I see the Iowa House passed HF 2676 including the ivermectin section which would make the anti-parasite drug available over-the-counter (OTC) in Iowa, despite arguments against it about the medical indications for the drug, which don’t include treatment of cancer and Covid-19 infection. There’s a high probability that some people might use it to treat those conditions. It now goes to the Senate.
It’s worth pointing out that a stand-alone version of this bill died in the first funnel. The text of this alternative bill, which is sponsored by Governor Reynolds, is distinctly different from the first one. It uses permissive language saying a pharmacist “may” (instead of “shall”) make this prescription drug used to treat parasite infections in humans and animals available OTC to those who want it for what some might call off-label use.
Recall the original version of this bill said the “medical director” of a pharmacy should write a “standing order” for ivermectin to be available “OTC.” This probably blurs what’s actually implied, which is that someone with “prescriptive authority” write the standing order, such as a physician.
This is clarified in the laws recently passed in June of 2025 in the Louisiana legislature stating 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.”
It looks like Iowa might be taking a slightly different approach. By the state making ivermectin OTC in the first place, the “standing order” piece is bypassed to avoid the apparent contradiction of ivermectin (a prescription drug) having both OTC and prescription features.
But it gets more complicated than that because Iowa has authorized a collaborative drug therapy management arrangement by which a licensed prescriber may allow an authorized pharmacist to prescribe certain drugs. Further, even though states can’t override FDA classification of a drug, they can decide on whether a drug needs a prescription or not. Would it make sense to ask what reason would there be for legislators to seek non-prescription status for a drug—other than expedience?
Under this bill, a pharmacist can’t be sued or be held criminally liable if patients suffer injury or even death by taking ivermectin for an indication which doesn’t make sense to medical science. By contrast, if someone suffers an adverse effect from a vaccine, patients and families have access to the Vaccine Injury Compensation Program and if that’s not effective, they can file lawsuits in state and federal courts. If this sounds unfair, there’s a reason for that which people might not discover until it’s too late. A strong mitigating factor is the pharmacist’s ethical standards.
The FDA has provided guidance about unapproved (off-label) use of FDA-approved drugs. It’s possible to use an approved drug for an unapproved use. However, the major reason why a physician might consider doing this is usually because an approved drug is not available to treat a patient’s condition.
In this case, ivermectin is approved for treatment of parasitic infections and there’s no credible scientific evidence it’s effective for treatment of Covid-19 or certain types of cancers. Off label use is not illegal in the U.S. Insurance may or may not cover the cost. There are a number of drugs used off-label, including the popular drug Ozempic, approved for diabetes and used off-label for weight loss.
I hope the Senate considers the potential for medical trouble with HF 2676.
Go Retire Psychiatrist 