Texas Ivermectin Law: A Shift in Pharmaceutical Access
On December 4, 2023, a new law will come into effect in Texas that allows pharmacists to dispense ivermectin without a doctor’s prescription. This legislative change, codified in House Bill 25 (HB 25), passed through the Texas Legislature and received Governor Greg Abbott’s signature in September. With this decision, Texas joins Tennessee, Arkansas, Idaho, and Louisiana in expanding access to this medication.
“This is huge,” reflects the sentiment expressed on social media regarding the bill. Supporters view it as a significant step towards enhancing medical autonomy and improving access to health care options.
Under this law, ivermectin will not be available on regular store shelves but will be stored behind the counter. Pharmacists will dispense it upon request, provided they follow state-created protocols. These healthcare professionals will also educate patients on how to use the drug appropriately and inform them of potential side effects, which can include dizziness and nausea.
Importantly, HB 25 provides legal protections for pharmacists from civil, criminal, and professional liability, as long as they dispense the medication responsibly. While the Texas State Board of Pharmacy is tasked with creating standard operating procedures, no such protocols had been finalized as of the signing. There will be a 30-day comment period for public input on these procedures.
The legislation has gained traction among various lawmakers and grassroots organizations. Rep. Joanne Shofner (R-Nacogdoches), the bill’s sponsor, contends that previous restrictions on ivermectin resulted from political influences. “It’s absolutely important for our rural communities,” Shofner remarked during legislative discussions, emphasizing that residents often have closer access to their pharmacists than to a physician.
Lt. Gov. Dan Patrick echoed her sentiments, suggesting the COVID-19 pandemic underscored the necessity for increased medical freedom in Texas. He indicated that access to ivermectin could particularly assist underserved rural areas where healthcare providers are limited.
Other supporters, including Sen. Bob Hall (R-Edgewood), have defended the measure by highlighting ivermectin’s safety record compared to common medications. “It has a better safety record than Tylenol,” he stated on the Senate floor. Medical professionals like Senators Donna Campbell and Charles Schwertner have also backed the bill, arguing for patient choice and recognition of community pharmacies as trusted medication providers.
Proponents assert that ivermectin is a well-recognized antiparasitic drug with a strong safety record when used correctly. During legislative hearings, advocacy groups, such as Texans for Vaccine Choice (TFVC), mobilized support by submitting over 7,000 signatures endorsing the removal of the prescription requirement. “The bill would reassure pharmacists and allow them to meet public demand without fear of reprisal,” said Michelle Evans from TFVC.
Notably, Robert F. Kennedy Jr., currently the U.S. Secretary of Health and Human Services, made a notable appearance at the Texas Capitol to commend the bill—an unexpected intersection of federal and state drug policy discussions.
Conversely, the legislation has encountered strong backlash from the Texas Medical Association (TMA) and several Democratic legislators. Rep. Rafael Anchia (D-Dallas) labeled the bill as “bananas,” arguing that it prioritized political showmanship over medical oversight. Sen. Roland Gutierrez (D-San Antonio) raised concerns during debates by highlighting that ivermectin was traditionally used for animals. “This is a drug that is used on horses, donkeys, correct?” he questioned.
Dr. Zeke Silva, the chair of the TMA’s Council on Legislation, expressed serious reservations about the lack of a prescription requirement. He cautioned that removing clinical oversight could be detrimental to patient safety, particularly due to the precise dosing required for ivermectin based on body weight and its potential interactions with other medications like warfarin.
“Departing from this framework and removing clinical involvement is a risk to patient safety,” he noted critically. Concerns from the TMA intensified as protocols for dispensing had not yet been established by the State Board of Pharmacy at the time of the bill’s passage.
During the COVID-19 pandemic, ivermectin became a controversial figure nationally. Although approved by the FDA for treating specific parasitic infections, the drug was widely—and controversially—used off-label for COVID-19 treatment. Proponents argued it was a safe and cost-effective option when other treatment avenues were restricted. Critics, however, highlighted significant risks, including hospitalization and toxic reactions, further underscoring the lack of strong clinical trial evidence supporting its effectiveness for COVID-19.
While ivermectin is now classified similarly to pseudoephedrine—available without a prescription but still requiring some level of pharmacist oversight—it signifies a notable shift in how such medications are accessed. Pharmacists will play an integral role in screening and counseling patients who request the drug. However, HB 25 has eliminated the requirement for pharmacists to report annual dispensing statistics, a change from previous iterations.
This policy change reflects a broader debate about the parameters of governmental regulation in personal health decisions. In Texas, a state characterized by recent disputes over vaccine mandates and public health directives, HB 25 is likely perceived by advocates as a corrective measure against what they view as overreach by federal and corporate health authorities.
The initiative for this legislation emerged in early 2023 with Rep. Shofner filing HB 3219. Although that bill stalled, renewed enthusiasm and pressure during a special session, reinforced by a letter signed by 20 GOP legislators and thousands of public comments, led Governor Abbott to prioritize ivermectin in the legislative agenda.
Speaker of the House Dustin Burrows underscored the importance of this push, as evidenced by assigning HB 25 a low-number designation—connoting high legislative priority. This allowed the bill to garner the attention necessary to ensure its final approval and enactment.
As Texas pharmacies brace for implementation on December 4, it marks a pivotal moment for patients seeking alternative options. For many Texans, this policy change symbolizes a triumph in the ongoing fight for medical choice.
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