Compounded ivermectin requires authorization from a licensed pharmacist (under the CPPA process) or a physician prescription. It cannot be dispensed without clinical oversight.
Compounded vs. Commercial: The Core Difference
Compounded Capsules
Made by a licensed 503A compounding pharmacy
- Custom doses: 3mg, 5mg, 9mg, 12mg, and others
- Formulated for the individual patient
- Allows precise weight-based dosing
- Not FDA-approved as a finished product
- Available at compounding pharmacies only
- Typical cost: $65–95 per course
Commercial Tablets
Stromectol (brand) and generic equivalents
- Available in 3mg and 6mg tablets
- Manufactured to FDA-approved specifications
- Widely available at participating pharmacies
- May require taking multiple tablets per dose
- Insurance may cover with physician prescription
- Typical cost: $50–85 per course
What 503A Means
A 503A compounding pharmacy operates under Section 503A of the Federal Food, Drug, and Cosmetic Act. These pharmacies compound medications for individual patients based on a valid prescription or, in Tennessee, under the CPPA process established by SB 2188.
503A pharmacies are licensed by the Tennessee Board of Pharmacy. They are subject to state oversight and USP compounding standards. A 503B outsourcing facility is different — those operate under FDA registration and produce larger batches not for individual patients.
Why Compounding for Ivermectin
Commercial tablets come in 3mg and 6mg. For a 90 kg patient needing 200 mcg/kg (18mg total), that means three 6mg tablets — which works, but is imprecise. Compounded capsules can be made at 9mg or 12mg, reducing pill count and improving dose accuracy.
For patients with swallowing difficulties, a compounding pharmacy can adjust the capsule formulation. Some pharmacies offer liquid formulations for specific patient populations.
Compounding is not always necessary. For many patients, commercial tablets at the right dose work fine. The pharmacist advises which formulation is appropriate.
Tennessee SB 2188 and Compounding
Under SB 2188, Tennessee pharmacists operating under a CPPA agreement can dispense both commercial ivermectin tablets and compounded capsules prepared by a licensed Tennessee 503A pharmacy. The pharmacist authorization covers both formulations.
Not every CPPA pharmacy stocks compounded capsules. Some work only with commercial tablets. If you need a specific compounded dose, ask the pharmacy before your visit whether they have a compounding arrangement in place.
Cost for Compounded Ivermectin
Compounded ivermectin capsules typically run $65–95 for a short course in Tennessee. The price varies by pharmacy and by the specific dose and capsule count required. Some pharmacies charge a separate compounding fee on top of the consultation.
Insurance does not cover compounded medications as a general rule. Out-of-pocket payment applies in almost all cases.