Hydroxychloroquine is most commonly used as an antimalarial drug, but is also closely associated with treatment of autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis.
Despite recent headlines during the coronavirus pandemic that have made hydroxychloroquine more of a household name, it’s important to only take medications when they are prescribed for you by your physician, and you take them as directed.
What is Hydroxychloroquine?
The medication is an antimalarial by definition, which means it treats and prevents the red blood cell infection known as malaria. Researchers believe that the medication interrupts how the immune system communicates with the body, which is why it can improve the symptoms of some immune diseases.
Available as both a brand name and generic drug, hydroxychloroquine is a white tablet that must be taken orally without crushing or cutting the tablet into pieces. Patients who have been prescribed hydroxychloroquine can expect to take the medication for up to three months.
Serious side effects may occur for some patients — this can include vision and skin issues, as well as mood changes, headaches and gastrointestinal upset. Any preexisting health condition or any change in symptoms should be reported to the prescribing physician so they can help determine if there is a strong likelihood of serious complications.
The risk of this medication interacting with other drugs is high, so patients should fully disclose any medications or supplements they take if they are going to be prescribed hydroxychloroquine. If the medication is being given as an antimalarial, the presence other antimalarials in the system may cause seizures.
A person’s age, weight and overall health may prohibit a physician from safely prescribing hydroxychloroquine since studies may not be considered conclusive enough to prove seniors, pregnant women or children to use this medication safely.
Medicare Coverage for Hydroxychloroquine
Prescription medication coverage for drugs like hydroxychloroquine is typically offered by a Part D prescription drug plan, which can be sold as a standalone plan or packaged together with Part A and Part B benefits through a Part C Medicare Advantage plan.
Medicare recipients with a Part D plan may have copayment obligations that are determined by which tier the medication’s cost places it in. These Medicare benefits are provided through private insurers, so out-of-pocket expenses for a recipient may differ depending on which plan they choose.
In most cases, a medication must be prescribed to treat a condition that the Food and Drug Administration has approved that medication to treat directly. Off-label use is still legal and safe for many medications, but Medicare and many other insurers will not offer prescription coverage benefits for medications that are prescribed for off-label reasons.
With that in mind, it’s important to note that Medicare recipients who have medical necessities confirmed by a doctor that are not responding to conventional treatments may be able to appeal for coverage of an off-label use for certain medications.
In rare, serious events, the FDA may also issue an emergency authorization that temporarily approves a medication for previously off-label uses, such as the case with approval for using hydroxychloroquine as a potential treatment for COVID-19. In these cases, Medicare may be able to approve coverage for off-label use of the medication at the request of a doctor.