The Iowa Boards of Medicine, Nursing, Physician Assistants, Dentistry and Pharmacy have recently received increased reports of prescriptions being issued for hydroxychloroquine, chloroquine, and azithromycin for prophylactic purposes in response to the COVID-19 outbreak. Concerns have been raised that this activity may lead to stockpiling of medication, inappropriate use and potential drug shortages for patients with a legitimate need. To protect the public health and safety, licensees are reminded of the following:

For prescribers:

  • Prescribing hydroxychloroquine, chloroquine and azithromycin for COVID-19 prophylactic use is discouraged and not recommend by the Boards at this time.
  •  Prescribing hydroxychloroquine, chloroquine, and azithromycin for yourself, family, friends and co-workers in anticipation of a COVID-19 related illness can significantly impact drug supplies, which may negatively impact the health of existing patients who are established on these medications for the treatment of indicated disease states as approved by the FDA.  Further, such prescribing may lead to improper use of these medications which can cause harm. Prescribers should exercise caution and refrain from prophylactic prescribing in light of the State of Public Health Disaster Emergency.
  • Prescribers should include the diagnosis code or diagnosis with prescriptions issued for hydroxychloroquine, chloroquine, and azithromycin. Including this information may prevent communications from the pharmacy which in turn will expedite the time to treat.
  • Prescribers should limit the amount prescribed of hydroxychloroquine, chloroquine, and azithromycin, unless otherwise deemed appropriate by the prescriber (e.g., 14-day supply, etc.).

For pharmacies:

  • Pharmacists should use their professional judgment and take appropriate steps to verify that newly issued prescriptions for hydroxychloroquine, chloroquine, and azithromycin are issued for a legitimate medical purpose. To prevent drug shortages, the Board of Pharmacy recommends contacting prescribers to confirm the diagnosis of patients newly prescribed these medications during the State of Public Health Disaster Emergency.
  • Multiple states[1] have adopted a 14-day supply limitation for the dispensing of these medications. While Iowa has not officially implemented a specific dosage unit or day supply limitation at this time, licensees are strongly encouraged to limit dispensing for patients newly prescribed hydroxychloroquine, chloroquine, and azithromycin during the State of Public Health Disaster Emergency if the prescription is not accompanied with a supporting diagnosis. The Board is not recommending that pharmacies refuse to fill legitimate prescriptions for hydroxychloroquine, chloroquine, or azithromycin; rather, the Board is recommending that pharmacies use caution and exercise professional judgment when deciding whether and how much to dispense of these medications.

While all Boards are recommending caution, licensees should avoid interruptions in care for patients previously established on these medications that have an appropriate diagnosis. The Boards recognize this may be a difficult balance; however, licensees should make a good faith effort to ensure appropriate prescribing, dispensing, and patient care.

Joint Statement

[1] North Carolina, Nevada, Louisiana, Texas, Ohio, and Idaho.