SPECIAL BULLETIN COVID-19 #17: Prior Approval for Hydroxychloroquine and Chloroquine Products

Thursday, March 26, 2020

Effective March 27, 2020, North Carolina Medicaid is requiring prior approval for hydroxychloroquine and chloroquine containing products. Prior approval is required to ensure beneficiaries continue to have access to these medications for maintenance of their autoimmune conditions, for treatment of malaria, and for treatment of extraintestinal amebiasis.  

This change is in support of the NC Board of Pharmacy’s COVID-19 Drug Preservation Rule enacted on 03/24/2020 in an effort to alleviate shortages and ensure that these drugs are available to patients who need them to treat chronic health conditions. Medicaid desires to monitor off label use by prescribers throughout the State. Per NC Medicaid Outpatient Pharmacy Policy #9 sec.3.2.1(a), the prescribed drug must have the Food and Drug Administration (FDA) approved indication for which it is being prescribed.

For newly diagnosed beneficiaries, providers will need to fax a prior approval request form to 1-855-710-1969 or call the NCTracks call center at 1-866-246-8505 to request prior approval. NCTracks will process these requests within 24 hours.

Hydroxychloroquine products are covered for:

  1. Treatment of uncomplicated malaria due to P. falciparum, P. malariae, P. ovale, P. vivax
  2. Prophylaxis of malaria in geographic areas where resistance to chloroquine is not reported
  3. Treatment of Chronic Discoid Lupus Erythematosus or Systemic Lupus Erythematosus in adults
  4. Treatment of Rheumatoid Arthritis in adults

Chloroquine products are covered for:

  1. Treatment of uncomplicated malaria due to susceptible strains of P. falciparum, P. malariae, P. ovale, P. vivax
  2. Prophylaxis of malaria in geographic areas where resistance to chloroquine is not reported
  3. Treatment of extraintestinal amebiasis

Prior approval request forms can be found at: https://www.nctracks.nc.gov/content/public/providers/pharmacy/forms.html

Prior approval criteria can be found at: https://www.nctracks.nc.gov/content/public/providers/pharmacy/pa-drugs-criteria-new-format.html

The Board of Pharmacy’s Emergency Covid-19 rule can be found at: http://www.ncbop.org/LawsRules/COVID19DrugPreservationRule21NCAC46.1819.pdf
 

Author: 
GDIT, (800) 688-6696