Demographic Variation In US Outpatient Hydroxychloroquine And Ivermectin Use During The COVID-19 Pandemic

As COVID-19 surged across the US starting in 2020, so too did the use of repurposed medications such as hydroxychloroquine and ivermectin to treat COVID-19 infections. Use of these medications throughout the public health emergency and across demographic subgroups is not well understood. Using insurance claims from the MedInsight Emerging Experience Research Database for 8.1 million patients from all fifty US states, we evaluated COVID-19-associated outpatient hydroxychloroquine and ivermectin use and spending throughout the public health emergency (January 30, 2020-May 11, 2023) versus pre-public health emergency rates. Extrapolated to the US population, approximately three million prescriptions (totaling $272 million in spending) were used; 7 percent followed Food and Drug Administration authorization of outpatient COVID-19 medications ritonavir-boosted nirmatrelvir, molnupiravir, and remdesivir in December 2021 and January 2022. The combined overall hydroxychloroquine and ivermectin utilization rate was threefold higher in older versus younger adults. Ivermectin use was greater among patients with the highest versus the lowest degree of social vulnerability and in the southern US versus other regions. These findings can inform policy efforts to mitigate the harms of non-evidence-based care, particularly among vulnerable populations.