Currently, ivermectin is sold throughout the state, including in roadside shops and local strip malls, with minimal health authority oversight. Billboards along highways promote ivermectin as “Available Without a Prescription in Tennessee!” At the same time, many pharmacies offer pills that are significantly more potent, sometimes 10 or 20 times stronger than standard tablets.
Ivermectin is a Nobel Prize-winning drug known for its safety and FDA approval for treating parasitic diseases in humans. Typically, a single dose of three or four prescription-strength tablets suffices. It is also employed as a dewormer for horses and other livestock.
The drug gained popularity during the pandemic as it was promoted by fringe doctors and anti-vaccine advocates as a Covid-19 treatment. However, clinical trials have demonstrated that ivermectin is ineffective against Covid-19.
Despite this, ivermectin has emerged as a symbol of opposition to the medical establishment among conservatives and followers of the Make America Healthy Again movement, led by Health and Human Services Secretary Robert F. Kennedy Jr.
Timothy Caulfield, a professor at the University of Alberta specializing in health misinformation, remarked that ivermectin became an “ideological flag” during the pandemic. This opened opportunities for influencers to market it for other ailments to audiences, even without proof of efficacy.
“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 stated in an interview with ABC News, which collaborated with KFF Health News in reporting on ivermectin.
After a hantavirus outbreak on a cruise ship earlier this year, unfounded claims of ivermectin’s efficacy against the virus spread via social media and right-wing figures, including Marjorie Taylor Greene. The World Health Organization reports no research supporting ivermectin as an effective hantavirus treatment.
The ivermectin bill in Tennessee was pushed through by a Republican supermajority in 2022, catching state medical officials off guard and benefiting groups spreading Covid misinformation.
Some pharmacy websites now market the drug for Covid, “long haul vax symptoms,” diabetes, or cancer, despite a lack of evidence for these uses. The new law largely shields pharmacists from lawsuits or professional sanctions related to ivermectin.
This legislation was a precursor: more than two dozen states have considered similar bills to make ivermectin available without a doctor’s visit.
John Mafi, a UCLA internal medicine physician, has studied the rise of ivermectin use among cancer patients and warns it might divert people from proven treatments. He co-authored a study showing a significant increase in prescriptions for ivermectin and another antiparasitic drug, especially in the South. This surge followed a January 2025 “Joe Rogan Experience” podcast episode where actor Mel Gibson claimed ivermectin cured three friends with stage 4 cancer.
“It’s going back to 19th-century quack science,” Mafi commented on the off-label use of ivermectin. “It is alarming that I’m seeing this really unproven therapy being touted to so many potentially vulnerable Americans.”
The FDA warns that ivermectin can be dangerous in large doses. Tennessee has seen a small but troubling rise in signs of overuse. In 2025, the Tennessee Poison Center received over 60 calls about possible ivermectin poisoning, the most since 2021. Symptoms included vomiting, blurred vision, neurological problems, and difficulty walking.
“People are taking this because they just feel unwell. It’s almost like a panacea now,” said Rebecca Bruccoleri, the poison center’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 dispenses ivermectin under the new law at two Tennessee pharmacies: Mt. Juliet Pharmacy and Compound Rx. He estimates that “up to 20 people in a week” buy ivermectin, with peak demand being double or triple that number.
For years, Hughey mentioned, customers have shared emotional “testimonies” about the drug healing 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 said, “I don’t really know that they’re practicing medicine. I think they’re just following the narrative.”
‘I’ve taken bucketloads of this stuff’
Denise Sibley, a conservative doctor, was pivotal in establishing Tennessee’s ivermectin market through the 2022 law. She has agreements with pharmacies across the state to sell the drug.
Tennessee’s legislation allows pharmacies to provide ivermectin without a specific prescription for each individual. This is done through a “collaborative pharmacy practice agreement” with a physician who issues a pre-written, nonspecific prescription for all potential customers.
In podcast interviews, Sibley has claimed she made up to 40 such agreements with Tennessee pharmacies, which send her the paperwork on each ivermectin customer. Pharmacies are required to ask customers about medical conditions and medications that could cause complications with ivermectin use. The collaborating physician is supposed to receive a record for each person who buys ivermectin.
“We literally have folks coming from all over the world to get our ivermectin,” Sibley said 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 said. “They’re from Canada. They’re from Europe.”
Sibley did not respond to requests for comment.
KFF Health News confirmed that Sibley signed agreements with at least 10 pharmacies. The agreements specify that pharmacists shall dispense ivermectin only in Tennessee, where Sibley is licensed, although one pharmacy stated that friends and family in Tennessee can “facilitate sending the medication.”
Hughey, a Tennessee pharmacist, credited Sibley with advancing ivermectin sales in the state, noting, “Had Dr. Sibley not stepped in and really pushed forward, there’s no telling how hard it would have been. It would have been a lot less widespread.”
Sibley is also associated with Children’s Health Defense, an influential anti-vaccine organization founded by Kennedy. In podcasts, she has referred to the Covid vaccine as a “bioweapon” and “the most toxic substance that’s ever been produced.”
She testified before Tennessee legislators in 2024 about an alleged plot to alter the weather and block sunlight. The New York Times included her in a story about conspiracy theorists.
Sibley has stated in podcasts that she was divinely guided to treat Covid patients, advocating for ivermectin ever since.
“God agrees with what I’m doing,” Sibley said on the podcast “Tomi Lahren Is Fearless” in 2023, recorded in Nashville. “I wake up every day and I say: ‘Yes, sir. I’m reporting to duty.’”
In legislative and government hearings throughout 2022, Sibley testified to treating around 4,400 people with ivermectin, including some Tennessee lawmakers, without accepting payment. Sibley described ivermectin as “a wonder drug” and stated that making it more available “would help me to save lives.”
“I’ve taken bucketloads of this stuff myself,” Sibley said at one hearing. “I feel like I’ve been a good test subject.”
Sibley mentioned that she dispenses ivermectin using guidelines created by Paul Marik, who co-founded the Independent Medical Alliance in 2020. This group promotes ivermectin as an effective treatment for Covid, flu, RSV, and cancer.
Several Tennessee pharmacies now follow these protocols, suggesting patients take 1.5 to five times the usual amount of ivermectin for parasites, with doses extending over days or weeks instead of a single dose.
Marik and other ivermectin proponents sued the FDA in 2022 after the agency discouraged ivermectin use for Covid, tweeting: “You are not a horse. You are not a cow. Seriously, y’all. Stop it.” The agency settled the lawsuit without admitting wrongdoing and deleted the tweet in 2024.
The American Board of Internal Medicine revoked Sibley’s and Marik’s board certifications but didn’t specify the reasons. Sibley retains her medical license in Tennessee, while Marik, based in Virginia, does not hold a license. Both Sibley and Marik disputed the board’s decision.
Responding to questions from KFF Health News, Marik, through an Independent Medical Alliance spokesperson, emphasized the importance of “open discussion of ideas and treatments” for medical science.
“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 stated in an emailed response.
During a legislative hearing in Tennessee in 2022, Marik argued that legislation was necessary because people might otherwise purchase animal-grade ivermectin in stronger doses intended for livestock.
“They’re buying ivermectin from farm stores. We don’t know the quality,” Marik said in March 2022 regarding the Tennessee bill. “So this would prevent that from happening.”
Tennessee does not track its ivermectin market
Arkansas, Idaho, Louisiana, and Texas adopted similar laws in 2025, and at least 24 other states have introduced or debated legislation to make ivermectin available without a doctor’s visit, according to KFF Health News analysis. This implies that half the country could be following Tennessee’s example, without knowing the full extent of its ivermectin market.
Tennessee does not effectively track which pharmacies offer ivermectin, and the state government has been unable to produce some essential documents that pharmacies are legally required to file before selling the drug, based on a KFF Health News investigation.
Doctors and pharmacies are required by law to notify the Tennessee Department of Health when they sign agreements allowing ivermectin to be dispensed without patient-specific prescriptions, but it is unclear if this is consistently adhered to.
In response to a KFF Health News public records request for these ivermectin notifications filed by pharmacies, the agency provided records from only 12 pharmacies over three months, half of which have agreements with Sibley. The agency claimed it couldn’t find records related to at least 13 other pharmacies identified by KFF Health News as selling ivermectin without needing individual prescriptions.
Department of Health spokesperson Dean Flener stated that the agency would not answer questions about whether or how it regulates ivermectin or the pharmacies distributing it.
Tennessee has acknowledged that it does not track how much of the drug is sold in the state, and this data is not well captured by federal or insurance data sources. This is because the drug is often sold at compounding pharmacies, which create customized medications that are not FDA-approved and rarely covered by insurance. Drugmakers and wholesalers did not respond to questions about how much ivermectin they supply to pharmacies in the state.
Even the Independent Medical Alliance, one of ivermectin’s biggest proponents, admits it doesn’t know how much is circulating in Tennessee.
IMA President Joseph Varon, a physician based in Houston, noted that states are facing pressure from clinicians “who have had success with the use of ivermectin.” He added, “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 law took immediate effect, even before the state’s physician and pharmacy licensing boards established rules for the process, which Tennessee law also requires.
Some board members expressed surprise.
“We’re talking about an unproven, potentially unsafe drug,” Shant Garabedian, a doctor on the state’s Board of Osteopathic Examination, said during a 2022 meeting about off-label ivermectin use. “It’s already law. Somehow it passes without our sort of input.”
In subsequent meetings, at least five members of Tennessee’s medical boards raised concerns about the law beyond safety and efficacy. Some worried that pharmacists could overcharge for a drug that normally costs pennies per pill. Others feared that a loosely regulated, cash-based ivermectin market might attract unscrupulous individuals, especially since the law also protects prescribers from ivermectin-related civil lawsuits.
“This involves no clinical engagement,” Melanie Blake, then-president of the Board of Medical Examiners, said during 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.”
The boards eventually enacted regulations confirming that ivermectin could be dispensed without a diagnosis. Board members said the law left them with little choice.
“This is more of a situation where, legally, the legislature has decided for us,” John McGraw, another board member, said in a 2023 meeting. “This has sort of tied our hands in a lot of ways.”
The first known sale under the new law took place in May 2022 in Sibley’s hometown of Johnson City, a city of about 74,000 people in northeastern Tennessee. According to a news release, Sibley entered into a collaborative agreement with pharmacist Josh Harrison at The Compounding Lab, which dispenses drugs for people and animals.
The first customer was Bernadette Pajer, an anti-vaccine activist affiliated with Children’s Health Defense. In a 2024 episode of the Nashville podcast “Rebunked With Scott Armstrong,” Pajer recounted that Sibley was a medical adviser for the group and described the first ivermectin sale.
“On that day, she was the doctor, he was the pharmacist making the sale, and I was the first customer,” Pajer said. “So that was pretty cool.”
Ivermectin pharmacies have proliferated across the state. In Nashville’s suburbs, Roman Pharmacy promotes ivermectin on at least four billboards along Interstate 65, and its website is primarily focused on the drug. Outside Knoxville, Fresh Pharmacy allows customers to order ivermectin for multiple sclerosis and Parkinson’s disease or “to use it to detoxify.”
Roman Pharmacy did not respond to interview requests. Fresh Pharmacy declined an interview.
In Chattanooga, the Medicine Counter pharmacy states on its website that ivermectin should be taken “only as prescribed by your healthcare provider.” Nonetheless, the pharmacy sells some of Tennessee’s most potent ivermectin available without a doctor’s prescription — up to 21 times stronger than a standard tablet, priced at nearly $19 per pill — according to a KFF Health News analysis.
Himanshu Patel, head pharmacist at Medicine Counter, declined an interview. He said in an email that the pharmacy operates in a “very competitive market” and that its strongest pills are below the maximum dose for humans evaluated by the FDA for safety purposes.
Then there is Compound Rx, which not only sells ivermectin in its store but has also developed a website to potentially ship buy-one-get-one-free pills nationwide. The site, currently in “test mode,” cannot make sales yet. It asks customers how they learned about the pharmacy, with a dropdown menu featuring right-wing figures such as Donald Trump Jr., Steve Bannon, Laura Ingraham, and Kevin Sorbo.
Who is not listed as an option? Your doctor.
Hughey, the Compound Rx pharmacist, said he wasn’t involved with the website, which he mentioned might never launch.
The high concentration of pills raises concerns for Tennessee state Sen. Richard Briggs, who worries lawmakers have created a “dangerous” ivermectin market replete with “misleading advertising” about the drug’s potential effects.
Briggs, a surgeon and the only Republican who opposed the ivermectin bill in 2022, stated he plans to introduce legislation to regulate ivermectin sales when lawmakers reconvene in 2027.
“But it may be a hard sell, because with the anti-vaxxers and some of these other folks,” Briggs said. “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’
This year, lawmakers in at least seven states, including Alabama, Florida, Oklahoma, and South Carolina, have considered ivermectin legislation. If passed, these bills would allow people to access ivermectin without an individual prescription, similar to Tennessee, or make it available over the counter.
Kennedy praised this type of legislation at an event in Texas last August.
“I think it’s a really good bill,” he said regarding Texas’ ivermectin legislation, according to The Texas Tribune. “I think Americans should have the choice.”
However, proponents have faced obstacles. A Utah bill failed to advance out of the state House this year. In Oklahoma, some lawmakers have resisted.
“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 bill, said in an interview. “And God forbid somebody start giving it to their kid.”
Back in Tennessee, one of the medical boards that expressed concern when the law was enacted in 2022 has begun to distance itself from ivermectin altogether.
In January, the Board of Medical Examiners dealt with how to sanction Ricky Lee Jackson, a doctor licensed in Tennessee who was fined and sanctioned by Washington state’s medical commission. The Tennessee board typically mirrors sanctions from other states without hesitation. However, the case in Washington centered on Jackson prescribing ivermectin for Covid, which in Tennessee no longer required a patient to see a doctor.
After a debate, the board decided to reprimand Jackson but instructed its staff to ensure the public record made no mention of ivermectin.
“This board has been in enough trouble with ivermectin,” member Keith Anderson said, according to 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.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
