BY: SUZANNE KING
A politically charged Missouri law that would prevent pharmacists from counseling patients or doctors about ivermectin and hydroxychloroquine, two treatments that have been debunked for COVID-19, has been on hold for two years in federal court.
Yet the Missouri Board of Pharmacy posted a guidance statement at the end of June that doesn’t mention that the law is on hold pending legal challenge.
The guidance tells licensed pharmacists that state law bars them from “contact(ing) the prescribing physician or the patient to dispute the efficacy of ivermectin tablets or hydroxychloroquine sulfate tablets for human use.”
Gov. Mike Parson signed it into law in June 2022, soon after COVID deaths had reached 1 million in the United States. The law drew criticism across the pharmacy and medical professions that saw it as a government-imposed gag order.
A St. Louis pharmacist filed a lawsuit the next month to stop the law. Ashley Stock sued members of the state pharmacy board, arguing that the law violated her First Amendment rights and should not be enforced.
As a retail pharmacist, Stock said in her complaint, her job was to consult with patients and doctors about medications, doses and potential interactions.
She said she had confronted doctors who had prescribed hydroxychloroquine, an anti-malarial drug, or ivermectin, an anti-parasitic medication, about the drugs’ effectiveness against a virus.
“If, after Stock’s discussions, the prescribing physicians or patients insisted on seeking (the medications),” her lawsuit said, “Stock sometimes refused to fill those prescriptions.”
The U.S. Food and Drug Administration continues to advise that ivermectin is not authorized or approved to treat COVID-19, nor has it been determined to be “safe or effective.” In 2020, the FDA warned that hydroxychloroquine could cause heart rhythm problems and should not be used outside a hospital setting. The drug also does not work to treat or prevent COVID.
But using both drugs to fight the virus — as then-President Donald Trump hyped them — became touchstones for some conservatives.
By restricting how pharmacists can do their jobs and how they treat patients, Stock and other pharmacists have argued, the law could set a dangerous precedent and damage their ability to act as important watchdogs for patients’ health care, such as noticing potential allergies, drug interactions or other risks that might have been overlooked by a doctor.
A federal judge granted a temporary injunction in response to Stock’s complaint in August 2022. This summer, both sides filed motions that would dismiss the case in their favor without a trial.
While that’s pending, the law is not in effect.
Matthew J. Tkachuk, the assistant state attorney general defending the pharmacy board in the lawsuit, said the guidance posted on the board’s website on June 26 offers insight about how the board plans to enforce the law if the judge allows it to take effect.
“Essentially, the guidance statement is not practically effective until the court … rules in our favor on summary judgment,” Tkachuk said. “It provides a lot of clarification and, to some extent, qualification, that might allay some pharmacists’ concerns.”
The board’s guidance says the 2022 ban on pharmacists proactively contacting doctors and patients about ivermectin and hydroxychloroquine should be seen within the context of the entire statute that governs how pharmacists are regulated.
The guidance points out that pharmacists should not provide false, misleading, deceptive or dishonest counseling.
“This would include initiating contact with a prescriber or patient to dispute that ivermectin or hydroxychloroquine are efficacious for human use as approved by the FDA,” the board guidance says.
It also says the law change passed two years ago “does not prohibit a pharmacist from sharing truthful and accurate medical/drug information with prescribers or patients, consistent with the standard of care, current FDA guidance, or evidence-based scientific data/research.”
The guidance does not give any indication that a federal judge could decide to strike it from the state statute. It also doesn’t acknowledge the court injunction that’s at least temporarily nullified the change.
Besides that, said Adam E. Schulman, the Virginia lawyer representing Stock, board guidance doesn’t hold the same weight as law.
“They’re trying to get the judge to change his mind,” Schulman said. “But (guidance) doesn’t change what is on the books.”
This article first appeared on Beacon: Missouri and is republished here under a Creative Commons license.