Can a pharmacist refuse to fill a valid prescription for a medicine like ivermectin written by a licensed healthcare provider?

No. Although it is true that in some states in the U.S., pharmacists have the right to refuse to fill a prescription, they can only do so if they are concerned about potential harm to the patient, a concern that is valid in few circumstances, such as the following:

  • A known allergy – i.e. the pharmacist would need to cite a documented history of an allergic reaction during prior treatment with ivermectin that the provider has not indicated they were aware of;
  • A known adverse interaction with another medication the patient is taking. In this case, the pharmacist would need to cite an absolute contraindication to concurrent use with another medication;
  • The prescribed dose is above the recommended dosage – given that studies using ivermectin doses up to 10 times the FDA approved dose of 0.2mg/kg have not been associated with any increased adverse effects, this reason would be invalid. Further, doctors can and do prescribe medicines above normal doses for patients and this practice is perfectly legal. Finally, of the many treatment studies of ivermectin in COVID-19, multi-day dose regimens of up to 0.3mg/kg have been used with no reported increase in adverse effects.

Note that if a pharmacist refuses to fill the ivermectin prescription by claiming that “it is not recommended or approved for COVID-19” they should be made aware of the following:

NIH treatment guidelines are not mandates and thus do not and cannot restrict any provider’s decision to prescribe a medication that the NIH Guidelines panel does not recommend. As stated in the NIH COVID-19 Treatment Guidelines:

“it is important to stress that the rated treatment recommendations in these Guidelines should not be considered mandates. The choice of what to do or not to do for an individual patient is ultimately decided by the patient and their provider.”

“Off-label” prescribing of a medicine that has received FDA-approval for another indication is both legal and common.

Thus, if a pharmacist refuses to fill a prescription without an accepted indication for refusal as above, this can be considered “practicing medicine.” Given that pharmacists have no legal right to practice medicine, in such a case, a complaint to the state medical licensing board may be appropriate. Further, the permit holder/store owner, the pharmacist in charge, the pharmacist who refuses to fill a prescription, and the wholesaler are all licensed by their state’s Board of Pharmacy. A complaint for unprofessional conduct can be filed against each with the appropriate Board of Pharmacy.

State Boards of Pharmacy
State Medical Licensing Boards

We offer step-by-step guidance to Overcoming Pharmacy Barriers here.