With increased attention to chloroquine and hydroxychloroquine as potential treatments for the COVID-19 coronavirus, the market is experiencing a significant flood in demand that is impacting patients.
New research from Vizient finds there has been a 6,842% increase in chloroquine tablets ordered, with fill rates dropping to as low as 1.4%, and a 2,196% increase in hydroxychloroquine tablets ordered, with fill rates dropping to as low as 12.1%, since March 16, when the World Health Organization declared COVID-19 to be a pandemic.
Because of this, Vizient has sent recommendations to the White House Coronavirus Task Force and the Food and Drug Administration 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.
WHAT'S THE IMPACT?
Vizient is advocating two main steps. The first is that 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 or well-established indications, such as lupus or 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 and health plans could also require all new retail prescriptions for the drugs to have prior authorization to confirm they are being dispensed for approved or well-established indications or confirmed COVID-19 patients.
An additional strategy to address dispensing concerns is to have state boards of pharmacy limit prophylaxis use and impose 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. Also, any new suppliers coming to market or donating large inventory of products should request that the distributors prioritize health systems.
The other main step promoted by Vizient is that all other distributions 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 and aggregated to inform ongoing understanding about the safety and efficacy of these therapies.
THE LARGER TREND
Everything has been in short supply during the coronavirus pandemic, from promising medications to personal protective equipment, and even hospital beds for sick patients. The ongoing situation is causing havoc to healthcare supply chains as global distribution networks are disrupted amid government lockdowns and widespread infection.
ON THE RECORD
"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."