Is Hydroxychloroquine available to you?

Is HCQ banned in your state? (probably not). From our friends at Free Republic. Posted one year ago (note date).
Various Sources – links inside | 8/18/2020 | States 

Posted on 8/18/2020, 10:48:11 AM by Pollard

Due to an earlier thread where someone was voicing their anger towards President Trump seemingly not doing anything to allow people to have access to hcq, I decided to do the state by state research into which states have banned hcq and which ones haven’t. 

The results are fairly surprising considering a group of doctors had a two day summit in DC campaigning for access to hcq. There are rules but not much for outright bans.

Most of the info comes from lupus.org (https://www.lupus.org/advocate/state-action-on-hydroxychloroquine-and-chloroquine-access) but in some cases I went to the state websites using links found on the above lupus.org state by state guide page.

The bottom line; You can get it no matter where you are even if you’re in one of the few states that has banned it. Many bans have expired. How would you get it in one of those few banned states? Pretty much all states allow a doctor to temporarily register in another state, presumably for emergency situations where a state has a dire, short term need for doctors. Likewise, a doctor is allowed to have a permanent license in more than one state. Find a doctor who’s office is right up against the state line and I bet he or she will be licensed in both states. Yes, this will require travel and doctor shopping. My only point is that it’s doable. 

However, as you’ll see in Post #1, there are very few states with an outright ban. Quite a few states have no rule regarding hcq use. Others simply discourage improper prescribing, such as doctors hoarding it for themselves, family and friends. Some states make the doctor write up a full diagnosis or possibly reference one study showing hcq;s usefulness for covid(they do exist) Some states simply limit the prescription to a 14 day period. Some states only allow a prescription for those who have tested positive and a couple of states specify the patient be hospitalized. I found a loophole in one state(NJ?) that does not have any restriction on Infectious Disease specialists. 

Where there’s a will there’s a way.

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FDA Rules

Source: https://www.healthy.arkansas.gov/programs-services/topics/covid-19-guidance-about-chloroquine

On June 15, 2020 the Food and Drug Administration (FDA) revoked the Emergency Use Authorization (EUA) for the use of chloroquine (CQ) and hydroxychloroquine (HCQ) to treat COVID-19 after concluding it was “no longer reasonable to believe that oral formulations of HCQ and CQ may be effective in treating COVID-19, nor is it reasonable to believe that the known and potential benefits of these products outweigh their known and potential risks”. The latter included serious cardiac adverse events. Based on this information, the Arkansas Department of Health (ADH) updated its guidance related to HCQ and CQ indicating that their use for treatment of COVID-19 should be avoided in both outpatient and hospitalized settings.

CQ and HCQ can continue to be administered, prescribed, and dispensed for FDA approved medical conditions under supervision of a patient’s healthcare provider. Unapproved use (i.e. “off label use”) of these medications is left to the discretion of individual clinicians and their patients. However, the ADH wants clinicians to be aware that coadministration of HCQ or CQ with remdesivir, an FDA EUA approved medication for treatment of COVID-19, is not recommended based on data showing an antagonistic effect of these medications on the antiviral activity of remdesivir.

Alabama (not banned)

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.”

Alaska (not banned)

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.”

Arizona (banned)

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. 

Arkansas (as per FDA)

On June 15, citing the FDA’s revocation of their Emergency Use Authorization for the use of hydroxychloroquine and chloroquine to treat COVID-19, the Arkansas Department of Health updated their guidance to indicate that the use of either drug for the treatment of COVID-19 should be avoided in both outpatient and hospital settings.

California (not banned)

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.

Colorado (not banned)

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

Connecticut (not banned)

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

Delaware (not banned)

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.

DC (not banned)

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.” 

Florida (not banned)

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

Georgia (sort of banned)

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.

Emergency Rule

Rule 480-10-0.38-.22 Medications Limitations.

No prescription or practitioner drug order for chloroquine, hydroxychloroquine, or mefloquine may be dispensed or distributed unless all of the following apply:

(a) The prescription or practitioner drug order must include a diagnosis, whether written or verbal, from the prescriber consistent with the evidence for its use;
(b) The prescription or practitioner drug order is limited to no more than a fourteen (14) day supply; and
(c) No refills may be permitted unless a new prescription or practitioner drug order is furnished.
(d) This emergency rule will not apply to patients previously established on any of the above listed drugs prior to the effective date of this rule.

Authority: O.C.G.A. § 50-13-4(b)

Hawaii (not banned)

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.

Idaho (not banned)

On June 11, the Idaho State Board of Pharmacy rescinded Rule 704, originally passed on March 26, which had established limits on how hydroxychloroquine and chloorquine could be prescribed and dispensed by healthcare professionals in the state.

With Rule 704 rescinded, the state of Idaho does not currently have any restrictions on the prescribing or dispensing of either hydroxychloroquine or chloroquine.

Illinois (not banned)

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

Indiana (not banned)

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.”

Iowa (not banned)

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.”

Kansas (not banned)

In March, the Kansas Board of Pharmacy issued guidance for pharmacists related to the prescribing of hydroxychloroquine and chloroquine for COVID-19. On June 15, the Board amended their previous guidance to note the FDA’s revocation of the Emergency Use Authorization for chloroquine and hydroxychloroquine for treating COVID-19 in certain settings.

The Board “continues to encourage vigilance in processing new prescriptions for chloroquine and hydroxychloroquine and recommends reaching out to prescribers to verify diagnosis.” 

Kentucky (discouraged but not banned)

Click to access Kentucky%20Board%20of%20Pharmacy%20COVID-19%20FAQs.pdf

VII.PRESCRIPTIONS FOR OFF-LABEL USE FOR COVID-19

1.Prescribers are writing prescriptions for the drugs that are in trial to treat COVID-19, such as chloroquine, hydroxychloroquine, mefloquine, and azithromycin. What are the recommendations for a pharmacist to dispense these prescriptions? 

A: At the July 29, 2020 Board Meeting, the Kentucky Board of Pharmacy rescinded the previous recommendations regarding chloroquine, hydroxychloroquine, mefloquine, and azithromycin.

For drugs being prescribed for off-label use for COVID-19, the Board encourages pharmacists to use professional judgement to determine if a valid patient-prescriber relationship exists, if the quantity prescribed is appropriate, and if there is a need to obtain a diagnosis. There are patients receiving these medications on a regular basis for their FDA indicated use or literature supported use, therefore, pharmacists need to consider the amount of drug in stock when determining which prescriptions to dispense. 

Louisianna (not banned)

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.

Maine (not banned)

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.

Maryland (not banned)

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.

Massachusetts (not banned)

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.”

Michigan (all but banned)

Click to access Reminder_of_Appropriate_Prescribing_and_Dispensing_3-24-2020_684869_7.pdf

The Department of Licensing and Regulatory Affairs has received multiple allegations of Michigan physicians inappropriately prescribing hydroxychloroquine or chloroquine to themselves, family, friends, and/or coworkers without a legitimate medical purpose.

Prescribing hydroxychloroquine or chloroquine without further proof of efficacy for treating COVID-19 or with the intent to stockpile the drug may create a shortage for patients with lupus, rheumatoid arthritis, or other ailments for which chloroquine and hydroxychloroquine are proven treatments. Reports of this conduct will be evaluated and may be further investigated for administrative action. Prescribing any kind of prescription must also be associated with medical documentation showing proof of the medical necessity and medical condition for which the patient is being treated. Again, these are drugs that have not been proven scientifically or medically to treat COVID-19.

Michigan pharmacists may see an increased volume of prescriptions for hydroxychloroquine and chloroquine and should take special care to evaluate the prescriptions’ legitimacy. Pursuant to Michigan Administrative Code, R 338.490(2), a pharmacist shall not fill a prescription if the pharmacist believes the prescription will be used for other than legitimate medical purposes or if the prescription could cause harm to a patient.

It is also important to be mindful that licensed health professionals are required to report inappropriate prescribing practices. LARA appreciates all licensed health professionals for their service and cooperation in assuring compliance in acting responsibly while continuing to provide the best possible care for Michigan’s citizens during this unprecedented and very challenging time.

Minnesota (banned)

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. 

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

Missouri discouraged but not banned)

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.”

Montana (discouraged but not banend)

http://bsd.dli.mt.gov/licensee-covid-19?pk_vid=dd66adfdc228e4e315877415076c034e

National and local reports indicate the potential inappropriate prescribing and dispensing of medications identified as possible treatment for COVID-19, including, but not limited to, chloroquine, hydroxychloroquine, mefloquine, and azithromycin.

The reports suggest inappropriate self-prescribing, prescribing with no diagnosis, stockpiling, and dispensing of these medications related to COVID-19 that may lead to drug shortages impacting patients who rely on the medications for treatment of chronic medical conditions, such as lupus, rheumatoid arthritis, and malaria diagnoses.

Providers and pharmacists are reminded 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. Inappropriate prescribing and dispensing is discouraged and could conflict with standards of conduct for prescribing and responsibilities to review prescription drug orders prior to dispensing.

Nebraska (not banned)

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

Nevada (not banned)

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.

On July 21, the Nevada Board of Pharmacy noted that the emergency regulation had expired and was no longer in effect.

With the expiration of the emergency regulation, Nevada does not currently have any policies regarding the prescribing or dispensing of chloroquine or hydroxychloroquine.

New Hampshire (banned)(live free or die?)

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.

New Jersey (Highly discouraged but not banned)

https://www.nj.gov/oag/newsreleases20/pr20200330a.html

Hydroxychloroquine or chloroquine may be prescribed and dispensed for treatment of COVID-19 only if supported by a positive test result, which must be documented on the prescription, and limited to a 14-day supply, with no refills permitted. 

New Mexico (discouraged but not banned)

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).

New York (ban expired)

On July 7, executive order 202.11, which established restrictions on the prescribing and dispensing of chloroquine and hydroxychloroquine, expired and is no longer in effect.

North Carolina (for confirmed covid cases only – no preventative use)

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.

North Dakota (not banned)

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

Ohio (not banned)

On July 30, the Ohio Board of Pharmacy announced that they would not move forward with proposed rule 4729:5-5-21 which would have prohibited the prescribing and dispensing of hydroxychloroquine for the treatment of COVID-19. 

Additionally, the Board noted that emergency rule 4729-5-30.2, which had established restrictions on the prescribing and dispensing of chloroquine and hydroxychloroquine, had expired and was no longer in effect.

Oklahoma (restrictions removed – not banned)

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. 

Oregon (Only if covid patient is hospilaized)

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. 

Pennsylvannia (confirmed cases only)

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.

Rhode Island (all but banned)(see section C for loophole)

x.3 Off-label prescribing of medications for treatment or preventionof COVID-19

A.No practitioner shall prescribe any medication for COVID-19, either for treatmentor prevention, unless treatment or prevention of COVID-19, or similar infectiousdisease, is within such practitioner’s usual and customary scope of practice.

B.Any practitioner who chooses to prescribe an FDA-approved medication for theoff-label purpose of treating COVID-19 shall:

1.Indicate on the prescription the applicable ICD-10 diagnosis code.

2.Indicate on the prescription a telephone number at which the dispensingauthority (e.g., pharmacist) may reach the health care provider to addressquestions relative to dose and treatment.

3. Document in the associated patient’s medical record that the specific risks and benefits of the off-label treatment were discussed with the patient. 

4. Document in the associated patient’s medical record the clinical rationale for the off-label prescribing, citing:

a. At least one peer-reviewed article that justifies the clinical decision for the off-label prescribing, in the event that the FDA publishes such guidance. 

b. Applicable FDA guidance justifying the clinical decision for the off-label prescribing, in the even that the FDA publishes such guidance. 

C. This Part does not apply to physicians, licensed to practice medicine in the state of Rhode Island pursuant to Title 5, Chapter 37 of the R.I. Gen. Laws, who are board certified in the American Board of Medical Specialties (ABMS) specialties of Infectious Disease and/or Critical Care.

South Carolina (discouraged but not banned)

Click to access Joint%20Order%20COVID-19%20Prescribing%20SIGNED.pdf

WHEREAS, to the extent that Hydroxychloroquine, Chloroquine,and Azithromycinare effective in the treatment of COVID-19, their usage for treatment of COVID-19 should be restricted to patients with an actual diagnosis of a COVID-19 infection—preferably such a patient who has been admitted to a hospital where the treatment can be appropriately monitored;

South Dakota (discouraged but not banned)

Click to access COVID-19Agents_BoardPolicyStatement.pdf

Medication Limitations.

No prescription or medication order for chloroquine, hydroxychloroquine, mefloquine, or azithromycin may be dispensed or distributed unless allthe following apply: 

1. the prescription or medication order bears a written diagnosis from the prescriber consistent with the evidence for its use; 
2. the prescription or medication order is limited to no more than a fourteen(14) day supply, unless the patient was previously established on the medication prior to the effective date of this rule; and
3. no refills may be permitted unless a new prescription or medication order is furnished.

Tennessee (discouraged but not banned)

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.

Texas (discouraged)

Click to access 291.30.pdf

Medication Limitations.

No prescription or medication order for chloroquine, hydroxychloroquine, mefloquine, or azithromycin may be dispensed or distributed unless all the following apply:

(1 ) the prescription or medication order bears a written diagnosis from the prescriber consistent with the evidence for its use;

(2 ) the prescription or medication order is limited to no more than a fourteen (14) day supply, unless the patient was previously established on the medication prior to the effective date of this rule; and

(3 ) no refills may be permitted unless a new prescription or medication order is furnished.

Utah ( not banned but 7 day limit)

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. 

Vermont (not banned – must be covid positive)

https://www.healthvermont.gov/Health-officials-caution-against-using-non-approved-drugs-for-COVID-19-treatment-March-25-2020

Providers should only prescribe these drugs for individuals with diagnosed conditions, and not for prevention, to help maintain the supply for Vermonters who need them.

Virginia (unclear)

Treatment of COVID-19

Dear Colleague:

In the most recent days, there has been a surge in demand of potential treatments for COVID-19 for drugs commonly used to treat malaria, lupus, rheumatoid arthritis, HIV, bacterial infections and other conditions. This is leading to an inadequate medication supply for patients already taking these medications for chronic conditions and hospitalized COVID-19 patients being treated with these medications under facility-specific treatment protocols while studies are ongoing.

There are currently no antiviral drugs approved by the U.S. Food and Drug Administration (FDA) to treat COVID-19. Somein-vitro ;or in-vivo studies suggest potential therapeutic activity of some agents against related coronaviruses, but there are no available data from observational studies or randomized controlled trials in humans for the CDC to support recommending any investigational therapeutics for patients with confirmed or suspected COVID-19 at this time.

The Virginia Department of Health in consultation with the Virginia Department of Health Professions recommends the following:

• Prescriptions for chloroquine, hydroxychloroquine, mefloquine and azithromycin should be restricted in the outpatient setting and should require a diagnosis “consistent with the evidence for its use.”
• Community pharmacists should use professional judgement to determine whether a prescription is valid and that there is a bona fide practitioner-patient relationship prior to dispensing.
• Prioritize treatment for continuation of existing medication therapy, inpatient settings, and other indications where there is not an alternative therapy.
• Advise against hoarding these medications or stockpiling.

There is currently no available data from randomized clinical trials to inform clinical use.  Refer to the CDC for more information on therapeutic options for COVID-19. (https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html).

Sincerely,

M. Norman Oliver, MD, MA
State Health Commissioner

Washington (discouraged but not banned)

https://www.wvbop.com/article.asp?id=45

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. 

West Virginia (highly discouraged)

Medication Limitations.

26.1 No prescription for chloroquine or hydroxychloroquine may be dispensed except if all the following apply:

• 26.1.a. The prescription bears a written diagnosis from the prescriber consistent with the evidence for its use;
• 26.1.b. The prescription is limited to no more than thirty (30) tablets, unless the patient was previously established on the medication prior to the effective date of this rule; and
• 26.1.c. No refills may be permitted unless a new prescription is furnished. This requirement does not apply to the patient previously established on the medication prior to the effective date of this rule.

Wisconsin (not banned)

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

Wyoming (discouraged)

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.