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The 8th U.S. Circuit Court of Appeals last week affirmed a federal district court’s ruling that sided with two Albert Lea pharmacies who refused to fill prescriptions in 2021 for off-label medications to treat COVID-19.

The court affirmed that Walmart and Hy-Vee pharmacies in Albert Lea could not be compelled to fill the prescriptions for ivermectin, an anti-parasitic agent approved by the FDA for treating intestinal conditions, and hydroxychloroquine, which is FDA-approved to treat several autoimmune conditions and malaria. The medications are not FDA-approved to treat COVID-19.

Missouri physician Mollie James had prescribed the medications for William and Karla Salier to treat their severe COVID-19 infections.

Court documents stated William Salier had contracted COVID-19 in October 2021 and became seriously ill. After an Iowa clinic denied his request for an ivermectin prescription to treat it, he obtained a prescription from James.

The Walmart pharmacist refused to fill the prescription and reportedly told Karla Salier that it was not an appropriate treatment for the condition. When she protested it, the couple alleged the pharmacist “rudely lectured” about the dangers of treating COVID-19 with ivermectin.

After Karla Salier contracted COVID-19, James sent over prescriptions for both ivermectin and hydroxychloroquine for her  to Walmart, of which the pharmacist also refused to fill. When the prescriptions were then sent to Hy-Vee, the pharmacist there also refused to fill them, “explaining that Hy-Vee’s ‘corporate policy’ barred its pharmacists from dispensing ivermectin and hydroxychloroquine to treat COVID-19.”

According to court documents, the Saliers ultimately obtained and consumed a more concentrated veterinary formulation of ivermectin, commonly known as “horse paste,” that is used to treat horses and other large animals. The couple’s symptoms improved, and they went back to their normal activities in one week and fully recovered in two weeks.

The Saliers filed the action against Walmart and Hy-Vee seeking damages for what they said were violations of their “common law right of ‘self-determination’” and for what they said was an intentional infliction of severe emotional distress.

The couple claimed the Walmart and Hy-Vee pharmacists had no reasonable medical or scientific basis for declining to fill the prescriptions and said that refusing to fill them endangered their lives and forced them to improvise with a version of the medication intended for horses. They also claimed Walmart refused to fill the medications because of “baseless political conclusions” and that Hy-Vee’s decision to do so was based on a “one-size-fits-all corporate policy based on political fear mongering.”

The district court ultimately dismissed all claims, as well as the couple’s self-determination claims as not being consistent with Minnesota common law. It also dismissed the emotional distress claim.

“Minnesota common law does not recognize a right ‘to compel an unwilling health care provider to participate in a plan of care that is contrary to its judgment, policy and/or public health agency guidance,’” the ruling said.

It said state law enables pharmacists to exercise independent judgment in filling prescriptions.

“The allegations that Walmart and Hy-Vee simply chose to replace the judgment of an outlier physician with their ‘baseless political conclusions’ and ‘a one-size-fits-all corporate policy based on political fear mongering’ are absurd hyperbole, if not outright falsehoods,” the court said.

The court stated the Saliers did not allege experiencing physical or specific psychological consequences after the pharmacists refused to fill the prescriptions and that they did not seek treatment for their distress.

“The Saliers allege defendants’ refusals caused them to suffer severe emotional distress — fear for each other’s lives,” it stated. “Unquestionably, the unknown and potentially severe consequences of contracting COVID-19, and the uncertainty of how to treat it, caused countless Americans great emotional distress. But this is not enough to plead a plausible claim of intentional infliction of emotional distress.”

The court also found the district court did not abuse its discretion when it refused to certify the case to the Minnesota Supreme Court.

The Saliers were unable to be reached for comment.