Adult Care Homes Access to Hydroxychloroquine Through NC DHHS
The NC Department of Health and Human Services (DHHS) secured a donation of hydroxychloroquine (HCQ) from Amneal Pharmaceuticals. DHHS is making this supply available to patients in adult care homes through the process detailed in this email. This supply is limited in quantity and must be used for treatment of confirmed or suspected COVID 19 cases (a lab-confirmed diagnosis is not required). A physician will need to write individual prescriptions for each patient and send to the pharmacy for dispensing. Prescriptions must meet the current COVID-19 Drug Preservation Rule (requirements below) passed by the Medical Board and Board of Pharmacy. DHHS asks that facilities share this email with the medical providers serving residents in their facility.
Because the DHHS supply is limited, they have been working with pharmacies that specialize in long term care pharmacy services across the state to make HCQ available for immediate dispensing. Attached is a list of pharmacies that have received, or are in the process of receiving, HCQ. Also in the attached list is a set of pharmacies in the enrollment process to receive HCQ, but which do not yet have a supply from DHHS on their shelf (though they may have privately purchased HCQ available).
While we believe most of your pharmacies are on the list, your regular pharmacy may not be on the attached list; but they can still fill HCQ prescriptions using the same COVID-19 Drug Preservation Rules below. If your regular pharmacy is out of HCQ, you may contact an alternate pharmacy to fill the patients’ HCQ prescription, including those on the attached list. In the event you need to use an alternate pharmacy, you will need to provide patient information to the pharmacy, including patient DOB and contact information, insurance information, and a current medication list. If your facility uses a single pharmacy that is not on the attached list, you can use the ordering instructions below to have HCQ from DHHS placed at your pharmacy if supply permits.
Hydroxychloroquine, though FDA approved for malaria, lupus, and rheumatoid arthritis, is not FDA approved for COVID-19, nor is any other medication. There is an Emergency Use Authorization in place from the FDA, however, it is limited to use in hospitalized patients. With no FDA approved COVID-19 treatments, physicians must use available data and professional judgment to determine appropriate therapy. There are multiple treatment regimens with hydroxychloroquine under investigation and some small studies with positive outcomes using hydroxychloroquine have been released. The American Society of Health System Pharmacists (ASHP) provides a summary of many treatments including hydroxychloroquine at https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/Coronavirus/docs/ASHP-COVID-19-Evidence-Table.ashx. You can view the package insert for hydroxychloroquine here.
Hydroxychloroquine has been shown to have a number of side effects, including cardiac and retinal impairments. It also has several drug interactions that providers should review before prescribing to patients.
HYDROXYCHLOROQUINE ORDERING (if your pharmacy is NOT on the attached list)
- Orders will be placed online to the NC Division of Public Health (DPH) using this link: https://nc.readyop.com/fs/4cjn/0518. (You ONLY need to order if your pharmacy is NOT on the attached list.)
- You will enter information about your facility including either the facility or MD provider number, a contact person, COVID cases (confirmed and suspected), and information on how much you are requesting.
- Quantity approved will be based on product available, facility size, and current cases.
- If your provider plans to use hydroxychloroquine, but you currently have NO confirmed or suspected cases, you may still order 1 bottle to have on hand at your pharmacy to start patients when identified. You may reorder additional supplies later.
- You will enter information about your pharmacy for shipping of the product. Information includes pharmacy name, address, contact name, and phone number.
- First time orders will receive a call to both the facility and the pharmacy prior to processing to review your order. First time orders will NOT be processed until someone from the DHHS team speaks to someone at both locations.
- SHIPPING: Approved requests will be processed at the state warehouse and delivered to your pharmacy via FedEx. You should enter the pharmacy FedEx shipping address when asked for your pharmacy address. Orders will be processed Monday through Friday and the cut-off time for next day delivery is 1:00 PM.
COVID-19 Drug Preservation Rule
- Medical Board Rule: https://www.ncmedboard.org/images/uploads/rules/21_NCAC_32B_.1708.pdf
- Board of Pharmacy Rule: http://www.ncbop.org/LawsRules/COVID19DrugPreservationRule21NCAC46.1819.pdf
- Prescription requirements:
- Indicate on the prescription that it is for COVID-19 treatment;
- Be limited to no more than a fourteen-day supply; and
- Not be refilled, unless a new prescription is issued in conformance with this Rule, including not being refilled through an emergency prescription refill.
- A physician or physician assistant shall not prescribe and a pharmacist shall not fill or refill a prescription for hydroxychloroquine for the prevention of, or in anticipation of, the contraction of COVID-19 by someone who has not yet been diagnosed.
North Carolina Assisted Living Association