Army Lt. Col. John Falzone, a pharmacist aboard the Military Sealift Command hospital ship USNS Comfort, verifies a patient's prescription. (U.S. Navy photo by Mass Communication Specialist 1st Class Scott Bigley)

By Patricia Kime

The Defense Health Agency and its Tricare pharmacy benefits manager, Express Scripts, are limiting prescriptions for several medications used by hospitals to treat patients with the novel coronavirus.

Pentagon officials said last week they have limited prescriptions containing albuterol and levalbuterol, also known by the brand names ProAir, Proventil, Ventolin and Xopenex, to one inhaler every 30 days to prevent shortages of these medications, which also are used to help COVID-19 patients breathe.

The drugs are widely prescribed to asthma sufferers for emergency respiratory use, as well as daily asthma control.

The DHA's announcement coincided with Express Scripts placing limitations on hydroxychloroquine, also known as Plaquenil, a medicine commonly used to treat autoimmune disorders such as lupus and rheumatoid arthritis that President Donald Trump promoted as a promising treatment for COVID-19.

DHA officials said the restrictions are in line with guidance from health systems, the American Medical Association and other health organizations to ensure that these drugs remain available for all patients who need them.

"Our goal is to provide you with the prescription drugs that you need," Air Force Col. Markus Gmehlin, DHA chief of pharmacy operations, said in a release. "We must be good stewards of health care resources during this national emergency."

Under the restrictions on albuterol and levalbuterol, if a patient has available refills, they can get one starting on or after the 22nd day after filling their prescription. If a physician deems it medically necessary to have more than one inhaler, a pharmacist can provide it, according to Tricare.

Mail-order quantities for new prescriptions for hydroxychloroquine are also limited to 30 days, although Express Scripts told the Military Officers Association of America that it is not experiencing shortages of the drug.

In March, Trump expressed support for hydroxychloroquine as a COVID-19 treatment after the results of a small non-clinical study in France showed it lowered the viral counts in coronavirus patients. The president continued to promote it for several weeks as the pandemic spread across the U.S.

But last month, physicians began raising concerns about the use of the medication, which can cause an irregular heartbeat and death. An analysis of Department of Veterans Affairs patients last month showed that more veterans with COVID-19 died while taking hydroxychloroquine or a combination of hydroxychloroquine and azithromycin than those who received routine care.

The study has yet to be peer reviewed or published, although the researchers said they had adjusted for the patients' concurrent medical conditions, other medications and additional circumstances.

The Food and Drug Administration, which granted an emergency authorization March 28 for physicians in hospitals to use hydroxychloroquine and chloroquine to treat patients with COVID-19, issued a warning last week about the risks of serious heart rhythm problems in patients receiving the medications in hospitals and as prescriptions.

"Hydroxychloroquine and chloroquine have not been shown to be safe and effective for treating or preventing COVID-19. They are being studied in clinical trials for COVID-19," FDA officials said.

According to the DHA, co-payments for these medications will remain the same at retail network pharmacies and through Tricare Pharmacy Home Delivery; however, a prescription obtained through mail order will cover 30 days instead of the 90 days usually distributed through mail order, so co-payments actually will triple in cost across three months.

Tricare officials said they will remove the limits as supplies become more plentiful.

"We're monitoring the availability of these medications on a daily basis," Gmehlin said. "All manufacturers of these products are increasing production levels to meet this increased demand. There are no current long-term shortages projected."