This article is for chloroquine and hydroxychloroquine prescribers
We are updating our standard Blue Cross formulary coverage for chloroquine and hydroxychloroquine (brand name: Plaquenil) for the duration of the COVID-19 public health emergency.
As of April 1, we have added a 10-day supply limit to these medications for:
- Members who are newly prescribed the medication for rheumatological and dermatological use (for example, to treat lupus, malaria, rheumatoid arthritis)
- Members using the medication for a COVID-19-related diagnosis.
If the member needs more than a 10-day supply (if they will be using it long-term for rheumatological and dermatological use, for example), you can request an authorization to cover more. To make this request, please submit the Massachusetts Standard Form for Medication Prior Authorization Requests (Click the link and find the form by choosing Authorization – Pharmacy). Or, contact our Clinical Pharmacy Operations area.
What about members who previously filled prescriptions for these medications?
Members who filled a prescription for rheumatological and dermatological use within the previous 180 days are excluded from the quantity limit. We’re contacting them to suggest that they take advantage of our early refill policy during this public health emergency, so they can have a supply of their medication. Some members may even contact you for a prescription for up to a 90-day supply from the Express Scripts Pharmacy®' (mail order).
Why is Blue Cross making this change?
You may be aware that on March 30, 2020, the Food and Drug Administration (FDA) issued an emergency authorization to use chloroquine and hydroxychloroquine as experimental coronavirus treatment.
The Massachusetts Division of Insurance (DOI) issued a March 26, 2020 Bulletin addressing this topic. The DOI asked insurers to continue covering these medications for rheumatologic or dermatologic conditions under their current policies. For COVID-19-related diagnoses, they asked insurers to add quantity limits.
What about members who have pharmacy coverage with another formulary?
For Federal Employee Program and Medicare Advantage members, coverage for these drugs remains the same at this time.
For members using the National Preferred Formulary (managed by Express Scripts, Inc.), there are new quantity limits for these medications.
Questions
If you have questions or need to request prior authorization, please contact Clinical Pharmacy Operations at 1-800-366-7778.
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