Updated March 24, 2020 –

People who take hydroxychloroquine (Plaquenil) are increasingly having trouble getting a refill from their retail or mail order pharmacy. Doctors are getting questions about this after news about the potential for the drug to help shorten the course of COVID-19 was broadly reported on March 19. Erin Fox, an associate adjunct professor of pharmacology at the University of Utah and an expert in drug shortages, says four of the eight suppliers of the drug report normal supplies. The others report back orders.  

The drug, originally approved for malaria in 1955, has been approved for decades as a disease-modifying antirheumatic drug to treat rheumatoid arthritis (RA) and systemic lupus erythematosus and is used in the treatment of juvenile idiopathic arthritis (JIA).              

Fox says that the sudden high demand comes from people and clinics that want to use hydroxychloroquine for COVID-19 prevention or treatment, although the drug is not approved for either indication, and there is limited evidence to support its use in COVID-19. Researchers are preparing to launch rigorous studies of its safety and effectiveness. Despite that, people and clinicians are putting their hope in hydroxychloroquine (and chloroquine, a closely related drug).  

But that is leaving many people who have lupus, RA and JIA without the medication they depend on and may have been taking for years.  

State boards of pharmacy in Nevada, Ohio, Texas and Idaho have established new rules to control the run on the drug, requiring a diagnosis for an indicated disease be written on the prescription. If the diagnosis is COVID-19, further restrictions apply, such as a 14-day supply limit, no refills and other measures intended to stop hoarding and maintain an adequate supply for patients who have been taking the drug for indicated uses.   

Jenny Wai, chief pharmacist, Ohio Board of Pharmacy, says of her state’s new emergency rule, “I hope we have stopped the bleeding now.” 

Several manufacturers have pledged to donate tens of millions of doses of hydroxychloroquine, or Plaquenil, the brand version, or chloroquine. The pharmaceutical manufacturer Novartis Sandoz has increased its donation pledge from 20 million doses to as many as 130 million doses, which includes both its current stock and supply expected from increased production through May. Access to the donated supply is controlled by the Department of Health and Human Services (HHS). “Any requests from new customers go to HHS,” says Linda Krystek, from Novartis customer operations department. She says the company is referring to HHS the many requests it is receiving from health organizations, hospitals and doctor offices.  

Michelle Petri, MD, a rheumatologist at Johns Hopkins University School of Medicine, in Baltimore, says she would never want her patients to stop a disease-modifying drug or reduce frequency or doses to conserve pills. “Systemic lupus erythematosus patients cannot ‘ration’ their drug, as that would lead to subtherapeutic hydroxychloroquine blood levels and loss of efficacy,” she says. 

“It should not be forgotten that SLE is the fifth or sixth leading cause of death in African-American and Hispanic-American young women. Hydroxychloroquine is the only SLE treatment shown in multiple studies to improve survival in SLE.” 

• If you are due for a refill, order if from your pharmacy now, or if you need a refill, contact your health care provider.  

• If your refill is for 30 days, ask your doctor to write it for a 90-day supply. That will give you a cushion in case it’s difficult to find later.  

• If your pharmacy can’t fill a full 90-day prescription due to short supply, see if you can take what’s available now and be contacted as soon as new stock comes in.  

• Try to refill even if it’s too soon according to the insurer’s rules. Some insurers are waiving the transaction block when a pharmacist tries to refill the prescription before the allowed date, says Mike Ganio, a pharmacist and director of pharmacy practice and quality for the American Society for Health-System Pharmacists.  

• Be sure to tell your pharmacist the reason you are taking the medication. Some states give pharmacists the discretion to decide which prescriptions to prioritize, if, for example, stock is low, says Ganio.  

• If the drug is out of stock, ask the pharmacist for help locating a refill. Another location in the same chain may have it or a nearby hospital pharmacy may be able to fill it.   

• Check with compounding pharmacies in your area. If the active ingredient in powder form is available, the specialty pharmacist may be able to make tablets for you, says Wai.  

• If you believe you have been inappropriately denied a prescription fill, look up your state board of pharmacy. Most board websites have a telephone number and email address for consumer complaints.
   
• If your in-network pharmacy cannot fill your prescription, check with an out-of-network pharmacy. Your co-pay may be higher. If you have to pay out of pocket, save money by using a discount card or coupon from FamilyWize, GoodRx or WellRx. You enter the drug name and your zip code to get a list of pharmacies in the area and the discount cost for card users. The list does not indicate whether those pharmacies have available inventory.

If your pharmacy and others in the area do not have any hydroxychloroquine in stock, ask your doctor for guidance. You can also report it to the FDA at [email protected]. 

Fox is optimistic that this shortage won’t be long-term. At least two pharmaceutical companies, including Novartis Sandoz, have committed to ramping up production, which is expected to ease the supply problem starting in mid- to late April. More relief is coming from overseas. Another company that doesn’t sell in the U.S. is donating a supply to boost the supply here.

The Arthritis Foundation joined with 96 other patient organizations to send a letter on medication access to congressional leaders, urging them to address issues people with chronic illnesses may face as the country combats COVID-19.  

In addition, the Arthritis Foundation sent a letter to members of the White House Coronavirus Task Force and the nation’s governors to ensure hydroxychloroquine access during the COVID-19 crisis for patients with rheumatoid arthritis and lupus. The joint statement was released alongside the Lupus Foundation of America, the American College of Rheumatology, and the American Academy of Dermatology. 

Learn more about coronavirus and arthritis.