Four years ago, Tennessee became the first state in the United States to allow pharmacies to sell ivermectin to adults without a patient-specific prescription. The law allowed pharmacists to dispense the antiparasitic drug under a standing, pre-written agreement with a physician — no individual doctor's visit, no individual diagnosis, no individual prescription required. A joint investigation published June 17, 2026, by KFF Health News and ABC News — with contributions from the Tennessee Lookout and Nashville Public Radio — documents what that law has produced four years on: dozens of pharmacies selling ivermectin in pills 10 to 21 times more potent than standard tablets, billboard advertising along interstate highways, and an estimated network enabled primarily by one vaccine-opposing physician who has signed agreements with at least 10 pharmacies.
"People are taking this because they just feel unwell. It's almost like a panacea now," said Rebecca Bruccoleri, medical director of the Tennessee Poison Center, which received more than 60 calls for possible ivermectin poisoning in 2025 — the most since 2021. Those reports included vomiting, blurred vision, neurological problems, and difficulty walking.
How the Law Works — and How It Was Built
Tennessee's 2022 ivermectin law, passed by the state's Republican supermajority, allows pharmacists to dispense ivermectin under collaborative practice agreements with physicians. These agreements substitute for individual patient prescriptions — any customer who requests ivermectin can receive it, as long as the pharmacy has a signed agreement in place with a licensed Tennessee physician. The pharmacists themselves are given broad immunity from lawsuits and professional sanctions related to ivermectin dispensing under the law.
The law was shepherded through by anti-vaccine and pro-ivermectin physician advocates, several of whom had spread COVID-19 misinformation. Its passage surprised state medical officials. Pharmacy and medical licensing boards, reviewing the law's requirements, concluded they had little discretion to restrict the practice — "the legislature has decided for us," one board member said in a 2023 meeting recorded by KFF Health News.
The central figure in the investigation is Denise Sibley, M.D., a physician and vaccine opponent who testified before Tennessee lawmakers in favor of the 2022 bill and subsequently signed collaborative practice agreements with at least 10 pharmacies across the state — confirmed by KFF Health News through independent verification. On a February 2025 podcast, Sibley said: "We literally have folks coming from all over the world to get our ivermectin. They're from every state. They're from Canada. They're from Europe."
Sibley did not respond to requests for comment. The agreements signed with pharmacies state that ivermectin can only be dispensed in Tennessee, where Sibley is licensed — though one pharmacy told KFF Health News that "friends and family in Tennessee can facilitate sending the medication." Pharmacist Josh Hughey credited Sibley with advancing ivermectin availability statewide: "Had Dr. Sibley not stepped in and really pushed forward, there's no telling how hard it would have been."
| Tennessee Ivermectin OTC Key Facts | Detail |
| Law enacted | 2022 — first in the U.S. to allow pharmacy ivermectin without patient-specific prescriptions |
| Mechanism | Collaborative practice agreement between pharmacist and physician; no individual prescription |
| Number of pharmacies dispensing ivermectin OTC | Dozens (specific number not fully tracked by state) |
| Potency of OTC pills | 10 to 21 times the strength of standard ivermectin tablets |
| Key physician enabling agreements | Dr. Denise Sibley, M.D. — confirmed agreements with at least 10 pharmacies |
| Tennessee Poison Center ivermectin calls 2025 | 60+ (most since 2021); symptoms include vomiting, blurred vision, neurological problems |
| State tracking capability | Tennessee does not effectively track which pharmacies sell ivermectin this way |
| State document production | Unable to produce legally required notification filings in response to KFF public records request |
| FDA position on large doses | Ivermectin can be dangerous in large doses |
| Clinical trial evidence for COVID-19 | No evidence of effectiveness; multiple clinical trials showed no benefit |
| WHO statement on ivermectin for hantavirus | No research showing effectiveness; WHO does not recommend |
| Pharmacy trying to build national shipping capability | Compound Rx (Cookeville, TN) — website in test mode |
What Is Being Sold — and for What
According to the KFF Health News / ABC News investigation, the concentrated ivermectin pills being sold at Tennessee compounding pharmacies are sometimes at dosing protocols recommended by ivermectin proponents that call for 1.5 to five times the standard therapeutic dose for parasites, taken for days or weeks rather than the single dose typically used for parasitic infections.
Some pharmacy websites offer ivermectin as a treatment for COVID-19, "long haul vax symptoms," diabetes, or cancer — despite no evidence of its effectiveness for any of these conditions. These are the same indications promoted during the COVID-19 pandemic by groups including the Front Line COVID-19 Critical Care Alliance (FLCCC), whose founding member Paul Marik testified in favor of Tennessee's 2022 legislation. The FDA says ivermectin can be dangerous in large doses.
The ivermectin has spread into a cultural and commercial ecosystem. Roman Pharmacy advertises on at least four billboards along Interstate 65 near Nashville. A pharmacy outside Knoxville allows customers to order ivermectin for multiple sclerosis, Parkinson's disease, or "to use it to detoxify." Compound Rx in Cookeville is building a website — currently in test mode — to ship pills nationally. The dropdown menu for "how did you hear about us" features Donald Trump Jr., Steve Bannon, Laura Ingraham, and Kevin Sorbo as options — but not "your doctor."
The Regulatory Accountability Gap
KFF Health News's investigation revealed that Tennessee does not effectively track which pharmacies offer ivermectin without patient-specific prescriptions. The state government was unable to produce legally required notification filings when KFF made a public records request. Over three months, the agency "produced records for only a small fraction of the agreements it should have on file," according to the investigation.
Tennessee pharmacy and medical boards reviewed the situation but concluded the legislature "has sort of tied our hands in a lot of ways." One board member, discussing whether to regulate the potency of OTC ivermectin pills, said in a recorded meeting: "This board has been in enough trouble with ivermectin. Maybe we ought to just leave that out."
Timothy Caulfield, a professor at the University of Alberta who studies health misinformation, told ABC News that the ivermectin movement is not primarily about the science: "This is really about profit. This is about political identity. This is about creating distrust in the existing biomedical community. This is about money."
Frequently Asked Questions
What did the KFF Health News ivermectin investigation find?
Published June 17, 2026 by KFF Health News and ABC News, the investigation found that four years after Tennessee enacted the first law allowing ivermectin to be sold without patient-specific prescriptions, dozens of pharmacies sell the drug in pills 10 to 21 times more potent than standard tablets — many through a single anti-vaccine physician's blanket prescriptions. The state tracks the practice poorly and was unable to produce legally required filings.
Is ivermectin effective for COVID-19, cancer, or other unapproved uses?
No. Multiple clinical trials have found ivermectin is not effective against COVID-19. There is no peer-reviewed evidence supporting its use for cancer, Parkinson's disease, multiple sclerosis, or "detoxification." The World Health Organization does not recommend ivermectin for hantavirus. The FDA says ivermectin can be dangerous in large doses.
How many poison calls has Tennessee's ivermectin program generated?
The Tennessee Poison Center received more than 60 calls for possible ivermectin poisoning in 2025 — the most since 2021. Symptoms reported included vomiting, blurred vision, neurological problems, and difficulty walking. The FDA states ivermectin can be dangerous in large doses.
Is this law spreading to other states?
Tennessee is currently the only state with this specific law. However, Compound Rx in Cookeville, Tennessee, is reportedly building infrastructure to ship pills nationwide, and the investigation found that at least one pharmacy told KFF Health News that "friends and family in Tennessee" can facilitate sending medication to residents of other states.
Who is Dr. Denise Sibley?
Dr. Sibley is a physician and vaccine opponent who testified before Tennessee lawmakers in favor of the 2022 bill. She subsequently signed collaborative practice agreements with at least 10 pharmacies across Tennessee, enabling those pharmacies to dispense ivermectin without patient-specific prescriptions. She has stated publicly that people travel from across the country and internationally to obtain ivermectin through these pharmacies.
