Buying Prescriptions Online: a Safe Bet?

With the high cost of prescription drugs, more consumers are turning to the Internet to cut expenses. But what you order on the Web isn’t always what you get.

Any outfit can put up a Web site and call itself an Internet pharmacy. But it’s not called the World Wide Web for nothing. Shady operators in third world countries represent themselves as legitimate pharmacies and, are not only ripping off consumers, but in some cases endangering their health as well.

Even worse, some Internet pharmacies are fueling drug addiction. The General Accountability Office, the investigative arm of Congress, conducted a study on Internet pharmacies in June 2004 and was able to purchase restricted narcotics from several online pharmacies without a prescription.

“There are Internet pharmacies out there that aren’t licensed to sell drugs, and they do it for profit because there is very little chance that they will get caught,” says Mike Patton, a licensed pharmacist who is the interim executive director of the Illinois Pharmacists Association. “It is a major shortcoming in our society that there isn’t real regulatory control of who sells what over the Internet.”

Despite these issues, there are legitimate pharmacies on the Internet. The Internet is a tool. Used wisely, it can help you pay less for drugs that are genuine and come from a legitimate outlet.

Types of online pharmacies

The rapidly growing online pharmaceutical industry isn’t dominated by one business model or one retailer. Instead, online pharmacies can be classified in several different ways, says Gabriel Levitt, vice president for research at PharmacyChecker.com, a site that rates online pharmacies.

Basic type. Not all online pharmacies actually operate pharmacies that dispense drugs. Some are what PharmacyChecker.com describes as “pharmaceutical intermediaries.” These companies don’t actually operate their own pharmacy, but fill orders through third-party pharmacies. Some pharmacies specialize in mail orders and Internet orders only, while others are extensions of brick-and-mortar stores and chains.

Prescriptions. In terms of prescription requirements, online pharmacies can be divided into three categories:

Prescription required: You must have a prescription from your doctor or medical provider to obtain nonover-the-counter medication. Remote prescription: You are required to fill out a questionnaire or form detailing your medical symptoms, and doctors affiliated with the pharmacy will examine the information and decide whether to prescribe medication. No prescription required: You can order prescription medication without a prescription or a consultation. This practice is illegal in the United States.

Location. It’s important to know where a pharmacy is located before entrusting your health to it. Just because a pharmacy states that it is located in a particular country doesn’t prove that it is.

Albert Wertheimer, director of the Center for Pharmaceutical Health Services Research at the Temple University School of Pharmacy, says, “It’s impossible to tell where an Internet pharmacy is actually located, and if it isn’t in the U.S., government inspections, regulation and testing in most other countries is pitiful.”

Regulations and certifications

While importing drugs — even for personal use — is technically illegal, in practice the U.S. government doesn’t stop such importation, which is why busloads of U.S. citizens continue to cross the borders between the United States and Canada or Mexico and come home with shopping bags full of their prescription drugs. Here’s a rundown on locations:

United States-based: Internet pharmacies actually based in the United States are usually online outposts of chain drugstores or online pharmacies that dispense only popular drugs, according to Levitt. Canada: Usually the foreign market of choice for U.S. consumers, Canadian pharmacies are regulated in a similar fashion to U.S. pharmacies. Mexico: The Mexican market is far less developed and regulated than either the U.S. or Canadian markets, and while U.S. consumers can access drugs more cheaply, and in many cases without a prescription, there are no guarantees about the quality of the drugs you’re getting, Levitt says. Britain, Australia, Israel, Europe, India and New Zealand: Strong regulation exists in these countries, with standards for drugs, drug distribution and pharmacies. Others: Regulation and oversight varies tremendously from country to country.

The Federal Drug Administration, or FDA, regulates drug approval and manufacturing in the United States. While the FDA isn’t perfect — witness the Vioxx scandal and attendant lawsuits — it still requires rigorous testing, an application process and review of drugs before they make it to market, as well as a review at the time the drugs are manufactured.

The FDA must approve prescription drugs sold in the United States, though individuals importing drugs from other countries for personal use aren’t usually sanctioned. Individual pharmacies are regulated by state pharmacy boards, which also license pharmacists. The National Association of Boards of Pharmacy, or NABP, certifies Internet pharmacies through its Verified Internet Pharmacy Practice Site program, or VIPPS. In order to become certified, an online pharmacy must:

Submit a detailed application, including licensure information; Host a site visit from a National Association of Boards of Pharmacy team; Pass a rigorous review of its policies, sales practices, Web site and application performed by the same team.

Once an Internet pharmacy is certified, it can display the VIPPS seal. Unfortunately, some pharmacies have displayed this certification without actually receiving it, so when you see the seal, click on it to make sure it is legitimate. When you click on it, you should go to the VIPPS Web site where you can confirm that the pharmacy is indeed certified. This program only covers U.S. pharmacies. To find a VIPPS pharmacy, go to: www.nabp.net/vipps/intro.asp.

PharmacyChecker.com includes data showing whether a pharmacy is VIPPS certified, as well as price comparisons and a rating. Pharmacy Checker also includes foreign Internet pharmacies in its database.

The Internet and Mail Order Pharmacy Accreditation Commission certifies international online and mail-order pharmacies through a similar process to VIPPS. To access a list of certified pharmacies, go to: www.impacsurvey.org. Canadian pharmacies that sell prescription drugs over the Internet are certified by the Canadian International Pharmacy Association. For a list of members, go to www.ciparx.ca.

Before you order

Before you input your credit card number and click on the “order” button, check out an Internet pharmacy’s policies regarding privacy, refunds, customer service, security, and mailing and shipping fees:

Privacy. Privacy is a vital issue for consumers when it comes to medical information. You need to know what a pharmacy’s privacy policy is and if you can opt out of having your contact information sold to other entities. If you can’t find a privacy policy, that’s a major red flag.

Security. The security of your financial information is as important as the privacy of your medical information. You don’t want hackers or others to gain access to your credit card and banking information. Make sure the pharmacy you are dealing with has security software so that your transactions are encrypted and can’t be read by third parties while in transit or while stored in a database.

Customer service. Nothing is more frustrating for an online shopper than encountering a problem and not being able to find a real, live person to help resolve it. Make sure the Web site has a customer service telephone number, preferably toll-free, and call it before you order to make sure there are actual human beings who speak English answering the phone. In addition, the pharmacy should have registered pharmacists on hand to answer questions. Inquire about this when you call.

Refunds. There should be a clearly stated, understandable return and refund policy. You need recourse if your order doesn’t arrive or if it isn’t packaged correctly, is damaged during shipping, or isn’t exactly what you ordered.

Fees. Carefully examine all of the fees involved before you place an order. Check out shipping fees, taxes and any other fees the pharmacy might tack on to your order. Add them up to make sure you really are saving money.

When your meds come

Your job isn’t done when your medications arrive. Exercise some care before popping the first pill in your mouth by checking out:

The packaging: Prescription medications should be packaged securely, and those that require special handling such as refrigeration or insulation should be wrapped appropriately. Don’t use the medication if the package or container is torn or ripped or looks like it has been opened and resealed. Labels and warnings: Prescription medication should include the name of the drug, the dosage information, as well as any warnings associated with the drug. The General Accountability Office found that some prescriptions obtained outside the United States and Canada from Internet pharmacies lacked any type of labeling. Return address: Make sure the company you ordered the medication from is the company that shipped it or is an affiliate of that company. Check out the postmark to make sure that the medication was shipped from where you ordered it and not from somewhere else. The bottom line: When in doubt, don’t take the medication. “People have false illusions about pharmacies,” says Patton. “I have seen capsules that the FDA has intercepted, and they would frighten you to death. It’s amazing that today people are willing to ingest capsules that come in a container with an information sheet that isn’t even in English.”