CareFirst Specialty Pharmacy’s Hydroxychloroquine and Chloroquine Dispensing Guidelines

To ensure that patients have the medication they need, CareFirst Specialty Pharmacy will NOT fill any prescriptions for either presumptive positive patients or prophylactic use of chloroquine or hydroxychloroquine related to COVID-19.

CareFirst Specialty Pharmacy will only fill chloroquine or hydroxychloroquine prescription when the following criteria are met:

• The prescription bears a written diagnosis from the prescriber consistent with the evidence for its use; FDA approved uses (i.e. lupus, Rheumatoid Arthritis, previous off label use established prior to March 22, 2020)

• The prescription is limited to no more than thirty days supply unless the patient was previously established on the medication prior to the effective date of this rule; and

• No refills may be permitted unless a new prescription is furnished. This requirement does not apply to patients previously established on the medication prior to the effective date of this rule.

For a COVID-19 Patient:

1. The prescription bears a written diagnosis code from the prescriber; and

2. If written for a COVID-19 diagnosis, the diagnosis has been confirmed by a positive test result, which is documented on the prescription and both of the following apply:

3. The prescription is limited to no more than a fourteen-day supply; and

4. No refills may be permitted unless a new prescription is furnished.