Which state pharmacy boards have issued guidance or emergency rules implementing OTC ivermectin statutes and what do those rules say?
Executive summary
A small but growing set of states have moved laws to reclassify ivermectin for human use as available without a prescription, and pharmacy boards have reacted unevenly: Idaho’s Board of Pharmacy issued explicit written guidance on handling OTC ivermectin, while Texas law authorizes the Texas State Board of Pharmacy to adopt procedures but reporting indicates the board had not finalized prescriptive rules at the time covered by the sources; elsewhere—Louisiana and Tennessee—statutes set operational requirements (standing orders, counseling, or unrestricted OTC sale) but the sources do not show a state board issuing emergency rules implementing those statutes [1] [2] [3] [4].
1. Idaho: the clearest board-level guidance exists and treats ivermectin like a behind‑the‑counter OTC
The Idaho Division of Occupational and Professional Licenses (Board of Pharmacy) published a memo explaining how pharmacists should comply with the legislature’s 2025 law that made “ivermectin suitable for human use” available OTC, telling licensees they may handle ivermectin similar to other behind‑the‑counter OTC products (pseudoephedrine, emergency contraception, OTC insulin) and that pharmacists can offer — but not require — counseling and screening tools, relying on the general standard‑of‑care statute for clinical decisions [1].
2. Texas: statutory delegation to the board, but no concrete statewide protocols in the reporting
Texas’s HB25 (and related bills) removed the prescription requirement and expressly authorized the Texas State Board of Pharmacy to develop standardized procedures and protocols for pharmacists dispensing ivermectin; the board’s news release notes the law authorizes pharmacists to act in accordance with any procedures issued by TSBP, but contemporaneous reporting and professional commentary indicate the board had broad authority yet had not issued a detailed, mandatory statewide rule in the coverage provided here [5] [2] [6].
3. Louisiana and Tennessee: statutes impose different mechanics; the role of pharmacy boards is unclear in the sources
Louisiana’s Act 464 (SB 19) requires pharmacists to dispense adult ivermectin “pursuant to a standing order issued by a healthcare professional with prescriptive authority” and mandates that pharmacists provide patients information on indications, contraindications and a screening risk‑assessment tool (and allows an administrative fee), but the sources describe statutory requirements rather than a pharmacy‑board emergency rule implementing them [3] [7]. Tennessee’s 2022 law made ivermectin OTC without a pharmacist consultation requirement—effectively bypassing board‑level restrictions—again reflecting statute rather than an implementing emergency rule from a pharmacy board in the materials provided [3] [7].
4. South Carolina and other states: pending bills but no board guidance cited
South Carolina introduced bills in the 2025‑26 session to make ivermectin available OTC (and another that also included hydroxychloroquine), specifying no prescription or pharmacist consultation would be required, but the sources are bill texts and do not show any state pharmacy board issuing rules to implement OTC ivermectin at the time of reporting [8] [9]. Multiple advocacy trackers and specialty outlets list several states with statutes or pending legislation, but those items are legislative steps rather than board emergency rules [4] [7].
5. What the rules and guidance actually say — common themes and limits of public reporting
Where boards or agencies have issued written guidance (Idaho), the tenor is operational: treat OTC ivermectin like other non‑prescription but controlled OTCs kept behind the counter, preserve pharmacists’ discretion under standard‑of‑care statutes, offer screening and counseling, and flag federal law and packaging limitations for off‑label dosing [1]. In states where statutes themselves specify mechanics, requirements vary from unrestricted OTC sale (Tennessee) to pharmacist‑mediated dispensing under standing orders and mandated patient information/screening (Louisiana) [3] [7]. The reporting does not provide a comprehensive catalog of emergency rules from every state board; it documents statutes and a few board memos or authorizing statements but does not show universal board‑level rulemaking in response.
6. Stakes, alternatives, and implicit agendas in the sources
Coverage comes from a mix of trade publications, legislative trackers, state memos and advocacy sites—each with different priorities: pharmacy outlets emphasize pharmacists’ professional burden and patient safety [4] [1], legislative trackers and advocacy groups highlight access and liability shields [5] [7], and medical association commentary emphasizes clinical risks and the absence of FDA approval for COVID‑19 [6] [3]. That mix suggests some sources aim to normalize access and protect pharmacists from discipline, while others foreground safety concerns and the limits of evidence; the public reporting here does not assert a uniform body of emergency pharmacy‑board rules beyond Idaho’s guidance and Texas’s statutory delegation [1] [2].