foundation to urge each state's Board of Pharmacy to take action to protect access to hydroxychloroquine and chloroquine for people with lupus and rheumatoid arthritis. Importantly, we are also reaching out to other key stakeholders, including each U.S. state's governor, major health plans, national retail pharmacies, and the trade associations who represent these organizations as well as those representing pharmacists and health professionals.

To learn about everything the Lupus Foundation of America is doing amid the coronavirus pandemic, click here

State-by-State: Access to HCQ and CQ

To find out what your state is doing to ensure people with lupus are able to access HCQ and CQ while they are being investigated for use in treating COVID-19, locate your state below.

If you are having issues filling your prescriptions for hydroxychloroquine or chloroquine, click here to learn tips for getting the medications you need during the coronavirus pandemic.

How to use this page

This page is intended to keep you updated on what your state has done, or not done, to ensure access to hydroxychloroquine and chloroquine for people with lupus and other conditions for which they are FDA-approved.

In states where their Board of Pharmacy, or other state entity, has issued recommendations, reminders, or guidelines, it should be noted that pharmacists and prescribers are not necessarily bound by those guidelines, and are still able to rely on their professional judgment in making prescribing and dispensing decisions. Additionally, their employers (i.e. the pharmacy chain where they work) may set policy of their own to guide their behavior towards these medications.

However, in a state where a rule has been issued, or there is an administrative or executive order in place, healthcare providers would be bound by that rule or order.

It's important to know what your state has done so that you can take appropriate steps to fill your prescriptions. In Louisiana, for example, their Board of Pharmacy "strongly encourages" that pharmacists in the state dispense a maximum of a 30-day supply of either drug. Since pharmacists remain free to use their discretion, if your prescriber has written you a prescription for a 60-day supply, it is worth checking with multiple pharmacies to find one that will dispense the full 60-day supply to you.

If you have questions, please contact our Health Educators.

Note that this situation is unfolding rapidly, and you should check back often for up-to-date information about your state's response.

Alabama

The Alabama Board of Pharmacy has issued an undated notice to pharmacists noting that they do "not intend to set policy about which drugs you [the pharmacist] should dispense or about the best decisions for your circumstances."

The Board goes on to note that there is no "reliable evidence that these drugs will be successful treatments for COVID-19" but that "pharmacists have the right to fill prescriptions for drugs written off label." The Board writes that "a written prescription, however, may not be protection for you [the pharmacist] if the patient has major problems."

Click here to read the Board's full guidance.

What this means for people with lupus

At this time, the Alabama Board of Pharmacy does not intend to intervene further and issue prescribing guidelines for hydroxychloroquine and chloroquine. Pharmacists are to use their professional judgment in deciding whether to fill prescriptions written for the explicit or implied purpose of treating or preventing COVID-19.

While nothing in this guidance would prevent a person with lupus from filling a prescription for HCQ or CQ as they have in the past, nationwide shortages and backorders could still affect pharmacies in Alabama.

 

Take action!

Right now, you can email Governor Ivey and urge her to take action to ensure access to hydroxychloroquine and chloroquine for people with lupus. It only takes one minute - please, act now!

Last updated: April 17, 2020

Alaska

According to an FAQ document from the Alaska Board of Pharmacy, they convened with the Alaska Boards of Medicine and Nursing to determine that "stockpiling or hoarding of these medications [hydroxychloroquine and chloroquine] is not warranted and that we all must do our part as healthcare team members to ensure such practices don't take place."

The Board of Pharmacy goes on to note that while they discussed regulating the dispensing of these medications, they believe that healthcare professionals "should be able to work together to resolve these situations without the need of creating rules or guidelines."

Click here to read the Board's complete FAQ document.

What this means for people with lupus

At this time, there are no limitations on prescriptions for hydroxychloroquine or chloroquine and both medications can be prescribed for lupus or other conditions, including COVID-19. However, there may be shortages of the medications within the state, and individual prescribers and pharmacists may use their professional judgment in writing and filling prescriptions, including limiting refills and access to the medications for certain conditions.

Because the state has not taken specific action related to hydroxychloroquine or chloroquine, people with lupus in Alaska may face challenges accessing the medications. 

Take action!

Right now, you can email Governor Dunleavy and urge him to take action to ensure access to hydroxychloroquine and chloroquine for people with lupus. It only takes one minute - please, act now!

Last updated: April 17, 2020

Arizona

On April 2, Arizona Governor Doug Ducey issued executive order 2020-20 which placed restrictions on the prescribing and dispensing of hydroxychloroquine and chloroquine for use in treating or preventing COVID-19.

The order requires prescribers to include a diagnosis on all prescriptions for the treatment of COVID-19, and pharmacists are not to dispense more than a 14-day supply with no refills allowed. The use of either drug for the prevention of COVID-19 is strictly prohibited until such time that peer-reviewed evidence to support that usage is available. 

Importantly, none of the restrictions in the executive order apply to patients taking hydroxychloroquine or chloroquine for conditions other than COVID-19, like lupus.

Click here to read the Governor's full executive order.

What this means for people with lupus

Arizona has taken aggressive action in an effort to reserve the supply of hydroxychloroquine and chloroquine in the state for people who need it for FDA-approved indications, like lupus.

None of the restrictions in the executive order apply to patients taking either drug for reasons other than COVID-19, so people with lupus should not experience quantity or refill limits when attempting to fill their prescriptions.

However, nationwide shortages and backorders of hydroxychloroquine and chloroquine may still affect pharmacies operating in Arizona.

Last updated: April 3, 2020

Arkansas

On March 21, the Arkansas Department of Health (ADH) issued guidance to pharmacists urging caution when prescribing hydroxychloroquine and chloroquine. ADH notes that neither drug is approved for the treatment or prevention of COVID-19, and if it is used, it should be restricted to patients admitted to the hospital with a confirmed case. The Department also notes that the drugs should only be prescribed in situations where side effects, drug interactions, and contraindications can be adequately monitored, which they note would be challenging for a patient not admitted to a hospital. 

ADH writes that prescribing either drug for the treatment or prevention of COVID-19 could negatively affect people using the drug for FDA-approved purposes like treating lupus or rheumatoid arthritis, and pharmacists should consider their supply of the medications before dispensing either drug for off-label purposes. They also recommend that providers prescribing either drug for an FDA-approved indication like lupus note that on the prescription to avoid any delays at the pharmacy counter.

Click here to read the Department's full guidance.

What this means for people with lupus

Arkansas has taken steps to manage the supply of hydroxychloroquine and chloroquine in their state to ensure that people with lupus are able to continue filling their prescriptions. The state has not implemented any guidance limiting refills or quantities - however, nationwide shortages and backorders may still affect the ability of pharmacists to dispense the medications as written by the prescriber.

For all new prescriptions, people with lupus should ensure that their prescribing physician notes their diagnosis on the prescription to avoid delays at the pharmacy.

Last updated: April 3, 2020

California

On April 1, the California State Board of Pharmacy, Department of Consumer Affairs, and the Medical Board of California issued a joint statement addressing inappropriate prescribing practices and hoarding of "certain medications" connected to COVID-19.

While the statement mentions emergency restrictions placed on medications in other states generally, it only mentions hydroxychloroquine and chloroquine in the context of the FDA's Emergency Use Authorization for those medications.

The statement reminds healthcare professionals that "inappropriately prescribing or dispensing medications constitutes unprofessional conduct in California" and that prescribers and pharmacists are "obligated to follow the law, standard of care, and professional codes of ethics in serving their patients and public health."

Click here to read the full joint statement.

Additionally, the Department of Health Care Services has placed restrictions on prescriptions of both drugs for Medi-Cal beneficiaries. Hydroxychloroquine is limited to 120 pills per prescription, and chloroquine is limited to 60 pills per prescription, which the Department says "will allow for up to a 60-day supply for accepted uses," including lupus. The Department notes that for the purposes of COVID-19, prescriptions for both drugs must be obtained through an established clinical trial or the process laid out in FDA's Emergency Use Authorization.

Click here to read the Department's complete guidance.

What this means for people with lupus

California is reminding prescribers and pharmacists that they are required to follow the law and professional codes of conduct, but not placing any restrictions on the prescribing or dispensing of hydroxychloroquine or chloroquine. 

Individual prescribers and pharmacists are to use their professional judgment in writing and filling prescriptions. At this time, there are no limitations on prescriptions for hydroxychloroquine or chloroquine and both medications can be prescribed for lupus or other conditions, including COVID-19.

Medi-Cal beneficiaries will be limited to 120 pills per prescription for hydroxychloroquine and 60 pills for chloroquine prescriptions. Larger quantities may only be dispensed by going through the TAR/SAR appeals process.

Absent any further guidance to protect the state's supply of these medications for use in the treatment of FDA-approved indications like lupus, people with lupus in California may experience challenges accessing their medications. Nationwide shortages and backorders may still affect pharmacies in California.

Take action!

Right now, you can email Governor Newsom and urge him to take action to ensure access to hydroxychloroquine and chloroquine for people with lupus. It only takes one minute - please, act now!

Last updated: April 17, 2020

Colorado

The Colorado State Board of Pharmacy has not issued any publicly-available guidance related to hydroxychloroquine or chloroquine. 

What this means for people with lupus

At this time, there are no limitations on prescriptions for hydroxychloroquine or chloroquine and both medications can be prescribed for lupus or other conditions, including COVID-19. However, there may be shortages of the medications within the state, and individual prescribers and pharmacists may use their professional judgment in writing and filling prescriptions, including limiting refills and access to the medications for certain conditions.

Because the state has not taken specific action related to hydroxychloroquine or chloroquine, people with lupus in Colorado may face challenges accessing the medications. 

Take action!

Right now, you can email Governor Polis and urge him to take action to ensure access to hydroxychloroquine and chloroquine for people with lupus. It only takes one minute - please, act now!

Last updated: April 17, 2020

Connecticut

The Connecticut Commission of Pharmacy has not issued any publicly-available guidance related to hydroxychloroquine or chloroquine. 

What this means for people with lupus

At this time, there are no limitations on prescriptions for hydroxychloroquine or chloroquine and both medications can be prescribed for lupus or other conditions, including COVID-19. However, there may be shortages of the medications within the state, and individual prescribers and pharmacists may use their professional judgment in writing and filling prescriptions, including limiting refills and access to the medications for certain conditions.

Because the state has not taken specific action related to hydroxychloroquine or chloroquine, people with lupus in Connecticut may face challenges accessing the medications. 

Last updated: April 10, 2020

Delaware

On March 24, the Delaware Division of Professional Regulation issued a letter to all healthcare providers in the state. The letter reaffirmed that there is no evidence to establish hydroxychloroquine or chloroquine as safe and effective treatments for COVID-19, and confirmed statewide shortages of the drugs as a result of inappropriate prescribing activities. 

The Division notes that many pharmacies in the state have attempted to mitigate these shortages by imposing 14-day supply limits on new prescriptions, and 30-day limits for patients who had been previously established on either medication. The Division encourages healthcare providers to adopt similar policies, and refrain from prescribing either drug for the prevention of COVID-19.

Click here to read the Division’s full guidance.

What this means for people with lupus

The Delaware Division of Professional Regulation has encouraged prescribers and pharmacists to  impose 30-day quantity limits on patients who were previously established on hydroxychloroquine or chloroquine, and 14-day limits for new patients. 

However, the Division has only recommended these policies, and has not required pharmacists to adopt them. As such, policies on quantity limits will vary between pharmacies. Nationwide shortages and backorders may still affect pharmacies in Delaware.

Last updated: April 3, 2020

District of Columbia

In a March 26 notice to all Washington, DC healthcare providers, the Department of Health reaffirmed that while hydroxychloroquine and chloroquine are under investigation for the treatment and prevention of COVID-19, there are currently no FDA-approved medications for that purpose. 

The Department notes that providers and pharmacists should “act with their best discretion to ensure patients continue to receive appropriate treatment in times of shortages,” but that they “discourage inappropriate prescribing of hydroxychloroquine or chloroquine for pre-exposure prophylaxis [prevention] and treatment of COVID-19, which may restrict access for patients who need appropriate therapy, such as patients with lupus, rheumatoid arthritis, or malaria.” The Department encourages providers “to exercise good professional judgment and stewardship over the drug supply chain during the public health emergency.”

Click here to read the Department's full notice.

What this means for people with lupus

The DC Department of Health is encouraging healthcare providers to use professional judgment when determining whether to prescribe or dispense hydroxychloroquine or chloroquine for the treatment and prevention of COVID-19, while noting that is it not FDA-approved for either purpose. By discouraging their use for COVID-19, the Department is attempting to reserve DC pharmacies’ existing supply of these drugs for FDA-approved uses, like treating lupus.

However, nothing in this guidance prevents healthcare providers from prescribing or dispensing hydroxychloroquine or chloroquine for the treatment or prevention of COVID-19, and shortages may still exist in the District. 

Last updated: April 3, 2020

 

Florida

The Florida Board of Pharmacy has not issued any publicly-available guidance related to hydroxychloroquine or chloroquine. 

What this means for people with lupus

At this time, there are no limitations on prescriptions for hydroxychloroquine or chloroquine and both medications can be prescribed for lupus or other conditions, including COVID-19. However, there may be shortages of the medications within the state, and individual prescribers and pharmacists may use their professional judgment in writing and filling prescriptions, including limiting refills and access to the medications for certain conditions.

Because the state has not taken specific action related to hydroxychloroquine or chloroquine, people with lupus in Florida may face challenges accessing the medications. 

Last updated: April 10, 2020

Georgia

Effective March 27, the Georgia Board of Pharmacy issued an emergency rule restricting the dispensing of hydroxychloroquine and chloroquine unless the prescription includes a written diagnosis consistent with the evidence for its use, which would include prescriptions written for the treatment of lupus. 

The rule also prohibits pharmacists dispensing more than a 14-day supply of either medication, and no refills are permitted without a new prescription. However, neither provision applies to patients who were already established on either medication prior to the effective date of the rule, March 27, 2020.

Click here to read the full emergency rule.

Prior to the issuance of the emergency rule, on March 22 the Georgia Department of Public Health sent a letter to all healthcare providers in the state reaffirming that there is no evidence that hydroxychloroquine is effective in the treatment of COVID-19 and noting that there are no FDA-approved drugs for the treatment of COVID-19.

Click here to read the full letter.

What this means for people with lupus

Georgia has taken aggressive action to reserve the state's supply of hydroxychloroquine and chloroquine for the treatment of FDA-approved indications, including lupus. 

While the state has set quantity and refill limits for both medications, they do not apply to patients who were already established on either drug prior to March 27, 2020.

For people with lupus who were prescribed hydroxychloroquine or chloroquine prior to March 27, 2020, nothing in this rule will prevent them from filling their prescription as they have in the past. However, nationwide shortages and backorders may still affect pharmacies in Georgia.

When receiving a new prescription for either medication, people with lupus in Georgia should ensure that their physician notes their lupus diagnosis on the prescription to avoid delays at the pharmacy counter. 

Last updated: April 14, 2020

Hawaii

On March 28, the Hawaii Department of Health (DOH) issued a release warning against the use of hydroxychloroquine and chloroquine for non-approved purposes. DOH notes that the medications are not approved for use related to COVID-19, and that using the drugs without physician supervision can be extremely dangerous, referencing a statement from the American Association of Poison Control about the dangers of unsupervised usage.

Click here to read the full release.

What this means for people with lupus

The release from Hawaii’s DOH does not address prescribing or dispensing hydroxychloroquine or chloroquine for uses that have not been approved by the FDA. Absent any other guidance, pharmacists in Hawaii are to use their professional judgment in deciding whether to fill prescriptions written for the explicit or implied purpose of treating or preventing COVID-19.

Without guidance, nothing is preventing a person with lupus in Hawaii from filling a prescription for hydroxychloroquine or chloroquine as they have in the past. However, allowing the drugs to be dispensed for COVID-19 could further deplete the state's supply of these drugs and cause loss of access for people with lupus.

Take action!

Right now, you can email Governor Ige and urge him to take action to ensure access to hydroxychloroquine and chloroquine for people with lupus. It only takes one minute - please, act now!

Last updated: April 17, 2020

Idaho

The Idaho State Board of Pharmacy first issued an FAQ document on March 13, which has since been revised several times, addressing questions related to the use of hydroxychloroquine and chloroquine for COVID-19. On the morning of March 26, the Board issued temporary rule 704, effective immediately, which established conditions for dispensing either drug.

For a pharmacist in Idaho to dispense hydroxychloroquine or chloroquine, the following provision must be met:

  • The prescribing physician includes the patient’s diagnosis on the prescription, and the diagnosis is consistent with the evidence for its use (lupus, RA, malaria)

There are two other provisions that must be met, limiting prescriptions to 14-day supplies with no refills, but they do not apply to patients “who were previously established on the medication prior to the effective date of this rule [3/26/2020].”

Click here to read the full FAQ document.

What this means for people with lupus

The Idaho State Board of Pharmacy has taken emergency action to place limits on new prescriptions for hydroxychloroquine and chloroquine in hopes of reserving the state’s supply of these drugs for conditions for which they are approved by the FDA, including lupus.

For people with lupus who were already established on either drug prior to March 26, 2020, there should be no quantity or refill limits placed on their prescriptions. While the state has taken aggressive action to manage Idaho’s supply of both drugs, nationwide shortages and backorders may still affect pharmacies in Idaho.

Last updated: April 3, 2020

Illinois

The Illinois State Board of Pharmacy has not issued any publicly-available guidance related to hydroxychloroquine or chloroquine. 

What this means for people with lupus

At this time, there are no limitations on prescriptions for hydroxychloroquine or chloroquine and both medications can be prescribed for lupus or other conditions, including COVID-19. However, there may be shortages of the medications within the state, and individual prescribers and pharmacists may use their professional judgment in writing and filling prescriptions, including limiting refills and access to the medications for certain conditions.

Because the state has not taken specific action related to hydroxychloroquine or chloroquine, people with lupus in Illinois may face challenges accessing the medications. 

Take action!

Right now, you can email Governor Pritzker and urge him to take action to ensure access to hydroxychloroquine and chloroquine for people with lupus. It only takes one minute - please, act now!

Last updated: April 17, 2020

Indiana

The Indiana Board of Pharmacy and the Medical Licensing Board of Indiana issued a joint statement directed to prescribers and pharmacists in the state addressing the use of hydroxychloroquine and chloroquine for COVID-19.

For prescribers, the Boards note that they discourage the use of any drug for the prevention of COVID-19, and that prescribers should especially avoid prescribing hydroxychloroquine or chloroquine for use by their family or friends because of the impact it will have on the state’s supply of the medications. The Indiana Board of Pharmacy suggests that providers include the diagnosis code for the patient with all prescriptions to avoid delays. Finally, prescribers should consider limiting the amount prescribed “unless deemed medically appropriate.”

For pharmacists, the Boards write that they should use their professional judgment and “take appropriate steps to verify that newly issued prescriptions for hydroxychloroquine, chloroquine…are issued for a legitimate medical purpose” and recommends contacting prescribers to verify the diagnosis for each prescription. The Board recommends that pharmacists consider limiting the quantity dispensed for use in COVID-19 but does not recommend a specific quantity. Finally, the Board notes that they “are not recommending that pharmacies refuse to fill, the Board is recommending that pharmacies use caution.”

In closing, the Boards note that while they are recommending caution, “licensees [prescribers and pharmacists] should avoid interruptions in care for patients previously established on these medications with an appropriate diagnosis” like lupus.

Click here to ready the full joint statement.

What this means for people with lupus

This joint statement advises both prescribers and pharmacists take care to manage Indiana’s supply of hydroxychloroquine and chloroquine to avoid disrupting care for patients who rely on either medication, like those living with lupus. 

While the Boards are acting to limit the amount of either drug that is dispensed for the purpose of preventing or treating COVID-19, they are not suggesting that pharmacists refuse to fill prescriptions for that purpose, but to use their professional judgment in evaluating prescriptions for the medications. 

While the state has taken action to manage Indiana’s supply of both drugs, nationwide shortages and backorders may still affect pharmacies in Indiana. However, nothing that the state has done is preventing a person with lupus in Indiana from filling a prescription for hydroxychloroquine or chloroquine as they have in the past.

Last updated: April 3, 2020

Iowa

The Iowa Boards of Medicine, Nursing, Physician Assistants, Dentistry, and Pharmacy issued a joint statement directed to prescribers and pharmacists in the state addressing the use of hydroxychloroquine and chloroquine for COVID-19.

For prescribers, the Boards note that they discourage the use of any drug for the prevention of COVID-19, and that prescribers should especially avoid prescribing hydroxychloroquine or chloroquine for use by their family or friends because of the impact it will have on the state’s supply of the medications. They suggest that providers include the diagnosis code for the patient with all prescriptions to avoid delays. Finally, prescribers should consider limiting the amount prescribed “unless deemed medically appropriate.”

For pharmacists, the Boards write that they should use their professional judgment and “take appropriate steps to verify that newly issued prescriptions for hydroxychloroquine, chloroquine…are issued for a legitimate medical purpose” and recommends contacting prescribers to verify the diagnosis for each prescription. The Board recommends that pharmacists consider limiting the quantity dispensed for use in COVID-19 but does not recommend a specific quantity. Finally, the Board notes that they “are not recommending that pharmacies refuse to fill legitimate prescriptions for hydroxychloroquine, chloroquine…rather, the Board is recommending that pharmacies use caution and exercise professional judgment when deciding whether and how much to dispense of these medications.”

In closing, the Boards note that while they are recommending caution, “licensees [prescribers and pharmacists] should avoid interruptions in care for patients previously established on these medications with an appropriate diagnosis” like lupus.

Click here to ready the full joint statement.

What this means for people with lupus

This joint statement advises both prescribers and pharmacists take care to manage Iowa’s supply of hydroxychloroquine and chloroquine to avoid disrupting care for patients who rely on either medication, like those living with lupus. 

While the Boards are acting to limit the amount of either drug that is dispensed for the purpose of preventing or treating COVID-19, they are not suggesting that pharmacists refuse to fill prescriptions for that purpose, but to use their professional judgment in evaluating prescriptions for the medications. 

While the state has taken action to manage Iowa’s supply of both drugs, nationwide shortages and backorders may still affect pharmacies in Iowa. However, nothing that the state has done is preventing a person with lupus in Iowa from filling a prescription for hydroxychloroquine or chloroquine as they have in the past.

Last updated: April 3, 2020

Kansas

The Kansas Board of Pharmacy has issued guidance for pharmacists, most recently revised on March 31, related to the prescribing of hydroxychloroquine and chloroquine for COVID-19. The Board “encourages vigilance in processing new prescriptions for chloroquine and hydroxychloroquine and recommends reaching out to prescribers to verify diagnosis.” 

The Board goes on to note that there are no FDA-approved drugs to treat or prevent COVID-19, and that hydroxychloroquine and chloroquine for emergency use in COVID-19 patients “should be obtained from the strategic national stockpile and should only be used in the hospital, inpatient treatment setting” and that FDA has not approved their use in outpatient settings. These drugs should only be used for COVID-19 patients who are admitted to a hospital with a confirmed diagnosis. Finally, the Board recommends that pharmacists consider that patients taking either drug for FDA-approved uses, like lupus, will be affected by increased prescribing and that each pharmacy should monitor their supply closely.

Click here to read the Board of Pharmacy’s full guidance.

In addition, the Kansas Board of Healing Arts has issued guidance to healthcare providers in the state to ensure that they are “complying with the standard of care and standards of professional conduct in regard to any prescription order for “off-label” uses of drugs that may be in limited supply” like hydroxychloroquine and chloroquine. The Board also reaffirms that prescribing decisions should be evidence-based, and that “aggressive off-label prescribing for general prophylactic [prevention] purposes” will negatively impact people who rely on the medications for FDA-approved indications, like lupus.

Click here to read the Board of Healing Arts’ guidance.

What this means for people with lupus

Both the Kansas Board of Pharmacy and the Kansas Board of Healing Arts have issued guidance for healthcare providers and pharmacists in an attempt to manage the supply of hydroxychloroquine and chloroquine in Kansas and reserve it for people with lupus and rheumatoid arthritis. 

The Boards are acting to limit the amount of either drug that is dispensed for the purpose of preventing or treating COVID-19, but they are deferring to the professional judgment of healthcare providers in evaluating whether it is appropriate to write or dispense prescriptions for the medications. 

While the state has taken action to manage Kansas’ supply of both drugs, nationwide shortages and backorders may still affect pharmacies in Kansas. However, nothing that the state has done is preventing a person with lupus in Kansas from filling a prescription for hydroxychloroquine or chloroquine as they have in the past.

Last updated: April 3, 2020

Kentucky

On March 26, the Kentucky Board of Pharmacy issued an FAQ document with Board guidelines addressing the issue of hydroxychloroquine and chloroquine dispensing. The document references a directive the Board issued at their meeting on March 25, which says that prescriptions for either drug may not be dispensed unless the following condition is met:

  • The prescription includes a written diagnosis consistent with the evidence for its use;

There are two additional conditions that limit quantities and refills, however the Board notes that they do not apply to patients who were established on the medication prior to the effective date of the rule (3/25/2020). 

Click here to read the Board's directive.

Click here to read the Board’s FAQ document.

What this means for people with lupus

Kentucky has taken aggressive action to manage their supply of hydroxychloroquine and chloroquine and reserve it for patients who rely on it for FDA-approved indications like lupus. To avoid delays in dispensing, people with lupus should work with their prescriber to ensure that any new prescriptions for either drug includes their diagnosis.

While the Board has placed quantity and refill limits on new prescriptions, those limits do not apply to patients who were already established on either medication prior to March 25, 2020.

Nothing that the state has done would prevent people with lupus who were already established on either drug from filling a prescription as they have in the past, however, nationwide shortages and backorders may still affect pharmacies in Kansas.

Last updated: April 3, 2020

Louisiana

On March 22, the Louisiana Board of Pharmacy issued an emergency rule addressing the dispensing of hydroxychloroquine and chloroquine but rescinded the rule the following day based on “new information” about the drug’s supply chain. On March 25, the Board cited more new information that led to the issuance of a guidance document “in lieu of another emergency rule.”

The new guidance urges pharmacists in Louisiana to “exercise their professional judgment” in dispensing both drugs over the next 30-60 days, and encourages pharmacists to ensure new prescriptions for use in COVID-19 include a written diagnosis, and to limit quantities dispensed to a 14-day supply with no refills.

For all other diagnoses, including lupus, the Board encourages a 30-day limit. 

Click here to read the full guidance.

What this means for people with lupus

Louisiana’s current guidance attempts to limit the dispensing of hydroxychloroquine and chloroquine for use in COVID-19, but also "encourages" pharmacists to establish a 30-day limit for people with lupus and other conditions for which the drugs have been approved by the FDA, with no provision limiting the guidance to only new prescriptions as other states have done.

While this guidance is in effect, people with lupus in Louisiana may be limited to 30-day supplies of hydroxychloroquine and chloroquine, but pharmacists are free to use their discretion. The state is attempting to manage their supply of both drugs, but nationwide shortages and backorders may still affect pharmacies in Louisiana.

Last updated: April 3, 2020
 

Maine

On April 11, the Maine Board of Pharmacy issued a statement regarding the dispensing of hydroxychloroquine and chloroquine.

In the statement, the Board reminds Maine pharmacists that they should verify that all prescriptions for these medications are for legitimate medical purposes and not prophylactic treatment. For patients not previously established on either medication, the Board suggests pharmacists contact prescribers to verify their diagnosis. Prescriptions for the treatment of COVID-19 should include the diagnostic code consistent with an active or presumed case and be limited to a 14-day supply.

Finally, the Board notes that pharmacists "should continue to fill prescriptions for up to 90-day supplies for patients who have existing prescriptions for any of these medications for treatment of conditions other than COVID-19" like lupus.

Click here to read the Board's complete statement.

What this means for people with lupus

Maine has taken action to preserve the state's supply of hydroxychloroquine and chloroquine for people who rely on them for FDA-approved indications like lupus. However, nationwide shortages and backorders may still affect pharmacies in the state.

While Maine has placed quantity limits on prescriptions for the treatment of COVID-19, those limits do not apply to existing prescriptions for FDA-approved indications like lupus, and pharmacists may still dispense up to a 90-day supply for those patients. 

People with lupus in Maine should ensure that on all new prescriptions for hydroxychloroquine or chloroquine, their physician notes their diagnosis on the prescription to avoid delays at the pharmacy counter.

Last updated: April 20, 2020 

Maryland

On March 31, the Maryland Board of Pharmacy issued guidance for the state’s pharmacists noting that there are no FDA-approved medications to treat or prevent COVID-19, and that the evidence of effectiveness for hydroxychloroquine, chloroquine, and others is extremely limited and “there are known contraindications with the use of these medications.”

The Board also reaffirms that pharmacists have the “right to refuse to fill prescriptions that, in the pharmacist’s professional judgment, are not clinically appropriate.” The Board notes that pharmacists should use their professional judgment to ensure that drugs are available to all patients, and can utilize “partial fills, limited days’ supply or other means to promote continuity of care for patients taking these medications for established, and approved, indications” like lupus.

Click here to read the Board of Pharmacy’s full guidance.

Additionally, the Maryland Board of Physicians issued a notice to all Maryland healthcare providers about reports of inappropriate prescribing of hydroxychloroquine, chloroquine, and others. The Board notes that stockpiling, or prescribing for uses other than those approved by the FDA, is creating shortages for patients who rely on the drugs for FDA-approved indications.

The Board concludes by reminding all prescribers “of the obligation to use sound professional judgment in determining if and when medications are clinically appropriate to prescribe.”

Click here to read the Board of Physician’s full guidance.

What this means for people with lupus

The Maryland Board of Pharmacy has reaffirmed pharmacists’ ability to refuse to fill prescriptions that they do not believe to be clinically appropriate. It also empowers them to take steps to manage their supply of drugs like hydroxychloroquine and chloroquine, suggesting partial fills, which could create issues for people with lupus.

The state’s Board of Physicians has also issued guidance to ensure that the state’s healthcare providers are prescribing hydroxychloroquine and chloroquine for legitimate purposes, and not exacerbating the problems with the supply chain with inappropriate prescriptions.

Pharmacists in Maryland may choose to institute quantity limits or dispense partial fills in order to manage their supply of the drug.  Nationwide shortages and backorders may still affect pharmacies in Maryland.

Last updated: April 3, 2020

Massachusetts

The Massachusetts Board of Registration in Pharmacy updated their FAQ document to advise pharmacists in the state that prescriptions written for hydroxychloroquine or chloroquine for the treatment or prevention of COVID-19 should be limited to a 14-day supply, and that they should verify the prescriber is operating "within their scope of practice." 

The Board notes that "new and refill prescriptions for treatment of non-COVID-19 health conditions do not need to be reduced in quantity."

Click here to read the Board's full FAQ document.

What this means for people with lupus

Massachusetts has issued guidance to pharmacists advising, but not requiring, them to limit prescriptions for hydroxychloroquine and chloroquine to 14-day supplies in order to maintain the state's supply of both drugs for FDA-approved indications like lupus.

At this time, the Board is not advising pharmacists to limit quantities or refills for people using either drug FDA-approved indications, so nothing the state has done would prevent a person with lupus from fill or refilling their prescription as they have in the past. However, nationwide shortages and backorders may still affect Massachusetts.

Last updated: April 10, 2020

Michigan

On March 24, Michigan’s Department of Licensing and Regulatory Affairs (LARA) issued a notice to the state’s prescribers and pharmacists about reports of inappropriate prescribing of hydroxychloroquine and chloroquine without a legitimate medical purpose. LARA notes that such prescribing, without evidence of efficacy, is creating shortages for people with lupus and others where the drugs have been proven to be effective. 

LARA writes that any prescription should only be written when it is “associated with medical documentation showing proof of the medical necessity and medical condition for which the patient is being treated,” before reasserting that neither hydroxychloroquine or chloroquine have been proven to treat COVID-19.

For pharmacists, LARA reminds them they “shall not fill a prescription if the pharmacist believes the prescription will be used for other than legitimate purposes or if the prescription could cause harm to a patient,” and that they are required to report “inappropriate prescribing practices.”

Click here to read the full notice.

What this means for people with lupus

Michigan is taking aggressive action, including future investigations and administrative action for prescribers found to be acting inappropriately, to manage their supply of hydroxychloroquine and chloroquine. The state has reminded pharmacists that they have a responsibility to only fill prescriptions which they believe to be appropriate, and report inappropriate prescribing conduct.

While the state has taken action to manage Michigan’s supply of both drugs, nationwide shortages and backorders may still affect pharmacies in Michigan. However, nothing that the state has done is preventing a person with lupus in Michigan from filling a prescription for hydroxychloroquine or chloroquine as they have in the past.

Last updated: April 3, 2020

Minnesota

On March 27, Minnesota Governor Tim Walz issued executive order 20-23 which stated that prescriptions for “hydroxychloroquine or chloroquine must contain a diagnosis appropriate for the use of these medications and be dispensed for no more than 30 days” and authorized the state’s Board of Pharmacy to enforce the order.

The Board of Pharmacy issued guidance related to the executive order, and clarified that the phrase “diagnosis appropriate for use” means any FDA-approved indication for the drug (which would include lupus for both), and at this time, does not include COVID-19. The Board goes on to note that the 30-day limit applies to all diagnoses and empowers pharmacists to contact the prescriber to question higher-than-normal doses for the diagnosis, presumably as a way to get around the 30-day limit.

Click here to read the Board of Pharmacy’s guidance.

What this means for people with lupus

Minnesota’s governor and Board of Pharmacy have taken action to manage the supply of hydroxychloroquine and chloroquine in the state, and at this time, are not allowing it to be dispensed for the treatment or prevention of COVID-19. 

However, the 30-day limit could cause issues for people with lupus who take the drugs and typically receive larger quantities of the medication. When receiving a new prescription from a healthcare provider, people with lupus should ensure that the prescription includes their diagnosis to avoid delays in filling the prescription. 

Despite the state’s action to manage Minnesota’s supply of both drugs, nationwide shortages and backorders may still affect pharmacies in the state.

Last updated: April 3, 2020

Mississippi

On March 21, the Mississippi Board of Pharmacy issued guidance to pharmacists urging caution when prescribing hydroxychloroquine and chloroquine. The Board notes that neither drug is approved for the treatment or prevention of COVID-19, and if it is used, it should be restricted to patients admitted to the hospital with a confirmed case. The Board also notes that they should only be prescribed in situations where side effects, drug interactions, and contraindications can be adequately monitored, which they note would be challenging for a patient not admitted to a hospital. 

The Board writes that prescribing either drug for the treatment or prevention of COVID-19 could negatively affect people using the drug for FDA-approved purposes like treating lupus or rheumatoid arthritis, and pharmacists should consider their supply of the medications before dispensing either drug for off-label purposes. They also recommend that providers prescribing either drug for an FDA-approved indication like lupus note that on the prescription to avoid any delays at the pharmacy counter.

Click here to read the Board's full guidance.

What this means for people with lupus

Mississippi has taken steps to manage the supply of hydroxychloroquine and chloroquine in their state to ensure that people with lupus are able to continue filling their prescriptions. The state has not implemented any guidance limiting refills or quantities - however, shortages within the state may still affect the ability of pharmacists to dispense the medications as written by the prescriber.

Last updated: April 3, 2020

Missouri

The Missouri Board of Pharmacy and the Board of Registration for the Health Arts issued a joint statement directed to prescribers and pharmacists in the state addressing the use of hydroxychloroquine and chloroquine for COVID-19.

For prescribers, the Boards note that they discourage the use of any drug for the prevention of COVID-19, and that prescribers should especially avoid prescribing hydroxychloroquine or chloroquine for use by their family or friends because of the impact it will have on the state’s supply of the medications. The Board of Pharmacy suggests that providers include the diagnosis code for the patient with all prescriptions to avoid delays. Finally, prescribers should consider limiting the amount prescribed “unless otherwise deemed medically appropriate.”

For pharmacists, the Boards write that they should use their professional judgment and “take appropriate steps to verify that newly issued prescriptions for hydroxychloroquine, chloroquine…are issued for a legitimate medical purpose” and recommends contacting prescribers to verify the diagnosis for each prescription. The Board recommends that pharmacists consider limiting the quantity dispensed for use in COVID-19 but does not recommend a specific quantity. Finally, the Board notes that they “are not recommending that pharmacies refuse to fill, the Board is recommending that pharmacies use caution.”

In closing, the Boards note that while they are recommending caution, “licensees [prescribers and pharmacists] should avoid interruptions in care for patients previously established on these medications with an appropriate diagnosis” like lupus.

Click here to read the full joint statement.

What this means for people with lupus

This joint statement advises both prescribers and pharmacists take care to manage Missouri’s supply of hydroxychloroquine and chloroquine to avoid disrupting care for patients who rely on either medication, like those living with lupus. 

While the Boards are acting to limit the amount of either drug that is dispensed for the purpose of preventing or treating COVID-19, they are not suggesting that pharmacists refuse to fill prescriptions for that purpose, but to use their professional judgment in evaluating prescriptions for the medications. 

While the state has taken action to manage Missouri’s supply of both drugs, nationwide shortages and backorders may still affect pharmacies in Missouri. However, nothing that the state has done is preventing a person with lupus in Missouri from filling a prescription for hydroxychloroquine or chloroquine as they have in the past.

Last updated: April 3, 2020

Montana

The Montana Department of Labor and Industry has posted a statement to their website noting that there are no FDA-approved treatments for COVID-19, and that there have been reports of inappropriate prescribing and dispensing of chloroquine and hydroxychloroquine nationally and locally in Montana.

The Department notes that inappropriate prescribing and dispensing creates issues for people who rely on the medications for FDA-approved indications, like lupus. They remind providers and pharmacists to "exercise their best professional judgment and discretion to ensure patients established on appropriate treatment prior to COVID-19 continue to have access to their medications, including during drug shortages."

The Department encourages anyone who is aware of inappropriate prescribing or dispensing to report that information to the Department.

Click here to read the Department's full statement.

What this means for people with lupus

Montana is deferring to the professional judgment of prescribers and pharmacists in determining the appropriateness and validity of prescriptions for hydroxychloroquine and chloroquine.

While individual prescribers and pharmacists may limit quantities and refills to manage their supply of the drugs, nothing that the state has done would prevent someone with lupus from filling their prescription as they have in the past.

Nationwide shortages and backorders may still affect pharmacies in Montana.

Last updated: April 24, 2020

Nebraska

Nebraska has not issued any publicly-available guidance related to hydroxychloroquine or chloroquine. 

What this means for people with lupus

At this time, there are no limitations on prescriptions for hydroxychloroquine or chloroquine and both medications can be prescribed for lupus or other conditions, including COVID-19. However, there may be shortages of the medications within the state, and individual prescribers and pharmacists may use their professional judgment in writing and filling prescriptions, including limiting refills and access to the medications for certain conditions.

Because the state has not taken specific action related to hydroxychloroquine or chloroquine, people with lupus in Nebraska may face challenges accessing the medications. 

Take action!

Right now, you can email Governor Ricketts and urge him to take action to ensure access to hydroxychloroquine and chloroquine for people with lupus. It only takes one minute - please, act now!

Last updated: April 17, 2020

Nevada

On March 23, the Nevada State Board of Pharmacy requested an emergency regulation from Governor Steve Sisolak to limit the prescribing of hydroxychloroquine and chloroquine for use treating and preventing COVID-19. The emergency regulation was signed by Governor Sisolak later that day, going into effect immediately.

The restrictions in the emergency regulation include prohibiting the prescribing and dispensing either drug for COVID-19 or new diagnoses made after 3/23/2020, requiring a written diagnosis for new prescriptions, and limited new prescriptions to a 30-day fill. The restrictions do not apply to “existing course of treatment for a diagnosis made before the effective date of the regulation [3/23/2020].”

Click here to read the full emergency regulation.

What this means for people with lupus

Nevada has taken aggressive action to manage their supply of hydroxychloroquine and chloroquine. By restricting the use of either drug for the prevention or treatment of COVID-19, the state has ensured that all of the supply in the state will be used for patients with diagnoses for which there is FDA-approval, including lupus.

It is important to note that the 30-day quantity limit in the emergency regulation does not apply to patients being treated with the medication prior to March 23, 2020. People with lupus should ensure that any new prescriptions written for either drug include their diagnosis to avoid delays in having their prescription filled.

While the state has taken action to manage Nevada’s supply of both drugs, nationwide shortages and backorders may still affect pharmacies in Nevada. However, nothing that the state has done is preventing a person with lupus in Nevada from filling a prescription for hydroxychloroquine or chloroquine as they have in the past.

Last updated: April 3, 2020

New Hampshire

On April 3, the New Hampshire Department of Health and Human Services issued an emergency order regulating the prescribing and dispensing of hydroxychloroquine and chloroquine in the state. 

The order prohibits the prescribing or dispensing of prescriptions for hydroxychloroquine or chloroquine for the prevention of COVID-19, and establishes a quantity limit of 30 days only for patients who were not already established on either medication. Patients already established will not be limited to a 30-day supply.

Finally, the order requires prescribers to note the patient's diagnosis on all prescriptions for hydroxychloroquine and chloroquine.

Click here to read the complete emergency order.

What this means for people with lupus

New Hampshire has taken action to reserve their supply of hydroxychloroquine and chloroquine for those who need it for the treatment of FDA-approved indications, like lupus, and people with COVID-19 receiving the medication through a clinical trial or in a hospital.

While the state has imposed a 30-day quantity limit on new prescriptions for hydroxychloroquine and chloroquine, patients who were already established on either medication will not be subject to the limit and can get their medication in larger quantities, pending availability at their chosen pharmacy. The emergency order does not specify a date before which a patient had to be established on the medication to be exempt from the quantity limit as other states have done. 

People with lupus in New Hampshire, when receiving a new prescription for either medication, should ensure that their physician notes their lupus diagnosis on their prescription to avoid delays at the pharmacy counter

Nationwide shortages and backorders may still affect pharmacies in New Hampshire. 

Last updated: April 28, 2020

New Jersey

On March 30, New Jersey’s Attorney General Gurbir S. Grewal and the Division of Consumer Affairs announced statewide restrictions for the prescribing and dispensing of hydroxychloroquine and chloroquine. 

Effective immediately, the Administrative Order prevents healthcare providers from prescribing “medications in short supply” to friends and family for the prevention of COVID-19, or for stockpiling for office use. Additionally, the state notes that healthcare providers should not be prescribing the medications outside of their usual scope of practice. Pharmacists are instructed not to fill prescriptions if they believe the prescriber is acting outside of practice.

The Order does set quantity limits for prescriptions to treat COVID-19, but notes that “the order does not limit prescriptions of hydroxychloroquine and chloroquine for patients being treated with maintenance prescriptions for preexisting conditions, such as lupus or other autoimmune diseases.” The Order does empower pharmacists to exercise their judgment when filling or refilling prescriptions “for medications that may soon be in short supply.”

Click here to read the full Administrative Order.

What this means for people with lupus

New Jersey has taken action to limit the use of hydroxychloroquine and chloroquine for the use in preventing and treating COVID-19. The state is not currently implementing quantity limits or restrictions for patients who were already being treated by either drug for an FDA-approved indication, like lupus.

While the state has taken action to manage New Jersey’s supply of both drugs, nationwide shortages and backorders may still affect pharmacies in New Jersey. Additionally, the state is allowing pharmacists to limit the quantities they dispense, even for valid prescriptions for FDA-approved uses, which may create issues for people with lupus.

Last updated: April 3, 2020

New Mexico

On March 21, the New Mexico Boards of Pharmacy and Nursing, and New Mexico Medical Board issued a joint letter to prescribers and pharmacists about reports of inappropriate prescribing of hydroxychloroquine, chloroquine, and others that are being investigated for potential use in treating and preventing COVID-19. The Boards note that inappropriate prescribing is creating shortages and access issues for people with lupus and other serious medical conditions.

The Board reaffirms that prescribers should be exercising good professional judgment and adhering to evidence-based standards when prescribing. When a patient was not previously established prior to the COVID-19 pandemic, the prescription should include a written diagnosis.

Finally, the Boards note that they do not intend to take action against pharmacists that decline to fill questionable prescriptions, or limit the supply for acute conditions (which would not seem to include lupus).

Click here to read the full joint letter.

What this means for people with lupus

New Mexico is encouraging prescribers and pharmacists to use their professional judgment to ensure that the supply of hydroxychloroquine and chloroquine are only used for FDA-approved indications, like lupus. 

While the state has taken action to manage New Mexico’s supply of both drugs, nationwide shortages and backorders may still affect pharmacies in New Mexico. However, nothing that the state has done is preventing a person with lupus in New Mexico from filling a prescription for hydroxychloroquine or chloroquine as they have in the past.

Last updated: April 3, 2020

New York

On March 27, Governor Andrew Cuomo issued executive order 202.11, which amended the provisions from executive order 202.10 related to the prescribing and dispensing of hydroxychloroquine and chloroquine. 

The new executive order maintained the provision prohibiting pharmacists from dispensing hydroxychloroquine or chloroquine except when written "as prescribed for an FDA-approved indication” like lupus. The order also expands the permitted uses of both drugs for COVID-19, including in inpatient and acute settings, subacute sections of skilled nursing facilities, and state-approved clinical trials. 

Notably, according to New York's Office of Professions' FAQ page, executive order 202.11removes the provision from 202.10 that prohibited pharmacists from dispensing more than a 14-day supply for any hydroxychloroquine or chloroquine prescription.

Finally, executive order 202.11 notes that prescribers must note on the prescription "the condition for which the prescription has been issued."

Click here to read executive order 202.11.

Click here to read executive order 202.10.

What this means for people with lupus

New York has taken aggressive action to reserve the state’s supply of hydroxychloroquine and chloroquine for people with lupus and rheumatoid arthritis. Importantly, the 14-day limit on hydroxychloroquine and chloroquine is no longer in effect.

Whenever being issued a new prescription for hydroxychloroquine or chloroquine, people with lupus in New York should advise their physician to note their lupus diagnosis on the prescription to avoid delays at the pharmacy counter. 

At this time, nothing that New York has done would prevent a person with lupus from filling a prescription as they have in the past. However, nationwide shortages and backorders, plus the abundance of clinical trials taking place in New York, could impact the ability of people with lupus to fill their prescriptions for hydroxychloroquine and chloroquine.

Last updated: April 14, 2020

North Carolina

On March 24, the North Carolina Board of Pharmacy passed an emergency rule in an effort to preserve the state’s supply of hydroxychloroquine, chloroquine and other drugs (classified by the state as “Restricted Drugs”) for people with lupus and other conditions for which they are FDA-approved. 

The rule requires that all prescriptions for one of the restricted drugs include a written diagnosis “consistent with the evidence for its use.” The Restricted Drugs cannot be dispensed for presumptive cases or for the prevention of COVID-19, and in cases where there is a confirmed diagnosis of COVID-19, the prescription should be limited to 14 days and cannot be refilled without a new prescription.

Importantly, nothing in the rule applies to “prescriptions for a Restricted Drug for a patient previously established on that particular Restricted Drug on or before March 10, 2020.”

Click here to read the Board of Pharmacy’s full emergency rule.

The North Carolina Medical Board also passed an emergency rule on March 27 placing similar restrictions on healthcare providers in North Carolina licensed to prescribe medications.

Click here to read the Medical Board’s full emergency rule.

What this means for people with lupus

North Carolina has taken aggressive action to restrict the use of hydroxychloroquine, chloroquine and other drugs by prohibiting their use for the prevention of COVID-19, and only allowing them to be used as a treatment for confirmed cases under very narrow circumstances.

North Carolina has not set any limits on the dispensing of hydroxychloroquine or chloroquine to patients who were already established on the medications on or before March 10, 2020.

Nothing the state has done would prevent a person with lupus, already taking either drug prior to that date, from filling their prescription as they have in the past. However, nationwide shortages and backorders may still impact the ability of pharmacies in North Carolina to fill prescriptions for these medications.

Last updated: April 3, 2020

North Dakota

The North Dakota State Board of Pharmacy has not issued any publicly-available guidance related to hydroxychloroquine or chloroquine. 

What this means for people with lupus

At this time, there are no limitations on prescriptions for hydroxychloroquine or chloroquine and both medications can be prescribed for lupus or other conditions, including COVID-19. However, there may be shortages of the medications within the state, and individual prescribers and pharmacists may use their professional judgment in writing and filling prescriptions, including limiting refills and access to the medications for certain conditions.

Because the state has not taken specific action related to hydroxychloroquine or chloroquine, people with lupus in North Dakota may face challenges accessing the medications. 

Take action!

Right now, you can email Governor Burgum and urge him to take action to ensure access to hydroxychloroquine and chloroquine for people with lupus. It only takes one minute - please, act now!

Last updated: April 10, 2020

Ohio

On March 22, the Ohio Board of Pharmacy, authorized by Governor Mike DeWine, issued an emergency rule related to prescriptions for hydroxychloroquine and chloroquine, effective immediately. 

All prescriptions for either drug must include a written diagnosis from the prescriber. If the prescription is for the treatment of a confirmed COVID-19 case, the prescription is limited to a 14-day supply and no refills may be dispensed without a new prescription. This quantity limit does not apply to prescriptions written for FDA-approved uses, like lupus.

Originally, the rule strictly prohibited using hydroxychloroquine or chloroquine for presumptive positive COVID-19 patients, or for the prevention of COVID-19. An update on March 26 amended the rule to allow the drugs to be used for presumptive positive patients if it is part of an approved clinical trial, or if it is the continuation of inpatient COVID-19 treatment for patients who have been discharged from the hospital. 

Importantly, the FAQ section of the rule reaffirms that “any prescription issued prior to 3/22/2020, including refills, may be dispensed without a documented diagnosis code.” All new prescriptions issued on or after 3/22/2020, for any purpose, must include a written diagnosis to avoid delays in dispensing the prescription while the pharmacist contacts the prescriber to receive a verbal diagnosis.

Click here to read the Board of Pharmacy’s full emergency rule.

What this means for people with lupus

Ohio has taken action to limit the use of hydroxychloroquine and chloroquine for COVID-19 except under narrow circumstances, and has prohibited its use for the prevention of COVID-19. 

While the state has taken action to manage their supply of both drugs, nationwide shortages and backorders may still affect pharmacies in Ohio. However, nothing that the state has done is preventing a person with lupus in Ohio from filling a prescription for hydroxychloroquine or chloroquine as they have in the past, and prescriptions written on or prior to March 22, 2020, including refills, do not need to include a written diagnosis. 

People with lupus should ensure that on any prescription written after March 22, 2020, their healthcare provider notes their lupus diagnosis to avoid any delays in being able to fill the prescription.

Last updated: April 3, 2020
 

Oklahoma

On May 12, Oklahoma Governor Kevin Stitt enacted Executive Order 2020-13 (Sixth Amended) which removed the restrictions on prescribing hydroxychloroquine and chloroquine that had been in place by previous order. 

Click here to read the Board of Pharmacy's statement on the executive order.

What this means for people with lupus

With the restrictions on prescribing hydroxychloroquine and chloroquine no longer in place in Oklahoma, physicians and pharmacists are free to prescribe and dispense either medication to any patient they believe would benefit from it, including for the prevention or treatment of COVID-19. Such prescribing is not recommended by the Food and Drug Administration, but medical professionals in Oklahoma are currently able to prescribe hydroxychloroquine and chloroquine using their professional judgment.

Nationwide shortages and backorders may still affect pharmacies in Oklahoma.

Last updated: May 14, 2020

Oregon

The Oregon Board of Pharmacy issued a temporary administrative order on March 25, effective immediately. The rule, noting the lack of evidence to establish hydroxychloroquine or chloroquine as viable treatments for COVID-19, restricts prescriptions for the drugs unless:

  • They are issued as the continuation of a therapy begun prior to 3/8/2020;
  • The prescription includes a written diagnosis consistent with the evidence, like lupus.

The drugs may only be dispensed for COVID-19 if the patient is hospitalized with a positive test result. The drugs cannot be dispensed under any other circumstances. 

Click here to read the Board of Pharmacy’s full administrative order.

What this means for people with lupus

Oregon has taken action to reserve the state’s supply of hydroxychloroquine and chloroquine for people already established on the drugs prior to March 8, 2020, or for new prescriptions written for the use in treating one of the medications’ FDA-approved indications, like lupus. Both medications may only be dispensed for COVID-19 if the patient is hospitalized with a positive test result for COVID-19.

While the state has taken action to manage their supply of both drugs, nationwide shortages and backorders may still affect pharmacies in Oregon. However, nothing that the state has done is preventing a person with lupus in Oregon from filling a prescription for hydroxychloroquine or chloroquine as they have in the past.

People with lupus should ensure that on any prescription written after March 8, 2020, their healthcare provider notes their lupus diagnosis to avoid any delays in being able to fill the prescription.

Last updated: April 3, 2020

Pennsylvania

In late March, the Pennsylvania Board of Pharmacy issued suggestions to the state’s prescribers. The Board suggests that pharmacists should, before dispensing hydroxychloroquine or chloroquine, verify that the patient confirmed positive for COVID-19, and consider dispensing smaller quantities for those patients.

Patients who are already established on either drug, or utilizing the drugs for FDA-approved purposes, should be able to continue accessing their medication without verifying their diagnosis. 

Pennsylvania’s Board of Medicine and Osteopathic Medicine issued similar suggestions for prescribers in the state.

Click here to read the suggestions issued by both Boards.

What this means for people with lupus

Pennsylvania is acting to ensure that people with lupus are able to continue accessing hydroxychloroquine and chloroquine without additional barriers. While nationwide shortages and backorders may still affect pharmacies in Pennsylvania, nothing that the state has done is preventing a person with lupus in Pennsylvania from filling a prescription for hydroxychloroquine or chloroquine as they have in the past.

Last updated: April 3, 2020

Rhode Island

On March 23, the Rhode Island Department of Health (DOH) issued an emergency regulation to restrict the prescribing and dispensing of hydroxychloroquine or other drugs for COVID-19 or off-label purposes until such point that there is peer-reviewed evidence establishing their safety and effectiveness to justify the clinical decision. The rule also establishes that the prescriber must certify that they have discussed the risks of off-label use of the treatment with the patient.

Click here to read Rhode Island’s emergency rule.

What this means for people with lupus

Rhode Island has taken aggressive action to prevent the dispensing of hydroxychloroquine and chloroquine for off-label purposes that are not supported by the available clinical evidence, including the treatment or prevention of COVID-19. 

Because lupus is one of the uses of hydroxychloroquine and chloroquine that has been approved by the FDA, nothing in this rule should impact the ability of people with lupus in Rhode Island to fill their prescriptions as they have in the past. However, nationwide shortages and backorders may still affect pharmacies in Rhode Island.

Last updated: April 3, 2020

South Carolina

On March 23, South Carolina’s Board of Medical Examiners and Board of Pharmacy issued joint guidance regarding the prescribing and dispensing of hydroxychloroquine and chloroquine. Noting the lack of evidence establishing either drug as a clinically appropriate treatment for COVID-19, the Boards establish that no physician should prescribe either drug to themselves or family members. The Boards also urge prescribers and pharmacists to consider the stress placed on the supply chain when these drugs are prescribed for the prevention or treatment of COVID-19.

Any new prescription for hydroxychloroquine or chloroquine should include the patient’s diagnosis, and the Boards note that physicians “could be subject to discipline for including an inaccurate diagnosis.” For pharmacists, the Boards write that they should use their professional judgment in determining whether to fill  prescriptions for these drugs, and should “consider the needs of patients previously prescribed these medications for conditions for which the medications have been approved by the FDA.”

Click here to read the complete guidance.

What this means for people with lupus

South Carolina is relying on the professional judgment of physicians and pharmacists in the state to manage their supply of hydroxychloroquine and chloroquine. People with lupus should ensure that new prescriptions for either drug include their written diagnosis to avoid delays in filling their prescription.

While nationwide shortages and backorders may still affect pharmacies in South Carolina, nothing that the state has done is preventing a person with lupus in South Carolina from filling a prescription for hydroxychloroquine or chloroquine as they have in the past.

Last updated: April 3, 2020

South Dakota

On April 2, the South Dakota Board of Pharmacy issued a new policy statement restricting the use of hydroxychloroquine and chloroquine for the treatment and prevention of COVID-19. The Board establishes that prescriptions for either drug may only be dispensed if:

  • The prescription includes written diagnosis consistent with the evidence for its use, like lupus;
  • The prescription is limited to a 14-day supply “unless the patient was previously established on the medication prior to the effective date of this rule [4/2/2020]”
  • No refills are permitted without a new prescription.

Click here to read the Board’s full regulation.

What this means for people with lupus

People with lupus in South Dakota will be required to produce a new prescription with a written diagnosis of lupus each time they need their prescription filled. However, the 14-day limit does not apply to people with lupus if they were already established on either drug prior to April 2, 2020.

While South Dakota has restricted the dispensing of hydroxychloroquine and chloroquine for treating or preventing COVID-19, nationwide shortages and backorders may still affect pharmacies in South Dakota.

Last updated: April 10, 2020

Tennessee

On March 26, Tennessee’s Department of Health issued a memorandum to all healthcare providers in the state addressing usage of hydroxychloroquine and chloroquine. While noting the lack of evidence establishing the drugs’ safety and effectiveness for treating and preventing COVID-19, and the clinical trials underway to investigate those uses, the Department urges prescribers and pharmacists “to act with their best discretion to ensure patients continue to receive appropriate treatment in times of shortages.”

Further, the Department discourages inappropriate prescribing or dispensing, or hoarding, of either drug for the prevention or treatment of COVID-19, which would limit access to medically necessary treatments for people with lupus and rheumatoid arthritis.

Click here to read the Department’s complete memorandum.

What this means for people with lupus

At this time, Tennessee is relying on the professional judgment of physicians and pharmacists in the state to manage their supply of hydroxychloroquine and chloroquine. 

While nationwide shortages and backorders may still affect pharmacies in Tennesee, nothing that the state has done is preventing a person with lupus in Tennessee from filling a prescription for hydroxychloroquine or chloroquine as they have in the past.

Last updated: April 3, 2020

Texas

On March 25, the Texas State Board of Pharmacy issued a new regulation restricting the use of hydroxychloroquine and chloroquine for the treatment and prevention of COVID-19. The Board establishes that prescriptions for either drug may only be dispensed if:

  • The prescription includes written diagnosis consistent with the evidence for its use, like lupus;
  • The prescription is limited to a 14-day supply “unless the patient was previously established on the medication prior to the effective date of this rule [3/25/2020]”
  • No refills are permitted without a new prescription.

Click here to read the Board’s full regulation.

What this means for people with lupus

People with lupus in Texas will be required to produce a new prescription with a written diagnosis of lupus each time they need their prescription filled. However, the 14-day limit does not apply to people with lupus if they were already established on either drug prior to March 23, 2020.

While Texas has restricted the dispensing of hydroxychloroquine and chloroquine for treating or preventing COVID-19, nationwide shortages and backorders may still affect pharmacies in Texas.

Last updated: April 3, 2020

Utah

On March 26, the Utah Department of Commerce issued guidance regarding prescriptions for hydroxychloroquine and chloroquine. Noting the lack of evidence establishing either drug as effective in the treatment or prevention of COVID-19, the Department has established guidance to govern the dispensing of both drugs.

No prescription for hydroxychloroquine and chloroquine should be dispensed in Utah unless it includes a written diagnosis, confirmed by a documented positive test result. If those conditions are met, pharmacists should only dispense a 7-day supply of the prescribed medication, with no refills permitted unless a new prescription is written. 

Click here to read the Department's full guidance letter.

What this means for people with lupus

The Utah Department of Commerce has restricted the usage of hydroxychloroquine and chloroquine for the treatment of COVID-19, and completely prohibited its use for the prevention of COVID-19.

While Utah is attempting to manage their supply of both drugs to avoid the interruption of care for people with lupus already established on them, nationwide shortages and backorders may still affect pharmacies in Utah. However, Utah has not taken any action that would prevent a person with lupus in the state from filling their prescription as they have in the past.

Last updated: April 7, 2020

Vermont

On March 26, the Vermont Department of Health urged caution in using non-approved drugs, like hydroxychloroquine and chloroquine, for treating or preventing COVID-19. The Department notes that neither drug has been approved for COVID-19, but that clinical trials are underway to investigate their safety and efficacy for that purpose.

Click here to read the Department’s news release.

What this means for people with lupus

Aside from this note of caution, Vermont has not taken action to restrict the use of hydroxychloroquine or chloroquine for the treatment or prevention of COVID-19.

While Vermont has not taken any action that would prevent a person with lupus in the state from filling their prescription as they have in the past, nationwide shortages and backorders may still affect pharmacies in Vermont.

Last updated: April 3, 2020

Virginia

On March 25, Virginia’s Department of Health issued a letter to the state’s healthcare providers and pharmacists regarding the use of hydroxychloroquine and chloroquine. Noting the lack of evidence to establish either drug as safe and effective for COVID-19, and the clinical trials underway, the Department recommends that prescriptions of either drug should be “restricted in the outpatient setting and should require a diagnosis ‘consistent with the evidence for its use’” like lupus.

Additionally, the Department encourages pharmacists to use professional judgment in determining whether a prescription is valid, and prioritize treatment for the continuation of existing therapies among indications where there is no alternative therapy, like lupus.

Click here to read the Department’s complete letter.

What this means for people with lupus

At this time, Virginia is relying on the professional judgment of physicians and pharmacists in the state to manage their supply of hydroxychloroquine and chloroquine. 

While nationwide shortages and backorders may still affect pharmacies in Virginia, nothing that the state has done is preventing a person with lupus in Virginia from filling a prescription for hydroxychloroquine or chloroquine as they have in the past.

Last updated: April 3, 2020

Washington

On March 24, the Washington State Pharmacy Quality Assurance Commission issued a statement reaffirming that there are currently no FDA-approved treatments for COVID-19, and that while hydroxychloroquine and chloroquine are under investigation for that purpose, they are not currently proven to be safe or effective.

The Commission encourages providers and pharmacists in Washington to "act with their best discretion to ensure patients continue to receive appropriate treatment in times of shortages" like those that currently exist for hydroxychloroquine and chloroquine. The Commission discourages the use of either drug for the prevention of COVID-19, and notes the issues it would create for patients who need the medications for FDA-approved purposes like lupus.

What this means for people with lupus

At this time, there are no limitations on prescriptions for hydroxychloroquine or chloroquine, although the Commission is discouraging the use of either drug for the prevention of COVID-19 in an effort to manage the state's supply of both medications. 

Individual prescribers and pharmacists in Washington may use their professional judgment in writing and filling prescriptions, and may choose to limit quantities or refills to manage their supply.

Nothing that the state has done would prevent a person with lupus from filling a prescription as they have in the past. However, nationwide shortages and backorders may still affect pharmacies in Washington.

Last updated: April 6, 2020

West Virginia

The West Virginia Board of Pharmacy issued a new temporary rule on March 21, effective immediately. The Board establishes that prescriptions for hydroxychloroquine and chloroquine may only be dispensed if the prescription includes a written diagnosis consistent with the evidence for its use. For patients who were not already established prior to the publishing of this rule (3/21/2020), the drugs may only be dispensed in 30-day supplies with no refills without a new prescription.

Click here to read the Board’s complete temporary rule.

What this means for people with lupus

In taking action to manage the state’s supply of hydroxychloroquine and chloroquine, the West Virginia Board of Pharmacy has instituted quantity limits and refill restrictions, but neither apply to people with lupus who were already established on either medication prior to March 21, 2020. 

While West Virginia has taken action to manage their supply of both drugs, nationwide shortages and backorders may still affect pharmacies in West Virginia. However, nothing that the state has done is preventing a person with lupus in West Virginia from filling a prescription for hydroxychloroquine or chloroquine as they have in the past.

People with lupus should ensure that on any prescription written after March 21, 2020, their healthcare provider notes their lupus diagnosis to avoid any delays in being able to fill the prescription.

Last updated: April 3, 2020

Wisconsin

Wisconsin has not issued any publicly-available guidance related to hydroxychloroquine or chloroquine. 

What this means for people with lupus

At this time, there are no limitations on prescriptions for hydroxychloroquine or chloroquine and both medications can be prescribed for lupus or other conditions, including COVID-19. However, there may be shortages of the medications within the state, and individual prescribers and pharmacists may use their professional judgment in writing and filling prescriptions, including limiting refills and access to the medications for certain conditions.

Because the state has not taken specific action related to hydroxychloroquine or chloroquine, people with lupus in Wisconsin may face challenges accessing the medications. 

Take action!

Right now, you can email Governor Evers and urge him to take action to ensure access to hydroxychloroquine and chloroquine for people with lupus. It only takes one minute - please, act now!

Last updated: April 17, 2020

Wyoming

The Wyoming Board of Pharmacy noted on March 25 that it was receiving inquiries about dispensing hydroxychloroquine and chloroquine for COVID-19, and issued guidance to assist pharmacists. After noting the lack of clinical evidence for the drugs’ use in treating and preventing COVID-19, and reaffirming the need for all prescriptions to be issued for legitimate medical purposes, the Board offers three considerations for pharmacists.

First, the Board encourages pharmacists to confirm that all prescriptions are consistent with the available medical evidence for that purpose. Second, pharmacists should question whether this is a routine medication for the patient. And finally, the Board encourages pharmacists to limit prescriptions to 14-days when presented with a prescription that is not consistent with the medical evidence, or for a patient not previously established on the medication.

Click here to read the Board’s full guidance.

What this means for people with lupus

Wyoming is encouraging pharmacists to use their professional judgment in deciding whether to dispense hydroxychloroquine and chloroquine. For people with lupus who are already established on either medication prior to the coronavirus pandemic, nothing that the state has done would impact their ability to fill their prescriptions as they have in the past. Nationwide shortages and backorders may still affect pharmacies in Wyoming.

People with lupus should ensure that on any new prescription, their healthcare provider notes their lupus diagnosis to avoid any delays in being able to fill the prescription.

Last updated: April 3, 2020