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Cuomo limits prescriptions for two drugs to active virus cases

Packets of tablets that contain chloroquine and hydroxychloroquine.

Packets of tablets that contain chloroquine and hydroxychloroquine. Demand for those drugs spiked after early anecdotal studies suggested — but with no proof from a wide-scale clinical study — that those medications could help fight the new viral infection.   Credit: AFP via Getty Images / Gerard Julien

Two drugs touted as possible treatments for COVID-19 can no longer be prescribed for people who want them just in case they get sick.

An executive order issued by Gov. Andrew M. Cuomo this week limits prescriptions of hydroxychloroquine and chloroquine to COVID-19 patients in state-approved clinical trials, and for FDA-approved uses as an antimalarial or autoimmune treatment, and then only for a 14-day supply with no refills. 

The order came as the state is starting wide-scale trials of hydroxychloroquine in hospitals treating COVID-19 patients. Surging demand for the medications had already depleted pharmacies of the drugs, and nearly 10 other states have also limited prescriptions amid reports that some physicians were self-prescribing drugs for themselves, families and friends as well as still-healthy patients. 

The president of the American Medical Association, Dr. Patrice Harris, issued a statement calling for a stop “to any inappropriate prescribing and ordering of medications,” and appealed “to physicians and all health care professionals to follow the highest standards of professionalism and ethics. The nation’s physicians and other health care professionals continue to demonstrate remarkable leadership every day.”

Demand for the drugs spiked after early anecdotal studies suggested — but with no proof from a wide-scale clinical study — that those medications could help fight the coronavirus.

Hospitals are treating patients with these and other treatments such as high-dose vitamin C after early reports showed possible promise, said Onisis Stefas, chief pharmacy officer for Northwell Health. He said the hospital system was tracking data on a relatively small number of patients getting vitamin C intravenously. "It's too early to tell, but anecdotally it looks like it could be helping patients here."

However, results of a small study in Shanghai published this week did not show significant difference in outcomes between COVID-19 patients who received hydroxychloroquine and a control group that did not. The study’s researchers called for a much larger study for more definitive findings. A small French study with no control group reported more promising results using higher doses for a longer period.

CVS Health said it was complying with state restrictions, and in “states with no guidelines, our pharmacies are limiting the dispensing of COVID-19 treatment to a 10-day supply with no refills,” said Mike DeAngelis, senior director of corporate communications.

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However, the limits, if applied to patients who use the drug long-term for chronic diseases, would be a huge burden, said rheumatologist Dr. Julie Nusbaum of NYU Winthrop Hospital.

Howard Jacobson, owner of three pharmacies including Rockville Centre Pharmacy, said that one or two doctors called in hydroxychloroquine prescriptions “for everyone in his family, but we wouldn’t allow it. At that point we decided we would only issue a prescription for someone with a documented case of COVID-19.”

But Jacobson, who is a board member of the Pharmacists Society of the State of New York and of the affiliated Long Island Pharmacist Society and is himself ill with COVID-19, said he has kept a small supply reserved for longtime customers with autoimmune disease and for his own workers in case they get sick. “I’m saving it for the people working their fingers to the bone working on the front lines. I told my staff that if, God forbid, they got sick, it’s going to be there for them.”

Dr. William Spencer, a Huntington ear, nose and throat doctor who serves in the Suffolk County Legislature and chairs its Health Committee, said that while a few doctors may have prescribed for themselves or families, he was mainly aware of doctors who prescribed hydroxychloroquine to their patients. “People are looking for anything that could help protect themselves,” he said. “I do think the governor’s executive order is wise. … Critically ill people should get it first.”

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