Support Centers for Disease Control (CDC)
This is a request to ask for your support of the U.S. government and CDC requests for judicious prescribing of Cipro or doxycycline to ensure the availability of these drugs for those in need. Your effort in this regard will discourage inappropriate use that could seriously deplete national supplies of the drugs.

Prevent hoarding
By refusing to unnecessarily prescribe Cipro or doxycycline for persons to keep on hand, you will assist in preventing the development of resistance of anthrax and other bacteria. In addition, you will assist in preventing potential medical complications to these antibiotics, which include superinfections, cartilage damage, hemorrhaging, nephrotoxicity and colitis.

Blue Cross and Blue Shield of Florida’s data indicate some patients appear to be trying to stockpile personal supplies of Cipro and doxycycline in reaction to anthrax media reports. Prescribing data will continue to be monitored closely.

Patient education
If you are asked by a Blue Cross and Blue Shield of Florida or Health Options member to prescribe Cipro or doxycycline, please take the time to explain why it is not appropriate to comply with their request:

• The President and U.S. health officials have requested that antibiotics NOT be prescribed for the purpose to have on hand for potential anthrax exposure.
• Unnecessary prescribing of antibiotics reduces the supply of medication for those who actually are exposed and require treatment.
• Unnecessary use of antibiotics is and has been a public health concern even prior to this anthrax scare.
• Unnecessary use is causing bacteria to be resistant to antibiotics.
• Antibiotics are medications; they can cause serious side effects.
• Unnecessary use of antibiotics may cause future anthrax cases to fail to respond to antibiotic treatment.
• Cipro is not approved for children younger than 18 years of age, and doxycycline is not approved for children younger than 8 years of age (unless used to treat for documented anthrax exposure).

Any Blue Cross and Blue Shield of Florida or Health Options member covered under our pharmacy plan who is exposed to anthrax and prescribed Cipro or doxycycline will certainly have the drug covered as a first-line defense. Following medical evaluation, further antibiotic therapy also would be covered as medically necessary.

Though Cipro and doxycycline have been getting most of the attention in connection with the anthrax outbreak, there are several other antibiotics that can be used, including penicillin, amoxicillin and ampicillin.

BCBSF requests that participating physicians follow the guidelines provided by the Centers for Disease Control and Prevention found at www.bt.cdc.gov.

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