903. Formulary Edits and Consistent Messaging for Unproven COVID-19 Therapeutics


 
 
 A challenge the healthcare system faced during the COVID-19 pandemic was ensuring appropriate use of therapeutics. Hydroxychloroquine (HCQ), azithromycin, and ivermectin are FDA-approved for rheumatic, antibacterial, and antiparasitic conditions, respectively. During the pandemic, these drugs were used for COVID-19 treatment, despite unproven benefit and lack of clinical guideline support. Payer-based formulary edits of these agents during the COVID-19 pandemic were reviewed to determine effectiveness in supporting appropriate use.
 
 
 
 After local discovery of COVID-19 the University of Rochester Medical Center and a local payor in the upstate New York area, Excellus BlueCross BlueShield, disseminated education about the unproven role of these agents in treatment or prevention of COVID-19. In March 2020, May 2020 and February 2021, respectively, Excellus BCBS placed a quantity limit (QL) on prescriptions for HCQ, azithromycin and ivermectin and prior authorization (PA) for ivermectin in October 2021 for all formularies except Medicare. The QL for HCQ and azithromycin were in effect until December 2020. An exception process was available for individuals who required a higher quantity. Data was gathered retrospectively for claims and total drug utilization amongst Excellus BCBS members through February 2022.
 
 
 
 Use of HCQ increased by 56.5% prior to QL implementation. After HCQ QL was implemented, HCQ use returned to near pre-pandemic baseline, and most (88%) claims were processed. For azithromycin, after the QL limit was implemented, while overall usage dropped, most claims (77%) were processed. Prior to QL and PA, ivermectin usage quadrupled. Following implementation of the ivermectin QL, usage was stable and a minority (41%) of ivermectin claims were processed. The month that PA was implemented, usage dropped by 81%, and 9% of claims were processed.
 
 
 
 Formulary edits resulted in returning use of HCQ to pre-pandemic levels despite an initial rise in use. The edits may have curtailed azithromycin use as well. A QL was associated with stabilization in ivermectin use but ultimately usage did not decrease until PA was required. Formulary edits consistent with local messaging appeared to help control use of unproven therapeutics for COVID-19.
 
 
 
 Alyssa Tutino, PharmD, BCGP, Excellus BlueCross BlueShield: Salary Justin Bender, BS, Excellus BlueCross BlueShield: Salary Michelle Sageer, Pharm D, BCACP, Excellus BlueCross BlueShield: Salary Mona Chitre, PharmD, Excellus BlueCross BlueShield: Salary.
