Kansas bill would force pharmacists to fill ivermectin, hydroxychloroquine as off-label COVID treatment
A group of Kansas politicians tasked with steering public health policy are pushing to allow doctors to prescribe unproven treatments and preventives for COVID-19 without any potential for responsibility.
While the U.S. Food and Drug Administration has warned against using ivermectin and hydroxychloroquine for COVID-19, some Republican senators want to shield doctors from legal liability and board discipline for prescribing the drugs.
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Ivermectin is used to treat parasitic worms, especially in livestock. Hydroxychloroquine, sometimes abbreviated as HCQ, is a malaria drug that is also used to treat lupus and rheumatoid arthritis. Neither drug has proven to be save and effective for treating or preventing COVID-19.
But that hasn't stopped the Senate Public Health and Welfare Committee from advancing a bill making it easier for doctors to prescribe the drugs for off-label use. The bill would also require pharmacists to fill such prescriptions, even if they believe the drugs would be dangerous for patients.
More: Fact check: Ivermectin is not a proven treatment for COVID-19
"This is just sort of messy," said Steve Stites, the chief medical officer at The University of Kansas Health System, when asked about the proposal during a Monday media briefing. "This is politics, unfortunately, and not health care. And when politics gets involved in health care, it kind of gets a little messy."
Doctors on the regular KU briefings have long opposed using ivermectin and hydroxychloroquine for COVID-19. In the past, infectious disease specialist Dana Hawkinson has advised people to find a new doctor if their current physician promotes ivermectin over vaccines.
"If the drug is FDA authorized, as a physician, the drug is authorized. And you can try and use it for other conditions," Stites said. "That's what's called off label use. Insurance companies are under no obligation to pay for the off-label use.
"The problem is that you are responsible for the outcome of that drug, and if it gives that patient a bad outcome, they can come back to you to say, hey, you had a bad outcome, I'm going to sue you, or you can get turned into the state board."
The Kansas proposal would remove that liability for off-label drugs for COVID-19.
"What the Kansas legislation is trying to say is, well look, if you want to use ivermectin for COVID, even though that's off label use — and let's be honest, even though the overwhelming weight of scientific evidence says that it doesn't work and may even be harmful to you because again, this is really a drug meant for parasites," Stites said.
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"What happens is that the Kansas legislators are now saying you can't be held responsible for any bad outcome. And I think, you know, it's really bizarre to me, that politicians ... want to move into the area of medicine. Essentially, the Kansas Legislature wants to practice medicine for one drug — one drug, you can give this drug and not get sued."
A fact check by USA Today found that ivermectin is not a proven treatment for COVID-19. Some lower-quality studies with potential sources of bias have suggested the drug could help, but more rigorous research has found little or no benefit.
Poison control centers have experienced an increase in human exposures from veterinary ivermectin products, the CDC reported in August.
"It is a shortsighted myopia, and it's dangerous," Hawkinson said. "I think, if we are talking about ivermectin, you have to understand that those studies that did show benefit, most of those studies have been retracted for falsifying data. Those authors have been punished for that.
"When you actually do the review and the analysis of the other articles and research articles that don't have those biases, such as, again, falsifying data, misrepresenting data, there actually shows no benefit for ivermectin. And so I think it is important to understand that, you know, we try to continue to promote the FDA, CDC, World Health Organization and NIH recommended therapeutics because they have those trials. They show benefit."
Hawkinson said reputable studies showed no benefit to using Ivermectin, and there is a potential for harm from the drug.
Stites said doctors and nurses want to help people be healthy and don't have a hidden agenda.
"Beware of politicians ... looking for votes," he said.
Taking away pharmacist discretion
Sen. Richard Hilderbrand, R-Galena and chair of the Senate Public Health and Welfare Committee, requested the introduction of Senate Bill 381.
The bill allows doctors and mid-level practitioners to prescribe ivermectin and hydroxychloroquine, as well as other drugs, for off-label use to treat and prevent COVID-19. It also makes the physician and the pharmacist immune from any civil liability.
Sen. Mark Steffen, R-Hutchinson, promised to introduce an amendment next week to remove the liability protection from the bill.
"That will 100% be removed because it is not our intention to skirt any liability," he said, noting that it had been fashioned after a bill in another state. "We want the liability."
Pharmacists would be required to fill the prescription.
Jenna Moyer, an assistant revisor of statutes, said the bill "would take away the discretion that pharmacists typically have (under state law) not to fill a prescription if it's in their judgment or discretion that it should not be filled."
Physicians and pharmacists would also not be subject to any disciplinary action for any "recommendation, prescription, use or opinion .... related to a treatment for COVID-19, including a treatment that is not recommended or regulated by the licensing board," KDHE or FDA. Such actions could not be considered unprofessional conduct. The provision would be retroactive to March 12, 2020.
The licensing board would be required to rescind any such disciplinary action.
The Board of Healing Arts has taken disciplinary action against one provider — a Lawrence chiropractor who falsely advertised coronavirus-related services.
Steffen, who is an anesthesiologist, has promoted ivermectin and hydroxychloroquine.
"Twenty percent of all prescriptions are FDA-approved drugs for off-label uses, so this is anything but unique," he said.
Written public testimony is already available
The public health committee met for an information hearing Tuesday morning in a first floor Statehouse meeting room. It was full of unmasked people with a standing crowd packing the entryway.
Due to time constraints, the hearing ended before any testimony from the public. The committee is expected to hold a bill hearing Wednesday morning.
Written testimony is already available.
"We physicians are here because we aren’t allowed to do what we have dedicated our lives to: providing the best care possible to our Covid 19 patients, keeping them alive and out of the hospital," wrote Festus Krebs, who identified himself as a doctor.
Krebs said he "spent the last three months, 8+ hours a day, seven days a week studying evidence to get to the truth." In advocating for Ivermectin and hydroxychloroquine, Krebs cited cardiologist Peter McCullough, who has spread misinformation about COVID-19 vaccines and treatments.
Troy Graves, of Louisburg, identified himself as an RN specializing in ICU and critical care.
"They deny any medications that have potential to help and won’t consider any off label uses," he said of the health care system. "The treatment plan they now use is remdesivir, an off label treatment."
That's not true. The FDA has approved remdesivir for use in adults and adolescents, and the drug has emergency use authorization for treatment of younger pediatric patients.
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Angelique Pritchett, of Shawnee, testified that she as a family physician has had a difficult time prescribing the drugs for off-label use.
"Patients who have opted for treatment with hydroxychloroquine or ivermectin have had an additional burden of finding a pharmacy or pharmacist willing to dispense the medication for this particular indication," she wrote.
Beverly Hoskins, of Hesston, identified herself as a retired pharmacist. She said the Kansas Board of Pharmacy "has their head in the sand" and is "not speaking the truth about alternative treatments."
"In my 45 years of practicing pharmacy, I have never seen a pharmacist refuse to fill a doctor’s prescription for an FDA approved drug for an off-label use," she wrote. "It is shocking to me that a pharmacist can now tell a physician, they can’t order ivermectin for covid, but that is what is happening."
More: Trying to figure out if your symptoms are the cold, flu or COVID? Kansas doctors say get tested.
Amy Hogan, of Salina, identified herself as a family practice physician. She said it is "undeniably the case" that ivermectin poses "very little risk" and has "great benefits."
"When I got a notice from the State Board of Healing Arts submitted by a pharmacist from Dillons in Salina, KS that I had prescribed 'dangerously high doses of ivermectin' it was certainly troubling to me," Hogan wrote. "Why would someone seek to ruin my good name?"
She said she "was turned in for purely political reasons."
Jason Tidd is a statehouse reporter for the Topeka Capital-Journal. He can be reached by email at jtidd@gannett.com. Follow him on Twitter @Jason_Tidd.
This article originally appeared on Topeka Capital-Journal: Kansas politicians promote off-label ivermectin, HCQ as COVID drugs
