By Leslie Small

With the death toll from COVID-19 continuing to rise in the U.S., President Donald Trump and some of his advisers have repeatedly touted the promise of anti-malarial drugs to combat the disease caused by the novel coronavirus. That enthusiasm has sparked increasing concern that the surge in demand for such drugs, hydroxychloroquine and chloroquine, is imperiling access for patients who take them to treat autoimmune conditions such as lupus and rheumatoid arthritis.

To help alleviate the issue, some major PBMs are placing utilization management controls on off-label use of hydroxychloroquine, chloroquine and other drugs with the potential to treat COVID-19.

CVS Health Corp.’s Caremark unit is placing “appropriate limits” on the quantity of medicines including hydroxychloroquine, the antibiotic azithromycin, one type of protease inhibitor used to treat HIV, and albuterol inhalers that are approved to treat asthma, per a news release. UnitedHealth Group’s OptumRx s limiting prescriptions for hydroxychloroquine and chloroquine to 30 tablets within a 90-day time period, “with an automatic bypass for members utilizing for chronic conditions such as rheumatoid arthritis or systemic lupus,” says Chief Medical Officer Sumit Dutta, M.D. And Prime Therapeutics, LLC, the PBM owned by 18 Blue Cross Blue Shield plans, tells AIS Health that it’s taking similar measures.

“These measures have been effective in controlling the surge in demand that occurred in the first two weeks of March,” for hydroxychloroquine and chloroquine, says Marc Guieb, Pharm.D., a consultant with Milliman, Inc. But with some plans reporting significant spikes in utilization for the medicines, “the alarming question that we should be wondering is, ‘How were patients getting so many prescriptions for these drugs in the first place?’” he tells AIS Health via email.

Results from two small studies — one in China and one in France — have fueled interest in the use of hydroxychloroquine and chloroquine to treat COVID-19, but more evidence is needed to determine whether they’ll actually be effective against the disease, says Esther Krofah, executive director of FasterCures at the Milken Institute.