Temporary Quantity Level Limits

To date, there is no proven treatment or vaccine for COVID-19. While there had been hope that hydroxychloroquine and chloroquine, either alone or combined with azithromycin, could be effective treatment for the infection, the FDA has recently warned that, for safety reasons, such use of the drugs should be limited to clinical trials or in-patient setting.

There is a risk that these drugs may be in short supply. In light of guidance published by the Pennsylvania Departments of State and Human Services, Capital BlueCross wants to minimize potential supply shortage, and to ensure these drugs are available to patients who take them for COVID-19 in the proper FDA-recommended settings and other medical conditions (e.g., lupus and rheumatoid arthritis). Therefore, we are placing quantity level limits (“QLLs”) on new prescriptions of azithromycin, chloroquine, and hydroxychloroquine for our nongovernment individual and group product members.

Chloroquine and Hydroxychloroquine Quantity Level Limit

Effective March 27, 2020

The following QLLs will apply to chloroquine and hydroxychloroquine. A quantity higher than the limits will require your provider to request an authorization. If these drugs were prescribed for non-COVID-19 medical conditions (e.g., lupus, rheumatoid arthritis), your provider may request an exception to these limits.

Affected Drugs (BRAND and generic):

  • ARALEN
  • PLAQUENIL
  • chloroquine
  • hydroxychloroquine

BRAND or generic

QLLs

chloroquine 250 mg tablet 40 tablets / 90 days
chloroquine 500 mg tablet 20 tablets / 90 days
hydroxychloroquine 200 mg tablet 40 tablets / 90 days

Azithromycin

Effective April 9, 2020

Effective April 9, 2020, the following QLLs will apply to azithromycin. A quantity higher than the limit will require your doctor to request an authorization. If this drug was prescribed for non-COVID-19 medical conditions, your provider may request an exception to the limit.

Affected Drugs (BRAND and generic):

  • ZITHROMAX
  • azithromycin

BRAND or generic

Quantity Level Limit

250 mg tablet Cumulative 60 tablets / 180 days for all dosage strengths
500 mg tablet Cumulative 60 tablets / 180 days for all dosage strengths
600 mg tablet Cumulative 60 tablets / 180 days for all dosage strengths

If you are taking one or more of these drugs, please talk to your provider if you have any concerns or questions about your treatment plan. Refer to your prescription drug plan materials for details about your particular benefits. If you have benefit questions, please call our Member Services team at the number on the back of your member ID card.