Tennessee became the first state to allow adults to buy ivermectin from a pharmacy without first seeing a doctor in 2022. The 2022 law was passed by a Republican supermajority and largely grants pharmacists immunity from lawsuits or professional sanctions related to ivermectin.

Pharmacies in Tennessee can use a pre-written, blanket prescription to sell ivermectin to customers. Some Tennessee pharmacies advertise ivermectin as available over the counter, though customers must technically request it from a pharmacist. Highway billboards in Tennessee advertise ivermectin as 'Available Without a Prescription in Tennessee!' Some pharmacies offer ivermectin pills that are 10 or 20 times the potency of a standard tablet.

Compound Rx in Cookeville, Tennessee, is one pharmacy that offers ivermectin without patient-specific prescriptions. Paul Hughey, a pharmacist who has dispensed ivermectin at Mt. Juliet Pharmacy and Compound Rx, estimated that up to 20 people a week purchase ivermectin at his pharmacies. John Mafi, a UCLA internal medicine physician, co-authored a study identifying an increase in prescribing rates for ivermectin and another antiparasitic drug, particularly in the South. Mafi said off-label use of ivermectin is "It's going back to 19th-century quack science."

Denise Sibley, a doctor in Tennessee, has signed agreements with pharmacies to dispense ivermectin under the 2022 law. Sibley stated in podcast interviews that she has made as many as 40 such agreements with Tennessee pharmacies. KFF Health News confirmed Sibley signed agreements with at least 10 pharmacies. "As the collaborator for these pharmacies, I get every person's sheet," Sibley said. "They're from every state. They're from Canada. They're from Europe."

The FDA has approved ivermectin for treating parasitic diseases in humans. However, clinical trials have shown that ivermectin is not effective against Covid. The FDA says ivermectin can be dangerous in large doses. Some pharmacy websites offer ivermectin as a treatment for Covid, 'long haul vax symptoms,' diabetes, or cancer, conditions for which the World Health Organization has found no research showing ivermectin is effective.

The Tennessee Poison Center received more than 60 calls for possible ivermectin poisoning in 2025, the most since 2021. Calls to the center regarding ivermectin included reports of vomiting, blurred vision, neurological problems, and difficulty walking. Rebecca Bruccoleri, the medical director of the Tennessee Poison Center, noted, "People are taking this because they just feel unwell. It's almost like a panacea now." She also stated, "I've heard rumblings on the internet of using ivermectin for an alternative cancer treatment, and we're seeing it definitely in here." Mafi said, "It is alarming that I'm seeing this really unproven therapy being touted to so many potentially vulnerable Americans."