House bill amendment allows pharmacists to dispense ivermectin under standing orders; sharp debate and narrow majority

The House Committee on Health, Human Services, and Elderly Affairs on Wednesday approved amendments to SB119 that would allow standing orders to enable pharmacists and certain clinicians to dispense ivermectin under specified conditions.

Representative Palazzo, who offered the amendment, said the change would extend standing orders to include physician assistants along with physicians and advanced practice registered nurses and allow pharmacists to dispense under those orders. "This amendment is based on what we heard during that hearing ... it changes to the word sign prescription," Palazzo said, describing revisions intended to make standing orders operational in practice.

The panel heard intense debate. Representative McGrath, a pharmacist, said doctors were reluctant to prescribe ivermectin during the COVID period and described efforts to remove barriers for patients seeking the drug: "doctors were losing their medical license for daring to do just that," she said, arguing the amendment would help patients obtain medications when clinicians were unwilling to prescribe. Representative Weber said she was "pretty aghast at this amendment," arguing it equated a standing-order approach for ivermectin with over-the-counter access and that the state should not make that policy without more evidence. Representative Lamontagne said the amendment bypassed the physician–patient relationship and raised concerns about pregnancy safety.

Committee members also considered a separate McGrath amendment that deleted a section enabling a chief medical officer to issue standing orders for Medicaid-covered items; McGrath and supporters argued pharmacies would be overburdened filling broad standing orders without reimbursement. That amendment and the Palazzo amendment each passed by 10–8 votes; the committee later approved SB119 as amended by the committee, also 10–8.

What the amendments do: committee discussion and the amendment language limited standing orders to adult, nonpregnant patients and added physician assistants to the list of authorized prescribers; pharmacists would be permitted but not compelled to fill under a standing order. Proponents said the change would expand access where physicians were unwilling to prescribe; opponents warned the evidence base for ivermectin as a COVID treatment was contested and said patient safety and pregnancy exclusions required caution.

Votes and next steps: the committee passed the Palazzo amendment 10–8, approved McGrath's amendment to delete the Medicaid standing-order section also 10–8, and reported SB119 ought to pass as amended, 10–8. The measure will be reported to the House calendar with the committee recommendations.

The committee's debate captured the deep divide among members over scope, clinical evidence and pharmacy practice; members frequently referenced national and international studies and the role of pharmacist discretion when filling standing orders.