According to the Legislative Budget Board (LBB), HB 25 is not expected to have a significant fiscal impact on the State of Texas. The analysis assumes that any implementation costs related to the expanded authority granted to pharmacists, such as regulatory updates or procedural oversight, can be absorbed within the existing budgets and operational capacity of relevant agencies, including the Texas State Board of Pharmacy and the Department of State Health Services.

For local governments, the bill also carries no anticipated significant fiscal implications. Because the bill neither mandates local enforcement nor requires reporting or infrastructure changes at the local level, there are no projected new costs or staffing burdens for municipal or county governments.

Overall, the bill is designed to operate within existing regulatory frameworks, relying on the Texas State Board of Pharmacy to potentially adopt rules as necessary. By leveraging existing administrative systems and avoiding new appropriations or mandates, HB 25 is structured to be fiscally neutral while still achieving its policy goal of expanding access to ivermectin.

HB 25 supports the principle of medical freedom by authorizing Texas pharmacists to dispense ivermectin without requiring a physician’s prescription. This bill marks a shift in policy that reaffirms the right of individuals to make informed decisions about their own health care in consultation with pharmacists, who are licensed professionals capable of advising patients on proper medication use. By removing the prescription barrier, the bill empowers patients to access a medication that, while FDA-approved for certain conditions, has also become part of broader debates surrounding off-label use and autonomy in personal medical decisions.

Under the bill, pharmacists may dispense ivermectin in accordance with protocols established by the Texas State Board of Pharmacy (TSBP), ensuring a professionally guided, safety-conscious framework rather than a free-for-all model. The bill also provides legal protections for pharmacists who act in a “reasonably prudent manner,” shielding them from civil, criminal, and professional liability when dispensing the medication under this statute. This encourages pharmacist participation while maintaining accountability through the existing standard of care. By limiting regulatory burden while still deferring to the TSBP for guidance, the bill achieves a balance between deregulation and professional oversight.

Notably, the substitute version of the bill simplifies the implementation framework by removing the Department of State Health Services (DSHS) and the requirement for a statewide standing order. This change transfers authority to a profession-specific body (TSBP), where rulemaking can be more responsive to practical realities in the pharmacy setting. Additionally, the removal of the annual reporting requirement alleviates administrative burdens on pharmacists and affirms the intent to treat ivermectin access similarly to other over-the-counter products dispensed under protocol.

Concerns about public health monitoring and potential misuse of ivermectin are understandable but ultimately speculative. Ivermectin has an established safety record in its approved uses, and pharmacists are trained to screen for contraindications, drug interactions, and proper use. The bill still allows the TSBP to implement dispensing guidelines, meaning the state retains the ability to shape appropriate use through rules rather than mandates.

The Legislative Budget Board's fiscal note confirms that there is no significant cost to the state or local governments. Any implementation expenses can be absorbed by the existing resources of the TSBP and related agencies, meaning the bill imposes no new budgetary burden.

In sum, HB 25 is consistent with Texas’s longstanding emphasis on personal liberty, limited government, and professional self-regulation. It affirms the individual’s right to make health choices and the pharmacist’s role in supporting those choices without inserting unnecessary bureaucratic hurdles. For these reasons, Texas Policy Research recommends that lawmakers vote YES on HB 25.

• Individual Liberty: The bill clearly supports individual liberty by empowering Texans to make their own health care decisions without first obtaining permission from a licensed physician. It reflects a policy stance that trusts individuals with bodily autonomy and acknowledges their right to choose treatments for themselves. By reducing the dependency on traditional gatekeepers (i.e., prescribing physicians), the legislation enhances personal access to FDA-approved medications for lawful use. This is particularly important in the context of medical freedom, where public discourse has increasingly emphasized the right to seek alternatives outside of centralized health directives.
• Personal Responsibility: By shifting decision-making authority directly to the individual and the pharmacist, the bill encourages Texans to take personal responsibility for their health. Pharmacists, acting under professional protocols, remain a safety net, but the burden of informed choice rests with the patient. The bill assumes that adults are capable of evaluating the risks and benefits of medication use, particularly when accompanied by proper guidance from trained professionals. It also reinforces the idea that individuals should be accountable for their own medical choices and outcomes, rather than relying solely on prescriptive health mandates.
• Free Enterprise: The bill promotes free enterprise by expanding the role of pharmacists in the health care marketplace. It allows pharmacies to meet consumer demand directly and without unnecessary regulatory gatekeeping, fostering innovation in service delivery and expanding the scope of practice for professionals operating in a competitive marketplace. Pharmacists, as private providers, gain more flexibility to operate efficiently and responsively under the oversight of their own professional board, the Texas State Board of Pharmacy (TSBP), rather than being constrained by a separate agency or political appointees.
• Private Property Rights: The bill does not have a direct impact on private property rights, as it neither imposes nor alters restrictions on the use or control of physical property. However, by expanding access to ivermectin, it could be argued that the bill indirectly supports property rights through the lens of medical autonomy, reinforcing the principle that individuals own their own bodies and should have discretion over what goes into them. Still, this connection is philosophical rather than legal or regulatory.
• Limited Government: This bill embodies limited government by eliminating the need for a top-down directive from the Department of State Health Services (as originally filed) and instead placing authority within a professional regulatory board. It removes unnecessary layers of government control and rejects the idea that the state must mediate every interaction between a consumer and a pharmacist. The removal of the reporting requirement and the narrowed rulemaking authority are further evidence that the legislature intends to create a permissive, not burdensome, regulatory framework.

Over-the-Counter Ivermectin Bill Gains Momentum During Special Session

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