How have state pharmacy boards changed regulations on ivermectin since the COVID-19 pandemic?
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Executive summary
Since the COVID-19 pandemic, a clear policy shift has emerged: multiple state legislatures have loosened pharmacist access to ivermectin — with at least Arkansas, Idaho, Louisiana, Tennessee and Texas moving to allow over‑the‑counter or pharmacist‑dispensed ivermectin — even as federal and major medical bodies maintain that ivermectin is not authorized for COVID‑19 and warn against its use for that purpose [1] [2] [3] [4]. Courts and professional organizations have also pushed back: a federal judge struck down parts of Missouri’s law that restricted pharmacists’ speech, and national medical/pharmacy societies urged an end to ivermectin use for COVID‑19 outside clinical trials [5] [4].
1. From counsels and cautions to loosened access: the legislative trend
Since the pandemic, state lawmakers have increasingly proposed and passed laws to make ivermectin available without a traditional prescription or to shield pharmacists who dispense it. Examples cited in recent reporting include Arkansas (Act 396), Idaho (SB 1211), Louisiana (SB 19 / Act 464), Tennessee (had prior OTC access), and Texas moving to allow pharmacist‑dispensed or OTC access effective in late 2025 — trends covered by MedPage Today and other outlets [1] [6] [2]. Reports note bills that would remove ivermectin from lists of “dangerous drugs,” authorize OTC sales, or permit standing orders that let pharmacists dispense ivermectin without individual prescriptions [6] [1].
2. Regulatory friction: boards, professional groups and federal agencies hold firm
Federal and professional authorities stand in contrast to the state legislative moves. The FDA has repeatedly said it has not authorized or approved ivermectin to prevent or treat COVID‑19 and warns of overdose risks and harms [3]. Major professional societies — the AMA, APhA and ASHP — released a joint statement calling for an end to prescribing and dispensing ivermectin for COVID‑19 outside clinical trials [4]. The NIH COVID‑19 Treatment Guidelines likewise state ivermectin is not approved for treating viral infections including COVID‑19 [7].
3. Legal and free‑speech flashpoints: courts carving out limits on state rules
Legislation that sought to control pharmacists’ speech or counseling has faced court pushback. A federal judge struck down part of Missouri’s 2022 law that barred pharmacists from disputing ivermectin’s efficacy unless asked, finding that provision unconstitutional — a ruling that has left enforcement and board guidance in flux [5]. Litigation and First Amendment claims have been a recurring feature of post‑pandemic ivermectin policy battles [8] [5].
4. Diverse state models: standing orders, behind‑the‑counter access, and liability protections
State approaches vary in detail. Some laws allow behind‑the‑counter sale or require a pharmacist discussion of side effects before dispensing (Texas HB 25 language reported later in 2025), others authorize pharmacist dispensing via standing orders issued by prescribers, and some bills include liability protections for pharmacists or carve ivermectin out of dangerous‑drug statutes [6] [9] [10]. Coverage warns that statutes often leave discretion to boards to set implementing rules, so practical access can differ from statutory language [9].
5. Public‑health tension: access vs. evidence‑based guidance
The legislative push for easier access frames the issue as medical freedom and consumer access; proponents argue ivermectin is a long‑used antiparasitic and should be available without barriers [11] [10]. Federal agencies and major medical organizations counter with evidence and safety concerns: randomized trials and guideline reviews have not shown ivermectin effective for COVID‑19, and agencies warn of toxicities from inappropriate dosing [7] [3] [4]. Both sides are explicit in their objectives: lawmakers emphasize access and autonomy, while agencies emphasize evidence and patient safety [10] [3] [4].
6. What reporting does not say — limits of the record
Available sources do not mention comprehensive, nationwide data on how many state boards of pharmacy have formally revised standing rules (rather than statutes) or the full set of implementing regulations and enforcement actions in each state. They also do not provide aggregated outcomes data linking these legal changes to harms or benefits at the population level; poison‑center spikes and prescription surges were reported during the pandemic, but recent outcome studies tied to new OTC laws are not cited in the materials provided [12] [3].
7. Why this matters now: competing agendas and future flashpoints
The shift reflects competing agendas: some state lawmakers and advocacy groups emphasize deregulation and medical autonomy; federal agencies and clinical societies emphasize adherence to evidence and public safety [10] [4]. Expect further legal challenges over speech and scope‑of‑practice rules, additional state bills, and continuing tension as pharmacy boards draft rules to implement — or resist — legislative changes [5] [1]. Readers should track state statutes, board rules, and federal guidance in parallel, because statutory access does not erase federal advisories warning against ivermectin for COVID‑19 [3] [1].
Sources cited above: MedPage Today, Vaccine Safety Research Foundation, FDA consumer update, AMA/APhA/ASHP statement, Texas reporting, Missouri court ruling, NIH treatment guidelines [1] [6] [3] [4] [2] [5] [7].