Online pharmacy
Encyclopedia
Online pharmacies, Internet pharmacies, or Mail Order Pharmacies are pharmacies
that operate over the Internet
and send the orders to customers.
Online or internet pharmacies might include:
and Good distribution practice
s are followed. Home delivery of pharmaceuticals can be a desirable convenience but sometimes there can be problems.
The shipment of drugs through the mail
and parcel post
is sometimes a concern for temperature-sensitive pharmaceuticals. Uncontrolled shipping conditions can include high and low temperatures outside of the listed storage conditions for a drug. For example, the US FDA found the temperature in a mail box in the sun could reach 136°F (58°C) while the ambient air temperature was 101°F (38°C)
Shipment by express mail
and courier
s reduces transit time and often involves delivery to the door, rather than a mail box. The use of insulated shipping container
s also helps control drug temperatures, reducing risks to drug safety and efficacy.
While many internet pharmacies sell prescription drugs only with a prescription, some do not require a pre-written prescription. In some countries, this is because prescriptions are not required. Some customers order drugs from such pharmacies to avoid the inconvenience of visiting a doctor or to obtain medications their doctors were unwilling to prescribe. People living in the United States
and other countries where prescription medications are very expensive may turn to online pharmacies to save money. Many of the reputable websites employ their own in-house physicians to review the medication request and write a prescription accordingly. Some websites offer medications without a prescription or a doctor review. This practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and the suitability of a medication for a specific individual. Pharmacies offering medication without requiring a prescription and doctor review or supervision are sometimes fraudulent and may supply counterfeit—and ineffective and possibly dangerous—medicines.
, Wyeth
, Roche, and generic drugmakers Cipla
and Ranbaxy of India and Teva Pharmaceutical Industries
of Israel.
The Washington Post reported that "...millions of Americans have turned to Mexico and other countries in search of bargain drugs...U.S. Customs estimates 10 million U.S. citizens bring in medications at land borders each year. An additional 2 million packages of pharmaceuticals arrive annually by international mail from Thailand, India, South Africa and other points. Still more packages come from online pharmacies in Canada."
Some people in the US, including some legislators, favor accessing foreign-made prescription drugs to lower Americans’ health costs. According to a Wall Street Journal/Harris Online poll in 2006, 80 percent of Americans favor importing drugs from Canada and other countries. President Obama’s budget supports a plan to allow people to buy cheaper drugs from other countries. A report in the journal Clinical Therapeutics found that U.S. consumers face a risk of getting counterfeit drugs because of the rising Internet sales of drugs, projected to reach $75 billion by 2010.
In the United States, there are two verification programs for online pharmacies that are recognized by the National Association of Boards of Pharmacy
(NABP). One is the Verified Internet Pharmacy Practice Sites Program (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 to the VIPPS program. The other is LegitScript
, which as of September 2010 had approved over 340 Internet pharmacies as legitimate and identified over 47,000 "rogue" Internet pharmacies.
introduced a 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 November 1999. The UK is a frontline leader in internet pharmacy since the law change in 2005 that made it legal for pharmacies to sell 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 low flat price or nothing for prescribed medicine (except for medicine classed as lifestyle medicine, eg: anti-malarials for travel), and medical equipment.
In the UK, online pharmacies often link up with online clinic doctors. Doctors carry out online consultations and issue prescriptions. The company employing the doctors must be registered with 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 carry out the online consultations; sometimes it is done almost entirely by questionnaire. Customers usually pay one fee which includes the price of the consultation, prescription and the price of the medicine.
Pharmacy
Pharmacy is the health profession that links the health sciences with the chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs...
that operate over the Internet
Internet
The Internet is a global system of interconnected computer networks that use the standard Internet protocol suite to serve billions of users worldwide...
and send the orders to customers.
Online or internet pharmacies might include:
- Pharmacy benefit manager - A large administrator of corporate prescription drug plans
- Legitimate internet pharmacy in the same country as the person ordering.
- Legitimate internet pharmacy in a different country than the person ordering. This pharmacy usually is licensed by its home country and follows those regulations, not those of the international orders.
- Illegal or unethical internet pharmacy. The web pageWeb pageA web page or webpage is a document or information resource that is suitable for the World Wide Web and can be accessed through a web browser and displayed on a monitor or mobile device. This information is usually in HTML or XHTML format, and may provide navigation to other web pages via hypertext...
for an illegal pharmacy may contain lies about its home country, procedures, or certifications. The "pharmacy" may send outdated (expired shelf lifeShelf lifeShelf life is the length of time that food, drink, medicine, chemicals, and many other perishable items are given before they are considered unsuitable for sale, use, or consumption...
) or counterfeit medicationsCounterfeit medicationsA counterfeit medication or a counterfeit drug is a medication or pharmaceutical product which is produced and sold with the intent to deceptively represent its origin, authenticity or effectiveness...
and may not follow normal procedural safeguards.
Home delivery
Conventional stationary pharmacies usually have controlled distribution systems from the manufacturer. Validation (drug manufacture)Validation (drug manufacture)
Validation in the pharmaceutical, medical device, food, blood establishments, tissue establishments, and clinical trials industries is defined as the documented act of demonstrating that a procedure, process, and activity will consistently lead to the expected results. It often includes the...
and Good distribution practice
Good distribution practice
Good Distribution Practice deals with the guidelines for the proper distribution of medicinal products for human use. GDP is a quality warranty system, which includes requirements for purchase, receiving, storage and export of drugs intended for human consumption.GDP regulates the division and...
s are followed. Home delivery of pharmaceuticals can be a desirable convenience but sometimes there can be problems.
The shipment of drugs through the mail
Mail
Mail, or post, is a system for transporting letters and other tangible objects: written documents, typically enclosed in envelopes, and also small packages are delivered to destinations around the world. Anything sent through the postal system is called mail or post.In principle, a postal service...
and parcel post
Parcel post
Parcel post is a service of a postal administration for sending parcels through the post. It is generally one of the less expensive ways to ship packages that are too heavy to be sent by regular letter post and is usually a slower method of transportation....
is sometimes a concern for temperature-sensitive pharmaceuticals. Uncontrolled shipping conditions can include high and low temperatures outside of the listed storage conditions for a drug. For example, the US FDA found the temperature in a mail box in the sun could reach 136°F (58°C) while the ambient air temperature was 101°F (38°C)
Shipment by express mail
Express mail
In most postal systems express mail refers to an accelerated delivery service for which the customer pays a surcharge and receives faster delivery. Express mail is a service for domestic mail and is governed by a country's own postal administration...
and courier
Courier
A courier is a person or a company who delivers messages, packages, and mail. Couriers are distinguished from ordinary mail services by features such as speed, security, tracking, signature, specialization and individualization of express services, and swift delivery times, which are optional for...
s reduces transit time and often involves delivery to the door, rather than a mail box. The use of insulated shipping container
Insulated shipping container
Insulated shipping containers are a type of packaging used to ship temperature sensitive products such as foods, pharmaceuticals, and chemicals. They are used as part of a cold chain to help maintain product freshness and efficacy...
s also helps control drug temperatures, reducing risks to drug safety and efficacy.
Risks and concerns
- Illegal or unethical pharmacies sometimes send outdated, substituted, or counterfeit medicationsCounterfeit medicationsA counterfeit medication or a counterfeit drug is a medication or pharmaceutical product which is produced and sold with the intent to deceptively represent its origin, authenticity or effectiveness...
- Sometimes an online pharmacy may not be located in the country that is claimed. For example, one study of drug shipments claiming to be from Canada revealed many actually originated in several different countries and were often bogus medications
- Minors or children can order controlled substanceControlled substanceA controlled substance is generally a drug or chemical whose manufacture, possession, or use are regulated by a government. This may include illegal drugs and prescription medications ....
s without adult supervision.
- Other concerns include potential lack of confidentiality, improper packaging, inability to check for drug interactions, and several other issues.
Discussion
Legitimate mail-order pharmacies are somewhat similar to community pharmacies; one primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient than traveling to a community drugstore, in the same way as ordering goods online rather than going to a shop.While many internet pharmacies sell prescription drugs only with a prescription, some do not require a pre-written prescription. In some countries, this is because prescriptions are not required. Some customers order drugs from such pharmacies to avoid the inconvenience of visiting a doctor or to obtain medications their doctors were unwilling to prescribe. People living in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
and other countries where prescription medications are very expensive may turn to online pharmacies to save money. Many of the reputable websites employ their own in-house physicians to review the medication request and write a prescription accordingly. Some websites offer medications without a prescription or a doctor review. This practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and the suitability of a medication for a specific individual. Pharmacies offering medication without requiring a prescription and doctor review or supervision are sometimes fraudulent and may supply counterfeit—and ineffective and possibly dangerous—medicines.
International consumers
International consumers sometimes purchase drugs online from online pharmacies in their own countries, or those located in other counties. Some of these pharmacies require prescriptions, while others do not. Of those that do not require prescriptions, some ask the customer to fill in a health questionnaire with their order. Many drugs available online are produced by well-known manufacturers such as PfizerPfizer
Pfizer, Inc. is an American multinational pharmaceutical corporation. The company is based in New York City, New York with its research headquarters in Groton, Connecticut, United States...
, Wyeth
Wyeth
Wyeth, formerly one of the companies owned by American Home Products Corporation , was a pharmaceutical company. The company was based in Madison, New Jersey, USA...
, Roche, and generic drugmakers Cipla
Cipla
Cipla Limited is a prominent Indian pharmaceutical company, best-known outside its home country for manufacturing low-cost anti-AIDS drugs for HIV-positive patients in developing countries...
and Ranbaxy of India and Teva Pharmaceutical Industries
Teva Pharmaceutical Industries
Teva Pharmaceutical Industries Ltd. , is an international pharmaceutical company headquartered in Petah Tikva, Israel. It specializes in generic and proprietary pharmaceuticals and active pharmaceutical ingredients...
of Israel.
U.S. consumers
An attraction of online pharmacies is drug prices. Shoppers can sometimes obtain 50 to 80 percent or more savings on U.S. prices at foreign pharmacies.The Washington Post reported that "...millions of Americans have turned to Mexico and other countries in search of bargain drugs...U.S. Customs estimates 10 million U.S. citizens bring in medications at land borders each year. An additional 2 million packages of pharmaceuticals arrive annually by international mail from Thailand, India, South Africa and other points. Still more packages come from online pharmacies in Canada."
Some people in the US, including some legislators, favor accessing foreign-made prescription drugs to lower Americans’ health costs. According to a Wall Street Journal/Harris Online poll in 2006, 80 percent of Americans favor importing drugs from Canada and other countries. President Obama’s budget supports a plan to allow people to buy cheaper drugs from other countries. A report in the journal Clinical Therapeutics found that U.S. consumers face a risk of getting counterfeit drugs because of the rising Internet sales of drugs, projected to reach $75 billion by 2010.
In the United States, there are two verification programs for online pharmacies that are recognized by the National Association of Boards of Pharmacy
National Association of Boards of Pharmacy
The National Association of Boards of Pharmacy is an international association which assists state licensing boards in developing, implementing, and enforcing uniform standards relating to pharmacies...
(NABP). One is the Verified Internet Pharmacy Practice Sites Program (VIPPS), which is operated by the NABP and was created in 1999. The Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
refers Internet users interested in using an online pharmacy to the VIPPS program. The other is LegitScript
LegitScript
LegitScript is a verification and monitoring service for online pharmacies and the only such service recognised by the National Association of Boards of Pharmacy as adhering to its standards aside from the NABP's own VIPPS program....
, which as of September 2010 had approved over 340 Internet pharmacies as legitimate and identified over 47,000 "rogue" Internet pharmacies.
Overseas online pharmacies and U.S. law
Legality and risks of purchasing drugs online depend on the specific kind and amount of drug being purchased.- It is illegal to purchase controlled substanceControlled substanceA controlled substance is generally a drug or chemical whose manufacture, possession, or use are regulated by a government. This may include illegal drugs and prescription medications ....
s from an overseas pharmacy. A person purchasing a controlled substance from such a pharmacy may be violating two federal laws that carry stiff penalties. The act of importation of the drug from overseas violates 21 USC, Section 952 (up to 5 years in prison and $250,000 fine for importation of non-narcotic Schedule III, IV, or V drugs; possibly more for narcotics and Schedule I and II drugs). The act of simple possession of a controlled substance without a valid prescription violates 21 USC, Section 844 (up to 1 year in prison and $1,000 fine). FDA does not recognize online prescriptions; for a prescription to be valid there must be a face-to-face relationship between the patient and the health-care professional prescribing the drug. What exactly constitutes a "face-to-face" relationship is considered by many online pharmacies to be a subjective definition that would allow them to operate as an adjunct to the patient's own physician if the patient submits medical records documenting a condition for which the requested medication is deemed appropriate for treatment. Sections 956 and 1301 provide exemptions for travellers who bring small quantities of controlled substances in or out of the country in person, but not by mail. - Importation of an unapproved prescription drug (not necessarily a controlled substance) violates 21 USC, Section 301(aa), even for personal use. The Food, Drug, and Cosmetic Act does allow for the importation of drug products for unapproved new drugs for which there is no approved American version. However, this allowance does not allow for the importation of foreign-made versions of U.S. approved drugs.
- The law further specifies that enforcement should be focused on cases in which the importation by an individual poses a threat to public health, and discretion should be exercised to permit individuals to make such importations in circumstances in which the prescription drug or device imported does not appear to present an unreasonable risk to the individual.
- It is also illegal to import non-approved drugs (21 USC sections 331(d) and 355(a)); however, FDA policies suggest that, under certain circumstances, patients may be allowed to keep these drugs.
- Individual U.S. states may implement their own laws regulating importation, possession, and trafficking in prescription drugs and/or controlled substances.
- For several years, the states of NevadaNevadaNevada is a state in the western, mountain west, and southwestern regions of the United States. With an area of and a population of about 2.7 million, it is the 7th-largest and 35th-most populous state. Over two-thirds of Nevada's people live in the Las Vegas metropolitan area, which contains its...
, MinnesotaMinnesotaMinnesota is a U.S. state located in the Midwestern United States. The twelfth largest state of the U.S., it is the twenty-first most populous, with 5.3 million residents. Minnesota was carved out of the eastern half of the Minnesota Territory and admitted to the Union as the thirty-second state...
, IllinoisIllinoisIllinois is the fifth-most populous state of the United States of America, and is often noted for being a microcosm of the entire country. With Chicago in the northeast, small industrial cities and great agricultural productivity in central and northern Illinois, and natural resources like coal,...
and WisconsinWisconsinWisconsin is a U.S. state located in the north-central United States and is part of the Midwest. It is bordered by Minnesota to the west, Iowa to the southwest, Illinois to the south, Lake Michigan to the east, Michigan to the northeast, and Lake Superior to the north. Wisconsin's capital is...
have run official state programs to help their residents order lower-cost drugs from abroad to save money.
Enforcement
- Any package containing prescription drugs may be seized by US Customs and Border Protection. The package may be held and eventually returned to the sender if the addressee does not respond and provide proof that they are allowed to receive these drugs (e.g., a valid prescription). In practice, the number of packages containing prescription drugs sent to United States on a daily basis far exceeds CBP's capabilities to inspect them. In the past, packages often passed through customs even if they were not sent from Canada or otherwise didn't meet the requirements of section 804 of 21 USC. Until recently, about 5 percent of prescription drug packages sent from Canada were being seized.
- DEADrug Enforcement AdministrationThe Drug Enforcement Administration is a federal law enforcement agency under the United States Department of Justice, tasked with combating drug smuggling and use within the United States...
and FDAFood and Drug AdministrationThe Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
generally do not target consumers unless drugs are imported in large quantities (suggesting intent to distribute) or represent a perceived danger to public health (opiates, amphetamines). - Rarely, drug importation laws are enforced on the local level. For example, in June 2005 in Baton Rouge, LouisianaBaton Rouge, LouisianaBaton Rouge is the capital of the U.S. state of Louisiana. It is located in East Baton Rouge Parish and is the second-largest city in the state.Baton Rouge is a major industrial, petrochemical, medical, and research center of the American South...
, a number of customers of online pharmacies were arrested by local law enforcement officers and charged with possession of a controlled substance without prescription.
UK consumers
In the UK more than 2m 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 RPSGBRoyal Pharmaceutical Society of Great Britain
The Royal Pharmaceutical Society of Great Britain was formerly the statutory regulatory and professional body for pharmacists and pharmacy technicians in England, Scotland and Wales...
introduced a green cross logo to help identify accredited online pharmacies (from 2010 the internet pharmacy logo scheme is run by the GPhC
General Pharmaceutical Council
The General Pharmaceutical Council is the body responsible for the independent regulation of the pharmacy profession within England, Scotland and Wales, responsible for the regulation of pharmacists, pharmacy technicians and pharmacy premises...
).
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 November 1999. The UK is a frontline leader in internet pharmacy since the law change in 2005 that made it legal for pharmacies to sell 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 low flat price or nothing for prescribed medicine (except for medicine classed as lifestyle medicine, eg: anti-malarials for travel), and medical equipment.
In the UK, online pharmacies often link up with online clinic doctors. Doctors carry out online consultations and issue prescriptions. The company employing the doctors must be registered with 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 carry out the online consultations; sometimes it is done almost entirely by questionnaire. Customers usually pay one fee which includes the price of the consultation, prescription and the price of the medicine.
Related topics
- The Silk Road (anonymous marketplace), an online marketplace thought to facilitate the anonymous sale of illegal drugs
- Internet fraudInternet fraudInternet fraud refers to the use of Internet services to present fraudulent solicitations to prospective victims, to conduct fraudulent transactions, or to transmit the proceeds of fraud to financial institutions or to others connected with the scheme....
External links
- FDA Enforcement Policy Regarding the Personal Importation of Violative Drugs (unapproved drugs in the US) — US Customs and Border Protection