Pharmacists would have to fill ivermectin prescriptions for COVID under Arizona proposal

PHOENIX — The way state Sen. Kelly Townsend sees it, if a doctor is willing to write you a prescription for ivermectin or any other drug, a pharmacist has no right to refuse to fill it — even if the manufacturer has not obtained federal approval for the drug to be used for that condition.

The proposal by the Mesa Republican is designed to ensure that patients get access to “off-label’’ medications their doctors have prescribed. Pharmacists who send customers away could be subject to discipline by the board that regulates them.

But Townsend’s proposal in Senate Bill 1016 is not absolute.

First, it would apply only when there is a proclaimed state of emergency.

And it would have to be for a drug that is “potentially lifesaving,” though Townsend’s legislation does not define what that would include.

Her proposal comes more than a year after Gov. Doug Ducey forbade pharmacists from dispensing hydroxychloroquine or chloroquine unless they have a prescription that specifically says the patient has COVID-19.

That followed a spike in demand for the drug in early 2020, before there was a COVID-19 vaccine. Then-President Donald Trump had mentioned the drugs in a White House briefing despite the lack of medical evidence they would prevent anyone from contracting the virus. Ducey, who had declared a pandemic emergency a month earlier, acted because the spike in demand resulted in shortages for patients who use the drugs for malaria or for autoimmune diseases such as lupus and rheumatoid arthritis.

But Townsend said her legislation is aimed at a more recent problem: the refusal of some pharmacists to fill prescriptions for ivermectin, a drug normally used to treat parasites, particularly in animals.

There have been some studies touting the anti-viral properties of the drug. And the Food and Drug Administration says that ivermectin, in tablet form — versus the topical paste — can be used to treat parasitic worms in humans.

However, the FDA says it has not authorized or approved ivermectin for use in preventing or treating COVID-19 in humans. And the agency has specifically cautioned against self-medication, especially using the version of the drug meant for livestock.

But prescribing it, by itself, is not illegal. Doctors in the United States have wide latitude to prescribe drugs “off-label,’’ meaning for conditions beyond those for which the FDA has approved their use.

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The problem, Townsend told Capitol Media Services, is that some pharmacies are refusing to fill these off-label but otherwise legitimate prescriptions. She said that is unacceptable.

“If a doctor feels this would save your life from the pandemic, from some whatever it is, and you say, ‘I agree with you, doctor, I want to try it,’ … who the hell is is the pharmacist to say ‘no’?” Townsend said.

She conceded that forcing pharmacists to fill prescriptions despite their own personal misgivings runs contrary to prior legislative precedent, which lets pharmacists turn away some customers.

An existing state law prohibits the government from denying, suspending or revoking anyone’s professional or occupational license for “declining to provide or participate in providing any service that violates the person’s sincerely held religious beliefs.” The sole exception to that involves peace officers.

And a separate and more specific law says that pharmacists, hospitals and health professionals are “not required to facilitate or participate in the provision of an abortion, abortion medication, emergency contraception or any medication or device intended to inhibit or prevent implantation of a fertilized ovum” if they object “on moral or religious grounds.”

“We don’t want to interrupt that,” said Townsend, saying she wants to preserve the ability of pharmacists to refuse to sell drugs that can cause an abortion, such as RU-486, or drugs like Plan B that may preclude a fertilized egg from implanting in a woman’s uterus.

She said that’s why she wrote her proposed legislation to be narrow, with the two conditions.

It would apply only during a pandemic where there is a declared emergency, and would pertain only to potentially lifesaving drugs.

She conceded that what constitutes a “potentially lifesaving’’ drug — the language in SB 1016 — may be subject to debate, since there is no evidence from the FDA or the Centers for Disease Control and Prevention that ivermectin is effective in COVID-19 patients.

Townsend said that may require some tweaks to her bill to put in a definition, perhaps a requirement for a doctor, in writing a prescription, to state that he or she considers the medication to be “potentially lifesaving.’’

“I don’t want to put that decision or definition in the hands of the CDC or any other political arm of any medical anything,’’ she said. “It should be the doctor and the patient.’’