Texas will soon allow pharmacists to dispense ivermectin without a prescription from a physician, raising fears of compromised patient safety.
House Bill 25 authorizes Texas pharmacists to distribute ivermectin “without requiring a prescription order from a licensed health care practitioner,” further elaborating in the bill’s text that “a pharmacist acting in a reasonably prudent manner is not criminally or civilly liable or subject to professional disciplinary action for dispensing ivermectin.”
The bill, which goes into effect Dec. 4, calls for pharmacists to adhere to “any written standardized procedures or protocols issued by the Texas State Board of Pharmacy,” including providing instructions on proper use, upon dispensing.
Texas Medical Association staff was not aware of any such guidance from the board as of this writing but pointed out state agency rulemaking typically incorporates a 30-day comment period. Staff also said that while the law did not specify how pharmacies would distribute ivermectin, it implies the drug will be kept behind the pharmacist’s counter and available upon request, rather than being stocked on shelves.
TMA submitted written testimony on the bill in August, citing physicians’ important role in prudent prescribing.
“Under the current legal framework, the patient’s physician promotes safe co-administration of prescription medications by counseling the patient on potential interactions and side effects, adjusting dosages when appropriate, all within a physician-patient relationship that accounts for the condition and comorbidities of the individual patient,” wrote Zeke Silva, MD, chair of TMA’s Council on Legislation, in testimony submitted to the House Committee on Public Health on Aug. 22. “We are very concerned that departing from this framework and removing clinical involvement is a risk to patient safety.”
He pointed out the state’s Pharmacy Act prohibits a pharmacist from dispensing a prescription drug without a valid physician-patient or practitioner-patient relationship.
“Prescription drugs are potentially harmful if not used under the guidance of a physician or other licensed health care practitioner authorized to prescribe medications,” he said.
He also noted that ivermectin’s prescribed dosage is dependent on the patient’s underlying conditions and body weight, and it can interact with other medications, including warfarin, a blood-thinning medication commonly used to reduce the risk of heart disease.
“If [ivermectin] is dispensed for an off-label use, it is unclear how the safe and effective dosage will be determined for the condition the patient seeks to treat,” Dr. Silva added.
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Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.