The Online Pharmacy Problem

Pill Popper

Pharmacies that operate online and deliver orders to customers through mail or shipping companies are known as online pharmacies, internet pharmacies or mail order pharmacies. The main difference between a normal retails community drugstore and a legitimate online pharmacy is how the medications are purchased and received; similar to any online shopping. More convenient than traveling to a local drugstore is why some customers go online to shop for their meds. Any pharmacy that sells medication without requiring a doctor’s prescription are sometimes fraudulent and may be pushing counterfeit drugs that are either ineffective or downright dangerous.

The main attraction of online pharmacies is its low prices. Shoppers can sometimes get up 80% or more savings at foreign pharmacies. It is estimated that around 2 million packages of pharmaceuticals arrive annually by international mail from Thailand, India, South Africa and other points into the United States. According to a poll in 2006 from the Wall Street Journal/Harris Online, 80 percent of Americans prefer importing meds from other countries. 97% of online pharmacies are viewed as illegal in the U.S., the FDA campaigns to prevent consumers from purchasing drugs overseas via online pharmacies. President Obama’s budget supports a plan that may allow people to buy cheaper drugs from other countries.

Reported in the journal Clinical Therapeutics, US consumers face a risk of purchasing counterfeit drugs because of the rising Internet sales of drugs. The worldwide sale of counterfeit drug, in total, was projected to reach $75 billion by 2010. There are two programs for online pharmacy verifications that are recognized by the National Association of Boards of Pharmacy. The first is VIPPS, which is operated by the NABP and was created in 1999. The Food and Drug Administration refers Internet users interested in using an online pharmacy service to the VIPPS program. The second is Legit Script, which as of September 2010 had approved over 340 Internet pharmacies as verified and legitimate, and further identified over 47,000 “unlicensed” Internet pharmacies. It is also important to note that Canadian and all non-U.S. online pharmacies that sell prescription medication to Americans, regardless of credentials, are not eligible for approval in the VIPPS and Legit Script programs. Many consumers and internet pharmacies see this as more of a market share protection for the big pharmacy companies in the US than an actual policy to protect consumers from fraudulent or counterfeit medications due to the wide availability and low prices of these legitimate medications in countries like Thailand, Philippines, South America, and India.

All online pharmacies sell through the internet but must ship the product usually via snail mail. The selling of many class (schedule) drugs without a valid prescription (also known as Rx-only drugs or legend drugs) is illegal and companies shipping them by mail may be prosecuted for mail fraud (Postal Inspection service) as well as investigations and Federal charges by the DEA, IRS, Homeland Security, Food and Drug Administration’s Office of Criminal Investigations, Department of Justice, INTERPOL  and the U.S. Immigration and Customs Enforcement (ICE) and it is common practice for many of the aforementioned agencies to jointly investigate alleged crimes. On top of that, the card associations will levy hefty fines on acquiring member banks for accepting card transactions from merchants who sell and ship controlled medications that would otherwise require a doctor’s prescription. With the tightening and crackdowns on internet pharmacies selling controlled medication, most have moved to non-controlled over the counter drugs to avoid problems with the said authorities.

In the UK over 2 million people buy drugs regularly over the internet from online pharmacies; some are legitimate but others have “dangerous practices” that could endanger children. In 2008, the RPSGB introduced the green cross logo to help identify accredited online pharmacies (from 2010 the internet pharmacy logo scheme is run by the GPhC). European registered pharmacists have reciprocal agreements allowing them to practice in the UK by simply getting registered with the General Pharmaceutical Council.

The first internet pharmacy in the UK was Pharmacy2U, which started operating in 1999.The UK is a frontline leader in internet pharmacy since a change to pharmacy regulations in 2005 that made it legal for pharmacies to fill prescriptions over the internet. Drugs supplied in this way tend to be medicines which doctors refuse to prescribe for patients, or would charge a private prescription fee, as all patients treated under the National Health Service pay either a flat price or nothing for prescribed medicine (except for medicine classed as lifestyle medicine, e.g. anti-malarial for travel), and medical equipment.

In the UK, online pharmacies are often linked up with online clinic doctors. The online doctors carry out online consultations and issue the prescriptions. The company employing the doctors must be registered under the Care Quality Commission. Online clinics only prescribe a limited number of medicines and do not replace regular doctors working from surgeries. There are various ways the doctors can carry out the online consultations; at times it is done almost entirely by questionnaire. Customers usually pay a one-time fee which includes the price of the consultation, prescription and the price of the meds.

At the end of the day, as long as there are cheaper alternatives for the purchase of medicines online and/ or overseas, than what is available locally, there will always be a demand for it. Especially with new anonymous payment methods like bitcoin and litecoin emerging, it will become easier for internet pharmacies to operate without intervention from the authorities. Unless the FDA allows and regulate internet pharmacies outside of the US, there will always be the risk of counterfeit meds being sold to Americans seeking a cheaper alternative for their medication.