Blue Cross NC has modified its COVID-19 coverage policies for hydroxychloroquine and chloroquine as a result of a recent update from the U.S. Food and Drug Administration.
On April 24, the FDA updated its drug safety information regarding use of hydroxychloroquine and chloroquine for COVID-19 outside the hospital setting or a clinical trial. The FDA cited the risk of heart rhythm problems. This announcement does not affect FDA-approved uses for malaria, extraintestinal amebiasis, chronic discoid erythematosus, systemic lupus erythematosus and rheumatoid arthritis.
Changes in Blue Cross NC coverage are as follows:
Commercial lines of business
Effective May 15, 2020, Blue Cross NC will no longer cover hydroxychloroquine and chloroquine outside of a hospital setting. Going forward, Blue Cross NC will modify prior authorization criteria to only cover these drugs for COVID-19 if a member has been started on hydroxychloroquine and chloroquine in the hospital and requires outpatient continuation. Members who were previously approved for coverage and/or cost waiver through this policy will not be impacted by this change.
Blue Cross NC currently offers a cost-share waiver for hydroxychloroquine and chloroquine for Medicare members with a COVID-19 diagnosis. Effective May 1, 2020, Blue Cross NC has modified the cost-share waiver to only apply to these drugs when they are started in the hospital, and it is medically necessary to continue treatment after discharge.
These changes apply to pharmacy benefit coverage for all Commercial and Medicare Advantage members who have their pharmacy benefits through Blue Cross NC, including individual (under-65) customers, fully insured group customers and self-funded (administrative services only) group customers. These changes will not apply to State Health Plan customers, Federal Employee Program customers or any self-funded employer groups that carve out their pharmacy benefits to another pharmacy benefits manager.