Redman owns the Medicine Man Prairie Pharmacy in Hayden, which as of late May has been selling ivermectin that it compounded in-house without a prescription.
IDAHO, USA — This story originally appeared in the Idaho Press.
A North Idaho pharmacy, co-owned by a state lawmaker, is among a few currently selling ivermectin over-the-counter. Although legislation passed this year made the sale legal in Idaho, there’s been uncertainty for some on how to do so while navigating other regulations in the industry.
The drug, frequently used in humans and livestock as an anti-parasitic, became popular during the COVID-19 pandemic; however, the federal Food and Drug Administration (FDA) does not recommend its use for the novel coronavirus based on “currently available clinical trial data.”
Senate Bill 1121, co-sponsored by Rep. Jordan Redman, R-Coeur d’Alene, went into effect upon the signature of Gov. Brad Little on April 14 — Idaho joined two other states in allowing for the over-the-counter sale of the drug.
Redman owns the Medicine Man Prairie Pharmacy location in Hayden, which as of late May has been selling ivermectin that it compounded in-house without a prescription.
However, administrative rules regulating the pharmacy industry in Idaho may not allow for the over-the-counter sale of compounded medication.
“State law requires a prescription for any compounded medication,” spokesman for the governing Idaho Board of Pharmacy Bob McLaughlin told the Idaho Press in an email.
McLaughlin said a violation of this rule would be determined only if a complaint was filed.
“The Board’s investigative team would be made aware if a complaint was filed by the public with the Idaho Board of Pharmacy,” McLaughlin wrote. “The Board’s investigative team would then determine if the Board had jurisdiction and if there was a possible violation of Idaho law. If the answer to both was yes, then an investigation could be conducted.”
Redman told the Idaho Press in a phone interview he thought the law as written should still allow pharmacies to sell it the drug if they compounded it in-house.
“I think the whole thought with Senate Bill 1211, at its core, was to make sure that Idahoans and people in the state could get access to over-the-counter ivermectin that was suitable for human use,” Redman said. “… I think the law was written in a way to be flexible.”
Redman said he had concerns about people obtaining the drug through animal feed stores and consuming animal-grade products and potentially large animal-size doses.
The bill, which is about a half-page long, states, “Notwithstanding any law to the contrary, ivermectin suitable for human use may be sold or purchased as an over-the-counter medication in this state without a prescription or consultation with a healthcare professional.”
Korey Kreider, a pharmacist who co-owns the Medicine Man location with Redman, said there are cases where it’s legal for pharmacies to sell compounded medication without a prescription, such as in-house compounded Tylenol or ibuprofen. He said there are also cases of pharmacies selling in-house-made supplements.
“It’s a very delicate thing on how you interpret it and how you’re going to do that,” Kreider said. “We’re open to suggestions as far as how we can go and make this safer, better, whatever we need to do to get the Board of Pharmacy, our Idaho Legislature all on the same page. And that’s what we’re trying to navigate.”
The regulation requiring a prescription to sell compounded medication is within Idaho Administrative Code, which carries the force of law.
Other pharmacies told the Idaho Press they had been hesitant to sell the drug without a prescription because of federal and administrative regulations.
Ivermectin can normally be obtained with a prescription, and the FDA has approved its use for conditions caused by parasitic worms. Boxes of the medicine distributed by the manufacturer have a label that says, “Rx only,” which means it cannot be sold without a prescription, Boise- and Eagle-based Customedica Pharmacy Director of Operations Matthew Murray told the Idaho Press in an email.
“We are not selling Ivermectin over-the-counter at this time,” Murray wrote. “I believe a couple additional changes need to be legislated in order for us to be able to do so.”
Murray said that his understanding is that additional legislation allowing for the over-the-counter sale of compounded medication may be needed, or a manufacturer would need to create an ivermectin product and label meant for sale without a prescription.
A pharmacist at Hells Canyon Pharmacy in Lewiston said their pharmacy only provided the drug with a prescription because of concerns regarding proper labeling.
The state Board of Pharmacy posted guidance on its website, noting that prescription-grade ivermectin packages do not include directions or dosages for “off-label” uses.
The board wrote in a memo for pharmacies that, if they wanted to sell it without a prescription, to consider keeping it behind the counter, similar to emergency contraception or over-the-counter insulin.
“Pharmacists may then offer (though not require) counseling to patients on proper dosage amounts, potential drug-drug interactions, and symptoms of ivermectin toxicity for which to monitor when taking this medication,” the board’s memo stated.
McLaughlin, the Board of Pharmacy spokesman, declined to weigh in on if the rules around selling compounded medication would conflict with the state ivermectin law or if changes were needed to the current language or rules.
“The Idaho Board of Pharmacy is under DOPL (the Division of Occupational and Professional Licensing). And DOPL, as an executive branch agency, executes only existing legislation,” McLaughlin wrote. “The Idaho Board of Pharmacy has posted guidance on the Board’s website, and the statute speaks for itself. Licensees who have questions about existing laws are encouraged to consult their own legal counsel.”
Pharmacists at Medicine Man in Hayden created their own label with recommended dosage, according to staff from the pharmacy.
The label states “Immune Support,” with an asterisk and note that says, “These statements have not been evaluated by the FDA. This Product is not intended to diagnose, treat, cure or prevent any disease,” according to a photo of the bottle posted on social media.
There is a QR code on the bottle that links to a list of ingredients, staff said. The pharmacy sells bottles with 30 capsules of 3 mg pills for $75.50 before taxes.
An Idaho woman on May 28 posted a photo of a bottle she said she received from Medicine Man with “no questions asked.” Just two weeks prior to her post, the drug was unavailable due to labeling issues, pharmacy staff told Coeur d’Alene Press reporter Kaye Thornbrugh.
Kreider said he had been selling the drug via prescription since early in the pandemic due to demand.
“There were thousands of people that were literally going to North 40 (Outfitters) … and it was flooding our urgent care because they weren’t dosing it correctly,” Kreider said, noting a North Idaho business that sells farm supplies, including veterinary pharmaceuticals.
In an earlier interview, the Idaho Press asked Redman if he considered his ownership of pharmacies as motivation to bring the legislation, Redman told the Idaho Press, “It was more a lot of constituents pushing on it.”
Business records with the Secretary of State’s Office show that Redman’s name appears on filings for Medicine Man North Pharmacy in Hayden starting around 2021.
When presenting the bill on the House floor, Redman declared what’s called a Rule 80 — a House rule that requires disclosure of a conflict on an issue before the chamber ahead of voting — noting that he owned retail pharmacies.
Redman told the Idaho Press he’s “not super involved” with running the pharmacy.
“I have managers, leaders there that run the show,” he said.
During debate, several lawmakers said that they or those they knew took the medicine for a variety of ailments, such as the common cold or “like vitamins” every day. The drug is often used in livestock, and some argued that it would be safer to ease access to it in human doses.
Rep. Jack Nelsen, R-Jerome, had said on the House floor that acquaintances of his had taken the drug that was meant for an animal and died from it. Nelsen later told the Idaho Press he voted in favor of the bill in the hopes that human-rated dosages would be safer.
The bill easily passed both chambers.
Redman said he thought the bill adequately allowed for the sale of the drug, however it is sold, but he was open to making changes to clarify it.
“If we need to change something, that’s totally fine,” he said.
Kreider similarly expressed an openness to adjusting the rollout, highlighting that it had been just a couple of months since enactment of a law that only exists in three states.
“We are still in our infant phases, we’re still trying to figure this out and trying to wrap our heads around it,” he said. “I will always work with the state board, I will always work with state regulations and making sure this is right, and if they tell me tomorrow we can’t do this, OK then, that’s it. It’s done.”
Coeur d’Alene Press reporter Kaye Thornbrugh contributed to this reporting.
For more stories from the Idaho Press, click here.