Kaiser Permanente will temporarily stop filling prescriptions for hydroxychloroquine for some patients in order to preserve the drug for “severely sick patients,” including those who have contracted the novel coronavirus (COVID-19).
Hydroxychloroquine, which is sold under the brand name Plaquenil, is an anti-malaria drug that is also used to treat lupus. Over the weekend, it was touted as a possible treatment for COVID-19 by Donald Trump.
“HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine,” Trump tweeted on Saturday — quickly creating a high demand for hydroxychloroquine and an ensuing shortage.
The regional medical director of Quality and Clinical Analysis at Kaiser Permanente, Southern California, Nancy Gin, told BuzzFeed News that there is a “real possibility” of running out of the drug if steps are not made to “mitigate the shortage.”
“As we face the real possibility of running out of the drug for everybody if we don’t take steps to mitigate the shortage, Kaiser Permanente, like other health care organizations across the country, has had to take steps to control the outflow of the medication to ensure access to severely sick patients, including both COVID-19 and those with acute lupus,” Gin told the outlet.
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Gin said that the drug can stay in the body for more than a month after it’s taken, and that Kaiser Permanente expects there to be plenty for every patient who needs it soon.
“Extensive experience and research show that hydroxychloroquine builds up in the body and continues to work for an average of 40 days even after the last dose is taken,” Gin said. “By then, we expect the drug manufacturers to have ramped up production to meet the increased demand. Until then, we are no longer refilling routine prescriptions to ensure we have adequate supply to care for our sickest patients.”
On Friday, Kaiser said in a statement to PEOPLE, “We are taking steps to ensure we have adequate supply to meet the existing needs of patients who are taking these medications, and also ensure access for severely sick patients hospitalized with COVID-19 infections.”
The health care provider said it is “actively converting patients” with rheumatoid arthritis, psoriasis, and dermatomyositis to other medications, and that physicians are individually contacting their patients to discuss their options.
“Very good alternative medications exist” for those conditions, Kaiser said.
As for lupus patients, Kaiser said it is “doing all we can” to fill their prescriptions.
“Until supplies can be increased to match the significantly increased demand, starting this week we will provide 14-day refills, instead of 90-day refills,” the statement explained. “Physicians will work with their patients to review their medications, to ensure they are able to manage their care under this approach. The collection of co-pays will be adjusted appropriately to fairly reflect this change in dispensing, during this time.”
“We and other health care organizations across the country are also working with manufacturers and other sources of these drugs to obtain increased supplies, to meet the expected needs to come,” the statement said. “If we don’t take steps to mitigate the shortage, we all will face the real possibility of running out of these drugs in the next few weeks.”
“Over the next several weeks, we expect the drug manufacturers to ramp up production to meet the increased demand across the U.S. and the world,” the statement concluded. “As supply becomes available, our physicians will evaluate these dispensing protocols and adjust accordingly.”
A 45-year-old woman in Los Angeles told BuzzFeed that when she tried to fill her prescription for hydroxychloroquine for her systemic lupus erythematosus, she was denied it.
In a message from Kaiser to the woman on Tuesday, the health care provider said it is “conserving the current supply for those who are critically ill with COVID-19,” according to a screenshot of the message obtained by BuzzFeed News.
“We are working very hard every day doing everything we can to find ways to replenish this medication as soon as possible,” the message said. “During this time, you should continue to take the remaining pills you have on schedule unless otherwise instructed by your prescribing physician.”
Later in the message, it stated, “Thank you for the sacrifice you will be making for the sake of those who are critically ill; your sacrifice may actually save lives.”
Smith Collection/Getty Images Kaiser Permanente
“We appreciate your understanding, and you will be notified of any changes in the policy as they happen,” the message concluded. “We all hope this will be a short-term situation.”
However, the woman, who asked BuzzFeed only to be identified by her first name, Dale, said that she fears going into a “lupus flare” without hydroxychloroquine.
“I am already immunocompromised, and not taking this medication with likely put me into a lupus flare, making serious complications from COVID more likely,” she said. “The fact that they thanked me for my ‘sacrifice’ is disturbing.”
“I never agreed to sacrifice my health and possibly my life and cannot believe that I am being forced to do so,” she told Buzzfeed.
On Monday, the Lupus Foundation of America published a letter urging manufacturers to ensure that people with the condition get the medication they need in the face of shortages of the drug.
“For many people with lupus there are no alternatives to these medications,” the foundation’s letter said. “For them, hydroxychloroquine or chloroquine are the only methods of preventing inflammation and disease activity that can lead to pain, disability, organ damage, and other serious illness.”
There is still little research on the use of hydroxychloroquine to treat COVID-19, and there are several clinical trials in the works around the world to determine its efficacy, Vox reported on Thursday.
Joshua Michaud, associate director for global health policy at the Kaiser Family Foundation, told Vox on Thursday that prescribing hydroxychloroquine is “kind of a ‘last resort’ measure for those with severe disease.”
“I would be more concerned about having large numbers of people, including those without symptoms or only mild symptoms, taking this drug because of the risk of negative side effects and unclear benefits at this point,” Michaud added to the outlet.
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