Vizient, Inc. announced it sent recommendations to the White House Coronavirus Task Force and the Food and Drug Administration (FDA) aimed at improving access to chloroquine and hydroxychloroquine for hospitals who are caring for patients with COVID-19. The recommendations center on redirecting the supply of the drugs from retail pharmacy settings to the hospital/acute care environment where critically ill patients are being managed.
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“Over the last week, we have seen 6,842% and 2,196% increase in orders by Vizient members for chloroquine and hydroxychloroquine, respectively, since the World Health Organization declared COVID-19 a pandemic. Unfortunately, supply has been unable to keep up with the significant demand, with fill rates dropping as low as 1.4% and 12.1% for those medications,” said Dan Kistner, group senior vice president, pharmacy solutions for Vizient. “Given the limited supply of these medications, and the increasing number of COVID-19 patients being hospitalized for severe illness, as well as those who have been using these products for existing diseases, it is essential that immediate steps be taken to adjust the flow of supply to minimize the potential for even greater negative outcomes.”
As a result, Vizient is advocating the two following steps be taken by the task force and the FDA to ensure current supplies of chloroquine and hydroxychloroquine are prioritized for the patients who most need the drug and to help ensure that efficacy data can be appropriately collected.
· Retail dispensing of chloroquine and hydroxychloroquine (or other pharmaceuticals under investigation for COVID-19) should be limited to those patients who have been receiving treatment for labeled/well-established indications (e.g., lupus, rheumatoid arthritis). Strategies to address dispensing issues could include:
· Retail pharmacies and their distributors partnering to identify and return any excess inventory in the retail channel back to the distributors so they can be ordered by health systems.
· Pharmacy Benefit Managers (PBMs) and health plans requiring all new retail prescriptions for chloroquine and hydroxychloroquine to have prior authorization to confirm it is being dispensed for approved/well-established indications or confirmed COVID-19 patients.
· State boards of pharmacy limiting prophylaxis use and imposing dispensing requirements for new retail prescriptions, specifically, that patients have tested positive for COVID-19 and the prescription length be 14 days with no refills.
· Any new suppliers coming to market or donating large inventory of products should request that the distributors prioritize health systems.
· All other distribution of chloroquine and hydroxychloroquine should be directed to the hospital/acute care environment where critically ill patients with COVID-19 are managed. Any information about its use in the critically ill patient population needs to be collected/aggregated to inform ongoing understanding about the safety and efficacy of these therapies.
Kistner noted, “The extent of evidence regarding the use of chloroquine and hydroxychloroquine is limited. Hospitals and health systems are best positioned to support this need given their responsibility for managing the most critically ill patients and in investigational drug research for critical care therapies.”
