Hydroxychloroquine is a prescription drug that’s used to treat malaria, lupus, and rheumatoid arthritis. Medicare prescription drug plans cover hydroxychloroquine for its approved uses only.

In recent years, hydroxychloroquine has come into focus as a potential treatment for COVID-19. But the Food and Drug Administration (FDA) has not yet approved the drug as a COVID-19 treatment or cure.

Because of this, Medicare generally only covers hydroxychloroquine when it’s prescribed for its approved uses, with a few exceptions.

In this article, we’ll explore the different uses of hydroxychloroquine and the coverage that Medicare offers for this prescription drug.

Medicare Part A (hospital insurance) covers services related to inpatient hospital visits, home health aides, limited stays at a skilled nursing facility, and end-of-life (hospice) care.

If you’re admitted to the hospital and doctors recommend hydroxychloroquine for your treatment, this medication would be included in your Part A coverage.

Hydroxychloroquine is currently FDA-approved to treat malaria, lupus, and rheumatoid arthritis, and it’s covered under many Medicare Part D prescription drug formularies for these conditions. You can use Medicare.gov’s plan comparison tool to find plans near you that cover hydroxychloroquine.

However, it has not been approved to treat COVID-19, so it will not be covered by Medicare Part D for this use.

Hydroxychloroquine, also known by the brand name Plaquenil, is a prescription drug that is used in the treatment of malaria, lupus erythematosus, and rheumatoid arthritis.

Hydroxychloroquine was originally used during World War II as an antimalarial to prevent and treat malarial infections in soldiers. During this time, it was noted that hydroxychloroquine also helped with inflammatory arthritis. Eventually, the drug was further researched and found to be useful for patients with systemic lupus erythematosus, as well.

Possible side effects

If you’ve been prescribed hydroxychloroquine, your doctor has determined that the benefits of the drug outweigh its risks. However, you may have certain side effects when taking hydroxychloroquine, including:

  • diarrhea
  • stomach cramps
  • vomiting
  • headache
  • dizziness

Some of the more severe side effects that have been reported with the use of hydroxychloroquine include:

Drug interactions

Whenever you begin a new medication, it’s important to be aware of any drug interactions that may occur. Drugs that may react with hydroxychloroquine include:

  • digoxin (Lanoxin)
  • drugs to lower blood sugar
  • drugs that alter heart rhythm
  • other malaria drugs
  • antiseizure drugs
  • immunosuppressant drugs

Effectiveness

Both the brand-name and generic versions of this drug are equally effective in the treatment of malaria, lupus, and rheumatoid arthritis. However, there are some cost differences between the two, which we’ll discuss later in this article.

In the early stages of the COVID-19 pandemic, some people were touting hydroxychloroquine as a “cure” for COVID-19. In fact, during this time, the Food and Drug Administration (FDA) allowed emergency use of the drug for this purpose. However, the FDA revoked this emergency approval in June 2020.

Since those early days, scientists have done more research into the effects of hydroxychloroquine on COVID-19.

Currently, the World Health Organization (WHO) does not recommend using hydroxychloroquine to prevent or treat COVID-19. This stance is based on the findings of many trials involving thousands of participants.

Costs with Medicare coverage for approved uses will vary from plan to plan, based on the formulary’s tier system. It will also depend on whether you’re prescribed the brand-name or generic version. You can contact your plan or pharmacy or look up your plan’s formulary for more specific cost information.

If your Part D plan includes coverage for hydroxychloroquine, you’ll still have certain out-of-pocket costs. These may include a monthly premium, deductible, coinsurance, and copayment. While specifics vary across plans, Part D coverage is broken down into stages:

  • Deductible stage: During this stage, you’ll pay all costs until reaching your deductible, if you have one. In 2025, the maximum deductible is $590.
  • Initial coverage stage: In this stage, you’ll pay a coinsurance on your medications until your out-of-pocket spending reaches $2,000.
  • Catastrophic stage: When you hit the $2,000 spending limit, you’ll have no more out-of-pocket costs for the rest of the year.
Getting help with prescription drug costs

Even if hydroxychloroquine is not covered under your Medicare prescription drug plan, there are still ways to pay less for prescription drugs.

  • Medicare offers programs to help cover your healthcare costs. You may qualify for Medicare’s Extra Help program, which is designed to help with your out-of-pocket prescription drug costs.

Hydroxychloroquine has not yet been approved to treat COVID-19, so Medicare coverage for this drug to treat COVID-19 is limited to in-hospital use under rare circumstances.

If you need this drug for an approved use, like malaria, lupus, or rheumatoid arthritis, it will likely be covered by your Medicare prescription drug plan.