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A Republican bill would require pharmacists to fill prescriptions for drugs like ivermectin and hydroxychloroquine to treat COVID-19 passed out of committee Wednesday.
The measure says that pharmacists in Arizona must “dispense all prescription orders written by a medical practitioner for the off-label use of a prescription drug” during public health states of emergency.
But the bill, Senate Bill 1016, does allow pharmacists some leeway. For instance, they can refuse to fulfill the prescription if the medication is illegal, if the medication is contrary to the “health and safety of the patient,” the prescription is unavailable, the pharmacist lacks sufficient equipment or the pharmacist does not regularly stock the medication.
In those instances, the pharmacist would not be subject to criminal prosecution or disciplinary actions from the Arizona Board of Pharmacy.
Sen. Kelly Townsend, R-Mesa, said she had been working with pharmacists to develop the bill, which she said would only have a real-world impact during a pandemic.
Off-label medications have become popular among conservatives and COVID-19 vaccine skeptics, with many in Arizona seeking out specific nurse practitioners who prescribe the medications. Some have taken more drastic measures, including buying animal use versions of the drugs which are dangerous for human consumption.
Many Arizonans in Facebook groups dedicated to helping each other find the alternative COVID-19 treatments have turned to compounding pharmacies.
The outbreak caused the passage of the Drug Quality and Security Act of 2013, which created “outsourcing facilities” for compounding pharmacies to get certain drugs in bulk. However, certain problems still remain.
Arizona is one of only 22 states that conducts routine inspections of compounding pharmacies and requires certain sterile conditions in facilities where medications are made. In Texas, more than 60 people lost all or some of their eyesight due to a contaminated steroid injection.
There is largely no federal regulation on compound pharmacies and regulation is mostly left to state entities like the Arizona State Board of Pharmacy.
The bill is similar in language to one in Indiana, and a number of other legislatures across the country are pushing similar bills around the off-label use of drugs touted by conservatives as alternative treatments to COVID-19. Lawmakers in Colorado, Florida, Idaho, New Hampshire, Pennsylvania, Mississippi, Indiana, Virginia and West Virginia have all introduced legislation that would limit medical board authority as it relates to COVID-19 treatments.
Ivermectin has not been approved by the Food and Drug Administration to treat COVID-19. It is primarily used for treating parasitic worms and is not an antiviral drug. One form of the medication is approved by the FDA is used for treating people with intestinal diseases and roundworms. Studies have also shown mixed results on how it can help with treating COVID-19.
One small study out of Brazil found that those who used the ivermectin, along with other drugs, actually had lower levels of the COVID-19 antibodies that are needed for immunity.
“[O]ur results strongly suggest that ivermectin use can interfere in the specific immune response to SARS-CoV-2 infection, affecting memory cells and the production of antibodies against that virus,” the study says. Those who took the medicine also experienced abdominal pain, diarrhea and a dulled sense of taste.
Townsend’s bill also could open pharmacists up to civil liabilities, according to pharmacists who testified against it during Wednesday’s Senate Health and Human Services Committee.
Jens Timothy, who has been a practicing pharmacist in Arizona for more than a decade, said that while the bill protects them from criminal liability, it does not protect them from civil liability. He gave a personal story of his own experience with ivermectin.
Timothy had an 81-year-old patient who he knew was on medication for a heart arrhythmia, or an irregular heartbeat. One day, this man came in with a prescription for ivermectin from a prescriber based out of Washington. Timothy said that was problematic, as ivermectin has been known to cause tachycardia, where the heart can speed up to over 100 beats per minute.
Timothy couldn’t get a hold of the patient or the prescriber, and under this new bill he would be forced to prescribe the medication. Doing so, he said, would more than likely kill the man and then he would be civilly liable.
“I have sacrificed a lot for my white coat,” Timothy said. “It means a lot to me to be a pharmacist and help my patients.”
Other pharmacists said the bill is unnecessary, noting that current state law already allows for prescribers to give out off-label medications.
One pharmacist who spoke in favor of the bill, Mark Boesen, said that it is about finding what is right for each patient.
“I think there needs to be a balance right now,” Boesen said.
Townsend said she is willing to work to tighten up the issue of civil liability for pharmacists, but said she disagreed with pharmacists who said that current law allows for the prescription of off-label medications. She called ivermectin a “very safe medication.”
“God above is going to shine down on you,” Townsend said about pharmacists who prescribed ivermectin and hydroxychloroquine. “You resisted the ‘high above’ CDC.”
The bill passed along party lines and will head to the full Senate for a vote.
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