The following was received from the Tennessee Pharmacists Association on March 27, 2020
Tennessee Department of Health Issues Statement on Chloroquine, Hydroxychloroquine, and Azithromycin

TPA and the pharmacy community have been calling on the Tennessee Department of Health to address issues related to the inappropriate ordering, prescribing, and dispensing of certain medications; most notably, hydroxychloroquine and azithromycin. TPA and the Tennessee Medical Association (TMA) issued a joint statement yesterday on the inappropriate ordering, prescribing or dispensing of medications to treat COVID-19.

Tennessee Department of Health Commissioner Lisa Piercey, MD, MBA, FAAP, has issued the following statement on chloroquine, hydroxychloroquine, and azithromycin.

According to FDA and CDC, there are no FDA-approved therapeutics to treat, cure, or prevent COVID-19 at this time. Specifically, hydroxychloroquine, chloroquine, and azithromycin are not FDA-approved for COVID-19 prevention or treatment. Likewise, there are no currently available data from Randomized Clinical Trials (RCTs) to inform clinical guidance on the use, dosing, or duration of hydroxychloroquine, chloroquine, or azithromycin for the indications being investigated.

Research is currently underway, and prescribers must be mindful that evidence of effectiveness is minimal and that there are known harms of these medications. Specifically, hydroxychloroquine and azithromycin, for example, are associated with QT prolongation and caution is advised when considering these drugs in patients with chronic medical conditions (e.g. renal failure, hepatic disease) or in patients receiving medications that might interact to cause arrhythmias.

We want providers and pharmacists to act with their best discretion to ensure patients continue to receive appropriate treatment in times of shortages. We discourage inappropriate prescribing or hoarding of this medication for prophylaxis or treatment of COVID-19, which may limit access for patients that require these medications for therapy for approved indications.

The letter from Commissioner Piercey is being sent to all providers in Tennessee and can be viewed HERE .

TPA appreciates Commissioner Piercey, as well as the leadership of the Tennessee Department of Health and Tennessee Board of Pharmacy, for recognizing pharmacists' concerns and issuing this statement in response to this very important patient-focused issue.

TPA reminds members that, pursuant to Tennessee Code Annotated 53-10-112, pharmacists are authorized in law to decline to dispense to a patient a legend drug which in that pharmacist's professional judgment, lacks a therapeutic value for the patient or which is not for a legitimate medical purpose. The entire code is listed below.
53-10-112. Prevention of abuse of drugs dispensed by pharmacist.

(a) For purposes of this section:
  1. “Pharmacist” has the same meaning as defined in § 63-10-204; and
  2. “Pharmacy” has the same meaning as defined in § 63-10-204.

(b) A pharmacy owner, manager or operator shall respect the professional judgment of the pharmacist in holding the health and safety of a patient to be their first consideration.

(c) A pharmacist shall, by utilizing education, skill, experience and professional judgment, make every reasonable effort to prevent the abuse of drugs which the pharmacist dispenses. In doing so, a pharmacist may decline to dispense to a patient a legend drug which in that pharmacist's professional judgment, lacks a therapeutic value for the patient or which is not for a legitimate medical purpose.

(d) A pharmacist shall not be subject to any penalty or fine when fulfilling the pharmacist's obligation to uphold the health and safety of a patient which results in the pharmacist declining to dispense any legend drug.

(e) It shall be a Class A misdemeanor, punishable by fine only, for the owner, manager or operator of a pharmacy to knowingly restrict or interfere with, or knowingly require a protocol or procedure that restricts or interferes with, a pharmacist's professional duty to counsel with patients and to evaluate the patients' appropriate pharmaceutical needs and the exercise of the pharmacist's professional judgment as to whether it is appropriate to dispense a legend drug to a patient.
For more pharmacy-specific information about the COVID-19 pandemic, visit TPA’s COVID-19 Practice-Based Resource Page  and watch your email for updates from TPA.
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