Recent law leads to ‘delicate’ navigation of ivermectin sales

A north Idaho pharmacy, co-owned by a state lawmaker, is among a few currently selling ivermectin over-the-counter. Although legislation passed this year made the sale legal in Idaho, there’s been uncertainty for some on how to do so while navigating other regulations in the industry.

The drug, frequently used in humans and livestock as an anti-parasitic, became popular during the COVID-19 pandemic; however, the federal Food and Drug Administration (FDA) does not recommend its use for the novel coronavirus based on “currently available clinical trial data.”

Senate Bill 1121, co-sponsored by Rep. Jordan Redman, R-Coeur d’Alene, went into effect upon the signature of Gov. Brad Little on April 14 — Idaho joined two other states in allowing for the over-the-counter sale of the drug. Redman owns the Medicine Man Prairie Pharmacy location in Hayden, which as of late May has been selling ivermectin that it compounded in-house without a prescription.

However, administrative rules regulating the pharmacy industry in Idaho may not allow for the over-the-counter sale of compounded medication.

“State law requires a prescription for any compounded medication,” spokesperson for the governing Idaho Board of Pharmacy Bob McLaughlin told the Idaho Press in an email.

McLaughlin said a violation of this rule would be determined only if a complaint was filed.

“The Board’s investigative team would be made aware if a complaint was filed by the public with the Idaho Board of Pharmacy,” McLaughlin wrote. “The Board’s investigative team would then determine if the Board had jurisdiction and if there was a possible violation of Idaho law. If the answer to both was yes, then an investigation could be conducted.”

Redman told the Idaho Press in a phone interview he thought the law as written should still allow pharmacies to sell the drug if they compounded it in-house.

“I think the whole thought with Senate Bill 1211, at its core, was to make sure that Idahoans and people in the state could get access to over-the-counter ivermectin that was suitable for human use,” Redman said. “I think the law was written in a way to be flexible.”

Redman said he had concerns about people obtaining the drug through animal feed stores and consuming animal-grade products and potentially large animal-size doses.

The bill, which is about a half-page long, states, “Notwithstanding any law to the contrary, ivermectin suitable for human use may be sold or purchased as an over-the-counter medication in this state without a prescription or consultation with a healthcare professional.”

Korey Kreider, a pharmacist who co-owns the Medicine Man location with Redman, said there are cases where it’s legal for pharmacies to sell compounded medication without a prescription, such as in-house compounded Tylenol or ibuprofen. He said there are also cases of pharmacies selling supplements made in-house.

“It’s a very delicate thing on how you interpret it and how you’re going to do that,” Kreider said. “We’re open to suggestions as far as how we can go and make this safer, better, whatever we need to do to get the Board of Pharmacy, our Idaho Legislature all on the same page. And that’s what we’re trying to navigate.”

The regulation requiring a prescription to sell compounded medication is within Idaho Administrative Code, which carries the force of law.

Other pharmacies told the Idaho Press they had been hesitant to sell the drug without a prescription because of federal and administrative regulations.

Ivermectin can normally be obtained with a prescription, and the FDA has approved its use for conditions caused by parasitic worms. Boxes of the medicine distributed by the manufacturer have a label that says, “Rx only,” which means it cannot be sold without a prescription, Boise- and Eagle-based Customedica Pharmacy Director of Operations Matthew Murray told the Idaho Press in an email.

“We are not selling Ivermectin over-the-counter at this time,” Murray wrote. “I believe a couple additional changes need to be legislated in order for us to be able to do so.”

Murray said that his understanding is that additional legislation allowing for the over-the-counter sale of compounded medication may be needed, or a manufacturer would need to create an ivermectin product and label meant for sale without a prescription.

A pharmacist at Hells Canyon Pharmacy in Lewiston said it only provides the drug with a prescription because of concerns regarding proper labeling.

The state Board of Pharmacy posted guidance on its website, noting that prescription-grade ivermectin packages do not include directions or dosages for “off-label” uses.

The board wrote in a memo for pharmacies that, if they wanted to sell it without a prescription, to consider keeping it behind the counter, similar to emergency contraception or over-the-counter insulin.

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