Four States Pass Laws Allowing OTC Ivermectin, More States Pending Legislation

Four states passed laws allowing for over the counter (OTC) sale of ivermectin (Stromectol; Merck)—a drug that has been a topic of controversy and gained significant attention during the COVID-19 pandemic. Amid the passages, concerns are abound amongst health experts and pharmacists as misinformation and public distrust in medical science persist as legislation.

Ivermectin tablets | Image Credit: © HJBC - stock.adobe.com

During the COVID-19 pandemic, discussion of ivermectin skyrocketed as misinformation tied its use to treatment of COVID-19. Despite numerous studies showing ivermectin is not effective against COVID-19 infection, argument over its use and suppression of the agent continue among the public and some health officials, such as Department of Health and Human Services Secretary Robert F. Kennedy Jr.¹

"As a pharmacist, this concerns me because expanded access increases the risk of adverse effects and drug-drug interactions,” Alisha Reed, PharmD, MBA, clinical pharmacist and wellness advocate, zone 4 director for the National Pharmaceutical Association, Inc, said in an interview. “More people will self-treat without a diagnosis. Certain patient populations should not use ivermectin (pregnant/breastfeeding), which is a safety concern. There is not much clinical data for use in children or the elderly. It is also dosed based on body weight.”

Ivermectin

Ivermectin is an anti-parasitic drug that has been used for decades to treat parasitic infections—such as intestinal strongyloidiasis and onchocerciasis—and is on the World Health Organization’s list of essential drugs. It is approved by the FDA at specific doses for treatment of parasitic worms and topical formulations are available for head lice and some skin conditions (eg, rosacea).²

“Ivermectin is FDA approved for the treatment of parasitic infections,” Reed said. “Misinformation led people to self-medicate with ivermectin for the treatment of COVID-19. Poison control centers were inundated with calls. People were purchasing the formulation of the drug that was intended for animals.”

The FDA provides multiple warnings about the agent, stating that ivermectin is not approved or authorized for treatment of COVID-19 and determined that available clinical trial data do not support its efficacy against the virus. The agency also reports multiple instances of patients who required medical attention, including hospitalization, after self-medicating with ivermectin intended for animals.²

“Animal ivermectin products are different formulations than those approved for humans,” the FDA states. “Due to the lack of testing of these formulations in humans, the safety of these products in humans is not known. Never use medications intended for animals on yourself or other people.”²

States Passing Legislation

As of July 10, 2025, 4 states passed laws allowing for OTC distribution of ivermectin. Tennessee was the first state to make the drug available in 2022 with SB 2188/HB 2746, which authorized "ivermectin [as] suitable for human use."³

In 2025, multiple other states followed suit. Arkansas passed SB 189 and Act 369 on March 25, 2025, and soon after on April 14, Idaho passed SB 1211. Both states and their respective acts indicate that “ivermectin [is] suitable for human use [and] may be sold or purchased as an over-the-counter medication in this state without a prescription or consultation with a health care professional.”³

Louisiana is the latest state to join the movement for legislation of OTC ivermectin. On June 20, 2025, SB 19 and Act 464 went into effect. The laws state that pharmacists can dispense ivermectin to adults "pursuant to a standing order issued by a health care professional with prescriptive authority." When administering ivermectin to a patient, the rule requires pharmacists to provide information on indications and contraindications. A screening risk assessment tool is also required. Pharmacists may charge an administrative fee for these services.³

The other existing laws in Tennessee, Arkansas, and Idaho do not include specifications or requirements, such as those in Louisiana’s law, for pharmacists when selling ivermectin OTC.³

Other states are following suit—passing legislation to expand public access to ivermectin. These include³:

• Texas: HB 3219 would reclassify ivermectin as OTC.
• New Hampshire: SB 119 would pair ivermectin status with an unrelated Medicaid provision and "…[direct] pharmacists to dispense brand name drugs to Medicaid beneficiaries when the brand name drug is on the Department of Health and Human Services preferred drug list."
• North Carolina: HB 618 would "issue a statewide standing order to allow pharmacists to dispense ivermectin without prescription" and "[provide] immunity from civil or criminal liability" for any pharmacist who dispenses ivermectin.
• Pennsylvania: SB 601 would amend the state’s Pharmacy Act to include OTC ivermectin.
• Georgia: SB 366 would "provide for ivermectin as an over-the-counter medication in this state" and "remove ivermectin from the definition of, exceptions to, and exemptions from dangerous drugs."
• Alabama: HB 278 would "permit a physician, a physician assistant, or a certified registered nurse practitioner to give a pharmacist a standing order that has been approved by the State Board of Pharmacy to dispense ivermectin to individuals without a prescription." This law includes similar requirements to the Louisiana bill. Additionally, it includes disciplinary protections for pharmacists and restricts them from endorsing the use of ivermectin to an individual or the public.
• West Virginia: SB 614 would authorize pharmacists to sell ivermectin without a prescription or consultation, as well as protect them from liability from damages or licensing board discipline.
• Missouri: SB 744 would permit pharmacists to dispense both ivermectin and hydroxychloroquine OTC.
• South Carolina: HB 3916 would allow OTC sales of ivermectin and hydroxychloroquine without a prescription or consultation.

Ivermectin and COVID-19 Studies

Since the COVID-19 pandemic, numerous studies on the potential use of ivermectin for treatment have been conducted. However, many of these studies were flagged for conflicts of interest, inaccurate data collection in meta-analyses, and improper study design leading to misleading data on ivermectin efficacy within this setting. Some in vitro studies show broad-spectrum anti-viral activity and inhibition of SARS-CoV-2, but this isn’t replicated in human studies.⁴

In the ACTIV-6 trial (NCT04885530), high dose ivermectin use was not associated with clinical benefit for mild to moderate COVID-19. Recovery time (defined as time from receipt of medication to achieving the third of 3 days of recovery) was the same in both the ivermectin and placebo groups (11 days) and ivermectin did not reduce 28-day mortality, hospitalizations, emergency department or urgent care visits, or duration of infection.^5,6

There are various meta-analyses of ivermectin and COVID-19 studies. Those confirming a positive correlation are under continued scrutiny. The most well-known paper, a meta-analysis published by Andrew Hill, PhD, et al, was retracted due to its reliance on poor-quality studies. In the retraction, Hill and his authors stated that “one of the largest studies on which this analysis was based was withdrawn due to fraudulent data; additional problems have emerged regarding other studies included in the original paper.”⁷

Implications for Pharmacists

As the legislative landscape shifts, pharmacists are uniquely positioned—but often left navigating murky waters. Although some laws build in safety measures such as counseling requirements and risk assessments, many others do not. This increases the burden on pharmacists to manage not just the logistics of dispensing ivermectin OTC, but also the difficult conversations that come with it.

Pharmacists are likely to encounter a wide range of patients who remain influenced by misinformation about ivermectin—much of it rooted in discredited studies or social media narratives. Many may not understand the importance of rigorous, ethically designed clinical trials in determining drug safety and efficacy. Others may distrust public health guidance altogether.

When counseling patients seeking OTC ivermectin, it’s crucial to meet them with empathy and clinical clarity. “As a pharmacist, I would first ask the patient what they are trying to treat,” suggested Reed. “Based on their response, I would either refer them to their provider or assist them with the selection of a safer alternative. I would also tell them what my concerns are and educate them about ivermectin’s intended use.”

Ultimately, pharmacists must strike a balance of upholding evidence-based care and helping patients feel heard and informed, not shamed. As access expands, so too does the responsibility to lead with both science and compassion.

REFERENCES

1. Gerlach A. Experts voice concerns, cautious optimism with Kennedy potentially leading the HHS. Pharmacy Times. December 6, 2025. Accessed July 10, 2025. https://www.pharmacytimes.com/view/experts-voice-concerns-cautious-optimism-with-kennedy-potentially-leading-the-hhs

2. Ivermectin and COVID-19. FDA. April 5, 2024. Accessed July 10, 2025. https://www.fda.gov/consumers/consumer-updates/ivermectin-and-covid-19

3. Robertson R. These states now allow OTC ivermectin, and more may follow. MedPage Today. July 9, 2025. Accessed July 10, 2025. https://www.medpagetoday.com/special-reports/features/116436?xid=nl_mpt_DHE_2025-07-09&mh=6d2b5f4f91352444bdf817a9c17750bc&zdee=gAAAAABm4uL9FCoIf1N83nrcwYYqnQUvN6Iw4dbaY-dGva4sOp57nSM2Ew3wD87ohRuoseQBDbCp1MG30J6ETpHXK1wNpp0NgnGTMFXrtFaNfWUoL5ekf-Y%3D&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Evening%20-%20Randomized%202025-07-09&utm_term=NL_Daily_DHE_dual-gmail-definition

4. Caly L, Druce J, Catton M. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Research. April 3, 2020. Doi:10.1016/j.antiviral.2020.104787

5. Bulloch M. Study: High Dose ivermectin not effective for outpatients with COVID-19. Pharmacy Times. February 23, 2023. Accessed July 11, 2025. https://www.pharmacytimes.com/view/study-high-dose-ivermectin-not-effective-for-outpatients-with-covid-19

6. ACTIV-6: COVID-19 study of repurposed medications. Updated November 13, 2024. Accessed July 11, 2025. https://clinicaltrials.gov/study/NCT04885530

7. Retraction to: Meta-analysis of randomized trials of ivermectin to treat SARS-CoV-2 infection. Open Forum Infectious Diseases. February 5, 2022. Accessed July 11, 2025. https://academic.oup.com/ofid/article/9/3/ofac056/6523214?login=false