The pharmacy: first established by ancient peoples seeking relief from ancient ailments by extracting would-be remedies from myriad foraged natural resources. The practice of treating wellness locally with a physical remedy even then, was rooted in good faith; to aid in another’s recovery from an injury or a disease. These concepts of community and healing are the pillars of the pharmacy. The ideal remains a common thread of today’s consumer habits of purchasing food from a trusted local grocer, and filling prescriptions with a trusted local pharmacy.
Today’s “neighborhoods” are newly defined, with familial groups congregating on larger regional, national, and global scales. One’s online community may be more familiar to them than the street they live on, for example. With this social paradigm shift, come new definitions of interaction with our friends, our occupations, our commerce, and our health care.
Modern consumers are steering away from traditional brick-and-mortar retail, leading to a spike in store closures. According to major news outlets, as of April 2019, US Retailers plan to close more stores this year, than in all of 2018. The New York Times states, “As the internet continues to change shopping habits, stores across the United States continue to close. Less than halfway through April (2019), American retailers have announced plans this year to shut 5,994 stores, exceeding the 5,854 announced in all of 2018”. In this on-demand, a la carte age of consumerism, our ideal user experience is based on a point-and-click, doorstep delivery model.
Studies are also finding that prescription drug consumption by Americans has steadily increased. According to a recent Consumer Reports study, “the total number of prescriptions filled by all Americans, including adults and children, has increased by 85 percent over two decades, while the total U.S. population has increased by only 21 percent”. More Americans are seeking the physical and mental support they need through prescribed medication, and do so through online resources.
While pharmaceutical best practices have shifted seismologically since the days of early man mixing mud salves, or Grecian botanists muddling herbal remedies, the scientific channel that led us to modern medicine has forged both a confident prescriber, and a discerning patient. As the consumer of the prescription, it is up to the patient to weigh his or her options, and judge the best available treatment. Fortunately, we live in an age where options abound, and online pharmacies are quickly becoming the first choice for consumers. The always-on availability of the online pharmacy makes an ideal option for those who seek both quality treatment, and the comfortable familiarity of the online marketplace. For those considering having their prescriptions delivered to their doorsteps, there are a few questions that may first need answering:
- How do I choose the right online pharmacy?
- Which prescriptions can and cannot be shipped to me?
- How does an online pharmacy verify my Doctor’s approval?
- How do I know the prescriptions I order are legitimate?
- Is an online pharmacy right for me?
Let’s start with what to look for in an online pharmacy. According to the U.S. Food & Drug Administration, there are a host of factors and characteristics of online pharmacies one should consider before moving forward. In order to choose the right prescription provider, and to make sure you’re keeping yourself safe, the FDA states that online pharmacies must:
- Require a valid prescription
- Provide a physical address in the United States
- (Be) licensed by the state board of pharmacy in your state and the state where the pharmacy is operating
- Have a state-licensed pharmacist to answer your question
– fda.gov
Confirming these four items with your online pharmacy selection should be the first step in solidifying your prescription provider. Every reputable stand-alone pharmacy in the country is governed by these baselines. Why would an online pharmacy function any differently? So, while the standard consumer may not be asking each CVS they walk into for copies of their state licensing credentials, or pharmacists’ state-issued pharmacology licenses, these should certainly be boilerplates of your online pharmacy selection criteria. Remaining a discerning consumer will protect you on both health and financial perspectives.
Choosing the right online pharmacy is paramount. One of the biggest factors when evaluating an online pharmacy is whether or not it is credible. While your insurance provider may be able to offer a preferred online pharmacy recommendation, it is up to the consumer to do their homework. Substantial risks loom in choosing the wrong online pharmacy. The FDA believes this so strongly, they’ve dedicated resources to a national BeSafeRx campaign, to “raise awareness of the dangers of buying medicines from fake online pharmacies”. They have highlighted the many benefits of online pharmacy usage (expedited access; insurance plan support; potential cost savings; convenience), but also warn of three primary pitfalls:
- Receiving counterfeit or poor-quality medication
- The drugs you receive may look real, but they could be counterfeit, contaminated, expired or otherwise unsafe, per the FDA
- Consuming unsafe, unapproved ingredients
- Medicine that is approved for use in the United States has been reviewed for safety and effectiveness by the FDA. Medicine that may be approved in other countries or produced by unknown sources may have slight variations or different ingredients that could cause you to get sicker, develop a resistance to your medicine or cause new side effects. If you take more than one medication, these differences could also affect the way other medicines work or cause harmful interactions, per the FDA
- Risking compromising your identity and financial well-being
- Most fake online pharmacies lack adequate safeguards to protect personal and financial information, and some intentionally misuse the information you provide. These sites may infect your computer with viruses or sell your personal information to other rogue websites and Internet scams, per the FDA
Selecting the right online pharmacy is critical for a number of reasons. Making that selection can be a trying task in and of itself. Ingesting counterfeit or poorer quality medicines could exacerbate your symptoms or ailments. According to the National Association of Boards of Pharmacy, consumers in the online pharmacy marketplace should always verify with the pharmacy’s VIPPS seal. This stands for “Verified Internet Pharmacy Practice Sites” and it should accompany any reputable online pharmacy. Ensure your online pharmacy is VIPPS approved before placing your first order.
Are there prescriptions that I cannot get shipped to me? Short answer, yes. For example, the U.S. Dept. of Justice prohibits a number of drugs and medicines from being imported into the U.S. Medications Outside of FDA regulations that may have been purchased from foreign countries cannot legally be shipped to consumers. With the FDA’s stamp of approval though, most medications available for distribution to and from a brick-and-mortar pharmacy, are eligible to ship to a residence.
There are classifications of medications that may require further credentialing for shipping, and details should be discussed with your pharmacy. These drug “schedules” are formed and regulated by the DEA under five distinct categories, based upon the drug’s “acceptable medical use and the drug’s abuse or dependency potential (which) is a determinant factor in the scheduling of the drug”.
Here is a list of the DEA’s five drug schedules, which can be found on the government website or via the link above:
Schedule I: Drugs defined with no current “accepted medical use and a high potential for abuse”
- Examples include: street drugs (cannabis, methamphetamine, etc.)
Schedule II: These are drugs defined as dangerous, and having a high potential for abuse, potentially leading to “severe psychological or physical dependence”
- Examples include: Vicodin, Demoral, fentanyl, oxycodone, Adderall, Ritalin
Schdule III: Drugs defined with “moderate to low” potential for dependency or abuse
- Examples include: codeine, ketamine, anabolic steroids
Schedule IV: Drugs with low potential for dependency or abuse
- Examples include: Xanax, Valium, Ambien, Tramadol, Ativan
Schedule V: Drugs with lowest potential for dependency or abuse and generally associated with “antidiarrheal, antitussive, and analgesic purposes”
- Examples include: Robitussin AC, Lomotil, Lyrica, Parepectolin
Additionally, because regulations vary from state-to-state, you should confirm which classification schedule your prescription may fall under to ensure timely delivery. The subscriber’s health insurance status may also hold bearing on the shipment of certain schedules of drugs. For more information on where you live, go here to find your state’s pharmacy licensing database.
Working through a credible, licensed online pharmacy will guarantee that all government approved medications will ship. Per the U.S. Postal Service, “All prescription, nonprescription, and patent medicines and related items, including solicited and unsolicited samples of such items, that are not considered to be controlled substances, are permitted to be mailed as follows: For prescription medicines containing a nonnarcotic drug(s), only a pharmacist or medical practitioner, etc.,who dispenses the medicine may mail such substances to the patients under their care.”
Additional items to discuss prior to your prescription shipment may include the following:
- Child-proof packaging. Are there family members at home that could gain access to the delivered medications?
- Temperature regulated medications. Does your online pharmacy’s preferred logistics provider follow thorough protocol for drug refrigeration? Do they keep the temperature regulated throughout the entire logistics cycle? Do they have proper temperature monitoring equipment? Has the medication provider ensured proper temperature-controlled packaging (tcp)? Best practices can be found in more detail on the UPS website, under their guidelines for shipping pharmaceuticals.
- Generic drug substitutes. As with traditional name-brand prescriptions obtained at a physical pharmacy, generic drug substitutes may also be available through your online pharmacy.
How does my online pharmacy communicate with my doctor? The protocol of every licensed online pharmacy mirrors that of a traditional pharmacy:
- Prescriptions can typically either be mailed in by the consumer with accompanying health insurance information
- Prescriptions can be called in by your doctor
The U.S. National Library of Medicine (NLM) has performed extensive research on the relationships of pharmacies, doctors, and hospitals. Communication protocol seems to vary circumstantially, but best practices are in place when submitting prescriptions from the doctor’s office to the pharmacy. The NLM notes, “Background Effective communication between health professionals contributes to safe and efficient patient care, whereas communication breakdown can lead to adverse patient outcomes and increased healthcare expenditure”.
How do I know if my prescriptions are legitimate? Government agencies designed specifically for the protection of American consumers have scrutinized the legitimacy of online pharmaceutical marketplaces since their inception. The FDA in particular warns consumers to be discerning, and has identified the following signs of a fake online pharmacy:
- Allows you to buy drugs without a prescription from your doctor
- Offers deep discounts or cheap prices that seem too good to be true
- Sends spam or unsolicited email offering cheap drugs
- Located outside of the United States
- Not licensed in the United States
As online pharmacies become more popular, we are seeing a concurrent amount of fraudulent pharmaceutical resources. Thankfully, with the growth of the online marketplace, comes advocacy and safety for its consumers. Tools to verify online pharmacy legitimacy are now available to consumers, from trusted resources like The Center for Safe Internet Pharmacies (CISP). Through “education, enforcement, and information sharing,” organizations like the CISP are helping to keep prescribers safe from potentially harmful fake medicines, and from fraudulent financial missteps.
Knowing the risks associated with some of the more unethical entities within the online pharmaceutical space will help us in educating others and pointing them toward legitimate resources for online prescriptions.
Is an online pharmacy right for me? Well, if the comforts of your own home outweigh the labors of driving to the pharmacy, then yes. If the ability to explore potential cost savings of online medication is important, then yes. Lastly, if you have gone through an agreeable amount of discovery on your online pharmacy of choice, and have verified the aforementioned criteria, then yes, an online pharmacy is right for you.
Remember, these are signs to identify a safe and legal online pharmacy. They must:
- Always require a doctor’s prescription
- Provide a physical address and telephone number in the United States
- Offer a pharmacist to answer your questions
- Have a license with your state board of pharmacy.
If you’re interested in more information, visit save.health for valuable insight and additional resources.
REFERENCES
- nytimes.com
- wsu.edu (College of Pharmacy)
- fda.gov (“BeSafeRx” campaign)
- fda.gov (Quick Tips)
- consumerreports.org
- ups.com
- fda.gov (Warnings)
- usdoj.gov
- usps.com
- webmd.com
- dea.gov/drug-scheduling
- ncbi.nlm.nih.gov
- safemedsonline.org (CISP)
