NASHVILLE, Tenn. — Four years in the past, Tennessee turned the primary state to permit adults to purchase the antiparasitic drug ivermectin from a pharmacy with out first seeing a physician. Pharmacies can use a pre-written, blanket prescription to promote to only about anybody who walks by way of their doorways.
The drug is now marketed and bought throughout the state in roadside outlets and small-town strip malls with little oversight from well being authorities. Highway billboards promote ivermectin as “Available Without a Prescription in Tennessee!” whereas dozens of pharmacies supply extremely concentrated tablets, typically at 10 or 20 occasions the efficiency of an ordinary pill.
Ivermectin is a Nobel Prize-winning, generally safe drug permitted by the FDA for treating parasitic diseases in humans, which might usually be finished with a single dose of three or 4 prescription-strength tablets. It can be used as a dewormer for horses and different livestock.
Its reputation surged through the pandemic as fringe docs and anti-vaccine activists promoted it as a remedy for covid. Clinical trials have proven that ivermectin is not effective in opposition to covid.
Nonetheless, it has since change into an emblem of resistance in opposition to the medical institution amongst conservatives and followers of the Make America Healthy Again motion, championed by Health and Human Services Secretary Robert F. Kennedy Jr.
Timothy Caulfield, a professor on the University of Alberta who research well being misinformation, mentioned ivermectin turned an “ideological flag” through the covid pandemic, opening the door for influencers to push the drug for different illnesses to a “captured audience” even with out proof it really works for these circumstances.
“This is really about profit. This is about political identity. This is about creating distrust in the existing biomedical community. This is about money,” Caulfield mentioned in an interview with ABC News, which partnered with KFF Health News to report on ivermectin.
After a hantavirus outbreak on a cruise ship earlier this yr, unproven claims that ivermectin is efficient in opposition to the virus have been unfold by some widespread social media accounts and right-wing figures, together with former congresswoman Marjorie Taylor Greene. The World Health Organization says it has seen no research that reveals ivermectin is an efficient hantavirus remedy.
Tennessee’s ivermectin invoice was shepherded by a Republican supermajority in 2022. Its passage blindsided state medical officers and handed a victory to medical teams that unfold covid misinformation.
Some pharmacy web sites now supply the drug as a remedy for covid, “long haul vax symptoms,” diabetes, or most cancers — regardless of no proof of its effectiveness for these functions — whereas the new law largely offers pharmacists immunity from lawsuits or skilled sanctions associated to ivermectin.
The regulation was additionally a harbinger of laws to return: More than two dozen states have since thought of look-alike payments that will make the politicized medicine accessible with out a requiring a physician go to.
John Mafi, a UCLA inner medication doctor who has studied the rise of ivermectin amongst most cancers sufferers, worries it’s going to lure individuals away from confirmed remedies. He co-authored a brand new research identifying a sharp increase in prescribing charges for ivermectin and one other antiparasitic drug, significantly within the South. The rise adopted a January 2025 episode of the Joe Rogan Experience podcast wherein actor Mel Gibson claimed ivermectin and different medicine cured three mates with stage 4 most cancers.
“It’s going back to 19th-century quack science,” Mafi mentioned about off-label use of ivermectin. “It is alarming that I’m seeing this really unproven therapy being touted to so many potentially vulnerable Americans.”
Concentrated ivermectin tablets like these are bought at compounding pharmacies throughout Tennessee. Under a 2022 regulation that made the drug accessible to individuals with out requiring a physician go to, some pharmacies supply tablets which might be 10 or 20 occasions the energy of normal ivermectin tablets. (Brett Kelman/KFF Health News)
The FDA says ivermectin could be dangerous in large doses. Tennessee has seen a small however regarding rise in indicators of overuse. The Tennessee Poison Center, which fields calls from individuals uncovered to medicine or poisonous substances, acquired greater than 60 requires potential ivermectin poisoning in 2025, probably the most since 2021. They included reviews of vomiting, blurred imaginative and prescient, neurological issues, and problem strolling.
“People are taking this because they just feel unwell. It’s almost like a panacea now,” mentioned Rebecca Bruccoleri, the poison middle’s medical director. “I’ve heard rumblings on the internet of using ivermectin for an alternative cancer treatment, and we’re seeing it definitely in here.”
Pharmacist Paul Hughey has allotted ivermectin underneath the brand new regulation at two Tennessee pharmacies: Mt. Juliet Pharmacy and Compound Rx. He estimated that “up to 20 people in a week” are shopping for ivermectin however that peak demand was double or triple that quantity.
For years, Hughey mentioned in an interview, prospects have relayed emotional “testimonies” concerning the drug therapeutic the sick, “especially with the cancer patients.”
“I’ll get a doctor call in and they say: ‘Guess what. So-and-so is cured.’ And it’s just amazing to hear that. So anybody who doubts that,” Hughey mentioned, “I don’t really know that they’re practicing medicine. I think they’re just following the narrative.”
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‘I’ve Taken Bucketloads of This Stuff’
The linchpin of Tennessee’s ivermectin market is Denise Sibley, a conservative physician who was instrumental to the creation of the 2022 ivermectin regulation. She has inked agreements with pharmacies throughout the state empowering them to promote the drug.
Tennessee’s regulation allows pharmacies to dispense ivermectin with out a particular prescription for every affected person, by way of a “collaborative pharmacy practice agreement” with a physician who offers what’s functionally a pre-written, nonspecific prescription for all potential prospects.
In podcast interviews, Sibley has mentioned she has made as many as 40 of those agreements with Tennessee pharmacies, which she mentioned ahead her the paperwork on every ivermectin buyer. Before promoting the drug, pharmacies are required to ask prospects questions on medical circumstances and medicines that would trigger issues if taken with ivermectin. Afterward, the collaborating doctor additionally is predicted to obtain a file for every one that purchases ivermectin.
“We literally have folks coming from all over the world to get our ivermectin,” Sibley mentioned on the Common Sense MD podcast in February 2025. “As the collaborator for these pharmacies, I get every person’s sheet.”
“They’re from every state,” she mentioned. “They’re from Canada. They’re from Europe.”
Sibley didn’t reply to requests for remark.
Denise Sibley, a physician and vaccine opponent, testifies earlier than Tennessee lawmakers in favor of the state’s 2022 invoice permitting ivermectin to be provided with out a particular prescription for every affected person. Sibley has since signed agreements that empower quite a few pharmacies to dispense ivermectin this fashion. (Tennessee General Assembly; screenshot by KFF Health News)
KFF Health News has independently confirmed that Sibley signed agreements with at the very least 10 pharmacies. The agreements say pharmacists shall dispense ivermectin solely in Tennessee, the place Sibley is licensed, though a kind of pharmacies mentioned family and friends in Tennessee can “facilitate sending the medication.”
Hughey, the Tennessee pharmacist, mentioned Sibley had prescribing agreements able to go when the regulation was enacted. He credited her with advancing ivermectin gross sales all through the state.
“Had Dr. Sibley not stepped in and really pushed forward, there’s no telling how hard it would have been,” Hughey mentioned. “It would have been a lot less widespread.”
Sibley additionally works with Children’s Health Defense, the Kennedy-founded group that has change into one of many nation’s most influential anti-vaccine organizations. In podcasts, Sibley has referred to the covid vaccine as a “bioweapon” and “the most toxic substance that’s ever been produced.”
Separately, she testified earlier than Tennessee legislators in 2024 about an alleged plot to vary the climate and block daylight. The New York Times then included her in a story about conspiracy theorists.
Sibley has mentioned in podcast interviews that she was advised by God to deal with covid sufferers. She mentioned she has advocated for ivermectin ever since.
“God agrees with what I’m doing,” Sibley mentioned in 2023 on the podcast Tomi Lahren Is Fearless, which is recorded in Nashville. “I wake up every day and I say: ‘Yes, sir. I’m reporting to duty.’”
In legislative and authorities hearings all through 2022, Sibley testified that she had handled round 4,400 individuals with ivermectin, together with some Tennessee lawmakers, all with out taking fee. Sibley described ivermectin as “a wonder drug” and mentioned making it extra accessible “would help me to save lives.”
“I’ve taken bucketloads of this stuff myself,” Sibley mentioned in one such hearing. “I feel like I’ve been a good test subject.”
Sibley has mentioned she dispenses ivermectin utilizing remedy pointers developed by Paul Marik, who in 2020 co-founded the Independent Medical Alliance, a medical group that has promoted ivermectin as an efficient remedy for covid, flu, RSV, and cancer.
Some Tennessee pharmacies now observe these protocols, too. The protocols suggest sufferers take 1.5 to 5 occasions as a lot ivermectin as is often prescribed to deal with parasites, with the dose taken for days or even weeks as a substitute of simply as soon as.
Marik and different ivermectin proponents sued the FDA in 2022 after it discouraged the usage of the drug for covid by tweeting: “You are not a horse. You are not a cow. Seriously, y’all. Stop it.” The company settled the lawsuit with no admission of wrongdoing and deleted the viral tweet in 2024.
The American Board of Internal Medicine has revoked Sibley’s and Marik’s board certifications however declined to elucidate why. Sibley nonetheless holds a Tennessee medical license; Marik relies in Virginia and isn’t licensed. Sibley and Marik each opposed the interior medication board’s actions.
In response to questions from KFF Health News, Marik, by way of an Independent Medical Alliance spokesperson, mentioned medical science advantages from “open discussion of ideas and treatments.”
“Many independent doctors have reported that treatments like Ivermectin, in conjunction with traditional treatments, are showing promise. These ideas should be explored,” alliance spokesperson Lynne Kristensen mentioned in an emailed assertion.
Marik testified in favor of Tennessee’s ivermectin laws in 2022, telling lawmakers that it’s mandatory as a result of individuals would in any other case purchase animal-grade ivermectin in stronger dosages meant for livestock.
“They’re buying ivermectin from farm stores. We don’t know the quality,” Marik mentioned at a March 2022 legislative listening to on the Tennessee invoice. “So this would prevent that from happening.”
One research recognized a pointy improve in prescribing charges for ivermectin after a January 2025 episode of the Joe Rogan Experience podcast wherein actor Mel Gibson claimed ivermectin and different medicine cured three mates with stage 4 most cancers. (Brett Kelman/KFF Health News)
Tennessee Does Not Track Its Ivermectin Market
Arkansas, Idaho, Louisiana, and Texas enacted comparable legal guidelines in 2025, and laws that makes ivermectin accessible with out the necessity for a physician go to has been launched or debated in at the very least 24 different states, based on a KFF Health News evaluation. That means half the nation may very well be following Tennessee down an unlit path, as a result of nobody is aware of the total scope of its ivermectin market.
Tennessee doesn’t successfully monitor which pharmacies supply ivermectin this fashion, and the state authorities has been unable to provide some foundational paperwork that pharmacies are legally required to file earlier than they promote the drug, based on a KFF Health News investigation.
Doctors and pharmacies are required by law to notify the Tennessee Department of Health after they signal agreements that permit ivermectin to be allotted with out patient-specific prescriptions, though it’s not clear whether or not this constantly happens.
In response to a KFF Health News public information request for these ivermectin notifications filed by pharmacies, the company over three months produced information from solely 12 pharmacies, half of which have agreements with Sibley. The company mentioned it didn’t find information associated to at the very least 13 others that KFF Health News has recognized as promoting ivermectin with out requiring particular person prescriptions.
Department of Health spokesperson Dean Flener mentioned the company wouldn’t reply questions on whether or not or the way it regulates ivermectin or the pharmacies that distribute it.
Tennessee has mentioned it doesn’t monitor how a lot of the drug is bought within the state, and the quantity is just not properly captured by federal or insurance coverage information sources. That’s as a result of the drug is commonly bought at compounding pharmacies, which make custom-made medicines that aren’t FDA-approved and infrequently lined by insurance coverage. Drugmakers and wholesalers didn’t reply to questions on how a lot ivermectin they provide to pharmacies within the state.
Even the Independent Medical Alliance, one in every of ivermectin’s biggest cheerleaders, says it doesn’t know the way a lot is flowing by way of Tennessee.
States are getting strain from clinicians ”who’ve had success with the usage of ivermectin,” mentioned IMA President Joseph Varon, a doctor primarily based in Houston. “That’s what happened in Texas, and that’s what happened in Tennessee.”
‘An Unproven, Potentially Unsafe Drug’
Once signed by Tennessee Gov. Bill Lee, the state’s ivermectin regulation took impact instantly — even earlier than the state’s doctor and pharmacy licensing boards created guidelines to information the method, which Tennessee regulation additionally requires.
Some board members have been shocked.
“We’re talking about an unproven, potentially unsafe drug,” Shant Garabedian, a physician on the state’s Board of Osteopathic Examination, mentioned of off-label ivermectin use throughout a 2022 meeting. “It’s already law. Somehow it passes without our sort of input.”
In conferences that adopted, at the very least 5 members of Tennessee’s medical boards voiced issues concerning the regulation past security and efficacy. Some mentioned pharmacists may overcharge for a drug that usually prices pennies per tablet. Some apprehensive {that a} loosely regulated, cash-based ivermectin market may appeal to shady characters, particularly as a result of the regulation additionally shields prescribers from ivermectin-related civil lawsuits.
“This involves no clinical engagement,” Melanie Blake, then-president of the Board of Medical Examiners, mentioned throughout a 2022 meeting. “If they’re exempt from liability as well, I hate to think of things that individuals could do just to make money, but this would be one.”
Roman Pharmacy is without doubt one of the many compounding pharmacies in Tennessee that provide concentrated ivermectin tablets. (Brett Kelman/KFF Health News)
The boards finally enacted rules affirming that ivermectin may very well be allotted with none analysis. Board members mentioned the regulation left them no selection.
“This is more of a situation where, legally, the legislature has decided for us,” John McGraw, one other board member, mentioned in a 2023 meeting. “This has sort of tied our hands in a lot of ways.”
The first identified sale underneath the brand new regulation occurred in May 2022 in Sibley’s house of Johnson City, a metropolis of about 74,000 individuals in northeastern Tennessee. According to a news release, Sibley entered right into a collaborative settlement with pharmacist Josh Harrison at The Compounding Lab, which dispenses medicine for individuals and animals.
The first buyer was Bernadette Pajer, an anti-vaccine activist who has labored with Children’s Health Defense. In a 2024 episode of the Nashville podcast Rebunked With Scott Armstrong, Pajer mentioned Sibley was a medical adviser for the group and described the primary ivermectin sale.
“On that day, she was the doctor, he was the pharmacist making the sale, and I was the first customer,” Pajer mentioned. “So that was pretty cool.”
Ivermectin pharmacies have unfold throughout the state. In the suburbs of Nashville, Roman Pharmacy advertises ivermectin on at the very least 4 billboards alongside Interstate 65, and its website is usually centered on the drug. Outside Knoxville, Fresh Pharmacy permits prospects to order ivermectin for a number of sclerosis and Parkinson’s illness, or “to use it to detoxify.”
Roman Pharmacy didn’t reply to interview requests. Fresh Pharmacy declined an interview.
In Chattanooga, the Medicine Counter pharmacy says on its web site that ivermectin ought to be taken “only as prescribed by your healthcare provider.” And but the pharmacy sells a few of Tennessee’s most potent ivermectin accessible with out a prescription from a physician — as much as 21 occasions as sturdy as an ordinary pill, for practically $19 per tablet — based on the KFF Health News evaluation.
Himanshu Patel, Medicine Counter’s head pharmacist, declined to be interviewed. He mentioned in an electronic mail that the pharmacy operates in a “very competitive market” and that its strongest tablets have been under the utmost dose for people evaluated by the FDA for security functions.
And then there is Compound Rx, which, in addition to selling ivermectin in its store, has built a website in preparation to ship buy-one-get-one-free pills nationwide. The web site, which is in “test mode,” can not at the moment make any gross sales. It additionally asks prospects how they heard concerning the pharmacy, with a dropdown menu of solutions that options right-wing figures akin to Donald Trump Jr., Steve Bannon, Laura Ingraham, and Kevin Sorbo.
Who is just not listed as an possibility? Your physician.
Compound Rx, in Cookeville, Tennessee, is one in every of dozens of pharmacies within the Volunteer State that provide ivermectin with out patient-specific prescriptions. Some pharmacies promote the drug as accessible over-the-counter, despite the fact that prospects technically need to request it from a pharmacist. (Brett Kelman/KFF Health News)
Hughey, the Compound Rx pharmacist, mentioned he wasn’t concerned with the web site, which he mentioned might by no means launch.
The extremely concentrated tablets are a priority for Tennessee state Sen. Richard Briggs, who worries lawmakers have created a “dangerous” ivermectin market rife with “misleading advertising” about what the drug can really do.
Briggs, who’s a surgeon and the one Republican who voted in opposition to the ivermectin invoice in 2022, mentioned he deliberate to introduce laws to rein within the sale of ivermectin when lawmakers reconvene in 2027.
“But it may be a hard sell, because with the anti-vaxxers and some of these other folks,” Briggs mentioned. “We don’t base a lot of things that we do on science, data, or facts. To a lot of folks in the legislature, the facts are just an inconvenience.”
‘Enough Trouble With Ivermectin’
Lawmakers in at the very least seven states have thought of ivermectin laws this yr, together with Alabama, Florida, Oklahoma, and South Carolina. If enacted, these payments would permit individuals to acquire ivermectin with out a person prescription, like in Tennessee, or make it accessible over-the-counter.
Kennedy praised such laws at an occasion in Texas final August.
“I think it’s a really good bill,” he mentioned of Texas’ ivermectin laws, based on The Texas Tribune. “I think Americans should have the choice.”
But proponents have hit roadblocks. A Utah invoice didn’t advance out of the state House this yr. In Oklahoma, some lawmakers have put up a struggle.
“I’m a scientific person. I need to see some research and some data that shows what we’re treating,” Oklahoma state Rep. Cynthia Roe, a Republican and nurse practitioner who opposes the state’s ivermectin invoice, mentioned in an interview. “And God forbid somebody start giving it to their kid.”
Back in Tennessee, one of many medical boards that was alarmed when the regulation was enacted in 2022 began to distance itself from ivermectin altogether.
In January, the Board of Medical Examiners grappled with how you can punish Ricky Lee Jackson, a physician who was licensed in Tennessee and had been sanctioned and fined by Washington state’s medical fee. The Tennessee board usually mirrors punishments from different states with out hesitation. But the Washington case centered on Jackson prescribing ivermectin for covid, which in Tennessee now not required a affected person to see a physician.
After a debate, the board voted to reprimand Jackson — however advised its workers to make sure the general public file made no mention of ivermectin.
“This board has been in enough trouble with ivermectin,” member Keith Anderson mentioned, based on a meeting recording. “Maybe we ought to just leave that out.”
Nashville Public Radio journalist Blake Farmer and Tennessee Lookout reporter Adam Friedman contributed to this report.
