Hydroxychloroquine: did COVID-19 change GP prescribing?

A study looking at prescribing patterns for hydroxychloroquine during the first months of the COVID-19 pandemic in Australia

Hydroxychloroquine has received a lot of interest during the COVID-19 pandemic.

But have doctors in general practice changed the way they prescribe this medicine?

To find out if the prescribing of hydroxychloroquine in Australia has changed, we compared GP prescribing before the pandemic with prescribing during the pandemic period.

Between March and May 2020, the Australian Government also introduced a number of regulatory changes to help control availability of this medicine.


What is hydroxychloroquine and what restrictions were introduced?

Hydroxychloroquine is the active ingredient in a medicine used to:

  • prevent and treat malaria, and
  • to treat autoimmune conditions such as rheumatoid arthritis and systemic lupus erythematous (SLE).

Use of hydroxychloroquine for these conditions is supported by a large body of scientific and clinical trial evidence.

Early in the pandemic, research started into the possible use of hydroxychloroquine to prevent or treat COVID-19, sometimes in combination with the antibiotic azithromycin. This research received a lot of media interest. As a result, there was a rapid increase in demand for hydroxychloroquine, and stories of stockpiling emerged. Some people who needed the medicine to manage their chronic diseases had difficulty filling their scripts.

To ensure people who needed it to manage their chronic conditions continued to have access to the medicine, the Australian Government changed the regulations around hydroxychloroquine. From 24 March 2020, only certain specialist doctors were allowed to write new prescriptions. GPs could still prescribe to continue existing treatment.

From 1 May 2020, all prescriptions of hydroxychloroquine had to be approved by the Pharmaceutical Benefits Scheme (PBS), further restricting its use.


MedicineInsight data used to inform study

The study used data from MedicineInsight, which is a large primary care dataset of de-identified electronic health records. MedicineInsight was established in 2011 with core funding from the Department of Health.

Data for this study came from 471 general practices, covering 3.71 million patients who consulted one of these practices during the study time period (1 March 2018 to 31 May 2020).


A mix of extra prescriptions for current users, and some inappropriate use

The study compared prescriptions for hydroxychloroquine made before the COVID-19 pandemic (between 1 March 2018 and 29 February 2020) and during the pandemic (between 1 March 2020 and 31 May 2020).

In March 2020, at the start of the pandemic, prescriptions for hydroxychloroquine doubled from 7 to 14 scripts per 10,000 patient-doctor consultations, compared to the pre-COVID period. Private scripts (not funded by the government), although only a tiny fraction of the total, saw a 20-fold increase in March 2020, compared to the pre-COVID period. Prescriptions returned to more normal levels after government restrictions on the medicine were introduced.

The study reported that 80% of people who were prescribed hydroxychloroquine between 1 March and 31 May 2020 were already using it before the pandemic. As fears of shortages were reported by some media outlets, these people may have stocked up with an extra supply to treat existing conditions like rheumatoid arthritis or SLE.

Of the 20% who were newly prescribed hydroxychloroquine during this time, around half didn’t have any illness recorded that requires treatment with hydroxychloroquine. Those prescribed hydroxychloroquine for the first time in this period were typically younger, lived in more socioeconomically advantaged areas, and were more often male and from a big city.

A small number of people prescribed hydroxychloroquine during the COVID-19 period also received a prescription for the antibiotic azithromycin on the same day. In this small group, only 25% of people had a recorded illness that requires hydroxychloroquine as part of treatment.

Between 15 February 2020 and 23 March 2020, around 1 in 7 hydroxychloroquine prescriptions prepared by a GP were new scripts for people who had never been prescribed this medicine before the COVID-19 pandemic and did not have an illness recorded that requires treatment with hydroxychloroquine. This shows there was some potentially inappropriate prescribing.

The number of potentially inappropriate prescriptions dropped to 1 in 14 after 24 March 2020, when the Therapeutic Goods Administration (TGA) ruled that only specialists could start hydroxychloroquine treatment . It dropped further to 1 in 27 after 1 May 2020, when approval from the PBS was required to prescribe the medicine.



A newly released study looking at Australian general practice has reported that prescriptions of the medicine hydroxychloroquine initially doubled at the start of the COVID-19 pandemic.

The findings suggest the increase was mostly due to people who already use the medicine getting extra supplies.

However, some of the increase appears to be due to a small number of people being prescribed the medicine inappropriately, despite not having an illness for which hydroxychloroquine is an indicated treatment. The number of prescriptions that were considered inappropriate dropped dramatically after government restrictions were introduced.