Most insurances have a "tier" system. They will not approve expensive medications, until the lower tier preferred agent is used and proven to not work.

Really clinically there are not many people on plaquenil today.
I worked some of the busiest stores in highly concentrated populations...doing 200 -300 Rxs a day... and getting one plaquenil RX a month, was unusual. When the population is so low, then reports will be so correspondingly. Not all doctors even report them. A fairly well known toxic agent like plaquenil won't be reported like a new drug with little know history. The serious side effects for an old agent like plaquenil are not new news... but when Lyrica gives confusing or dangerous reports, those get reported more often because doctors are surprised and were not told to expect them. There have been sites that comment that less than 1% of all adverse reactions ever get reported at all. Doctors fear liability concerns...putting it down in writing, shines a light on them. And some are just too busy or jaded to even bother. That has been my experience and is my opinion.