by Tod Cooperman, MD, President, PharmacyChecker.com, and Gabriel Levitt, Vice President, PharmacyChecker.com | Mar 7, 2013 | Drug Importation, Healthcare Reform, Online Pharmacies, Pharmaceutical Industry
Dr. Roger Bate, an economist who publishes extensively about drug quality, safety, and intellectual property, finds himself a bit out in the cold right now and we think that’s wrong. It’s all because of his latest work on Internet pharmacies and personal drug importation.
He was once a favorite of the pharmaceutical industry. In a 2004 National Review article called “What Patent Problem?” Dr. Bate enraged the progressive, health activist community for arguing that patents are not obstacles to needed medication in poor countries because 95% of World Health Organization Essential Medicines are already off patent. Arguments like those were welcomed by industry, but things have changed. His recent research showing that personal drug importation (which undermines pharmaceutical profits) through online pharmacies can be safe has made him persona non grata in some pharma circles, despite his other positions which support pharma. Unfortunately, it seems the health activist community is also hesitant to embrace Dr. Bate’s current work on personal drug importation, perhaps because they don’t want to lend credence to his past research.
We think it’s time that everyone, including the FDA, listens carefully to what Dr. Bate is saying about personal drug importation. After extensive mystery shopping and testing of products, Dr. Bate came to a very simple conclusion: As long as people purchased medication from websites (foreign or domestic) approved by PharmacyChecker.com or the National Association of Boards of Pharmacy, they were generally safe doing so. His data also showed that Americans could save a lot of money (an average of 52%) on brand name medicines from legitimate pharmacies outside the U.S. He believes this option, to be fair, should exist mainly for lower income individuals rather than people able to afford U.S. prices.
Dr. Bate’s conclusions about online pharmacy are an inconvenient truth for the pharmaceutical industry and U.S. pharmacies – which include some of the funders of his employer, the American Enterprise Institute. These industries lobby the government to prevent Americans from accessing drugs online at lower cost from foreign pharmacies. Their strategy has been to ignore Dr. Bate’s findings on Internet pharmacies. The FDA seems to be playing the same game by scaring the public away from personal drug importation through public information campaigns, such as Be Safe Rx.
We know that Dr. Bate’s work on online pharmacies is guided by hard data, objective analysis, and his free market sensibilities. We do not agree with his positions on all subjects, but his studies on drug safety demand respect from all sides and could help policy-makers reach the right conclusions for the public good.
Tagged with: Counterfeit Medication, Online Pharmacies, Pharma, Roger Bate
by Gabriel Levitt, President, PharmacyChecker.com and Prescription Justice | Dec 31, 2012 | Advocacy, Drug Importation, Drug Prices, Medication non-adherence, Online Pharmacies, Personal Drug Importation, Pharmaceutical Industry, Skipping medications
The Deadly Problem of High Drug Costs and How Personal Drug Importation Helps
High prescription drug prices continue to be a public health crisis in America and the problem appears to have worsened throughout 2012. The added healthcare costs to the economy caused by Americans not taking their medication have increased from $290 billion to $313 billion. According to a study by the New England Healthcare Institute, over one million Americans die each year because they do not correctly take needed medications or do not take them at all. Though not all of those deaths are due to cost, it’s fair to estimate that hundreds of thousands of Americans are dying each year because drug costs are the number one reason for people not taking prescribed medications. It follows that all avenues of access to safe and affordable medication save lives, including access to safe online pharmacies with the lowest drug prices, international or domestic, which are a real lifeline for American consumers. Therefore, the federal statute banning personal drug importation under most circumstances doesn’t change the fact that current access to safe personal drug importation is good for the public health.
Savings Online Internationally Have Increased; U.S. Has Best Deals on Generics
Online pharmacy savings increased in 2012 due to lower international pharmacy prices coupled with extreme drug price increases – 13 % — in the United States. The potential savings on popular brand name drugs increased to 85% in November 2012 from 80% in March 2011, according to PharmacyChecker.com research. Online pharmacy savings are greatest on brand name medications, which when purchased internationally often help Americans save thousands of dollars each year. Some American lives are saved by online access to international pharmacies. In stark contrast to pricing on brand name drugs, U.S. generic drug prices remained globally competitive and offered Americans their best bet on many popular medications available generically at U.S. pharmacies, such as Walmart’s $4 discount programs, and usage of prescription drug discount cards. And because many popular drugs, such as Lipitor and Plavix, are now sold generically in the U.S., we can expect a shift from international to domestic pharmacies in 2013.
Rogue Online Pharmacies vs. High Drug Prices: Which is More Dangerous?
Rogue online pharmacies are a serious public health threat and need to be put out of business, but the draconian public health consequences of Americans going without needed medication due to cost is a much bigger problem. While one death is too many, very few Americans have died from rogue online pharmacies, domestic or foreign. In dire contrast, as mentioned above, it’s estimated that over one million Americans die each year from not taking needed medication with U.S. drug costs identified as the main culprit behind Americans going without prescribed medication. It’s worth noting that the research showing this sobering data was funded in part by pharmaceutical companies, including PhRMA and Pfizer (Read the research by the New England Health Institute. Follow this hyperlink to the full report; the sponsors are made clear).
The Media Storm of Misinformation on Online Pharmacies
It’s not a freakish editorial accident that the media appears far more interested in reporting about the evils of online pharmacies, especially foreign ones, and their dangers, than the national disgrace of high drug prices causing bankruptcy, sickness, hospitalization and death. The amazing profits of the global pharmaceutical industry are overwhelmingly dependent on charging U.S. consumers the world’s highest prescription drug prices. Preventing Americans from access to lower international drug prices is obviously one of their major goals. The power of the pharmaceutical and the U.S. pharmacy industries, exercised through billions of dollars spent on advertising, lobbying, and media relations, has led to the mainstream media propagating a false narrative about an online marketplace in which it’s not safe to buy lower priced medication from non-U.S. online pharmacies under any circumstances. We’ve written about most of the groups responsible for perpetuating the false narrative:
Alliance for Safe Online Pharmacies
Center For Safe Internet Pharmacies (CSIP)
LegitScript.com
National Association of Board of Pharmacy
Partnership For Safe Medicines
With the exception of CSIP, each of the groups above receives funding or revenue from the pharmaceutical industry, U.S. pharmacy industry, and/or the U.S. Food and Drug Administration. They all conflate the evils of dangerous rogue online pharmacies with the safe practice of personal drug importation from safe online pharmacies, mostly based in Canada. While FDA’s policies continue to allow Americans to personally import prescription medication, the FDA now engages fully in promoting the industry-sponsored media script. CSIP is largely the brain child of the White House Office of the Intellectual Property Enforcement Coordinator, an office dedicated to protecting intellectual property rights and strenuously lobbied and influenced by the pharmaceutical industry.
The Truth About Online Pharmacies
There are many international online pharmacies, mostly based in Canada, that have operated safely and ethically for over a decade. Independent research demonstrates that there are clearly safe online pharmacies, international and domestic, including those approved by PharmacyChecker.com. Safe international online pharmacies meet the same or similar standards as U.S. mail-order pharmacies. Their main difference is that they sell medication at a much lower price than U.S. pharmacies. They are not rogue online pharmacies. It’s that simple.
The dangers of rogue online pharmacies are very serious. Such rogues purport to be real and safe pharmacies when often they are not selling from licensed sources, requiring prescriptions or following other basic pharmacy safety protocols. Some online pharmacies are even operated by organized crime groups. And some sell deadly products.
Online Pharmacies in 2013
In 2012, law enforcement successfully shutdown more dangerous rogue sites. We should all applaud and encourage further efforts to crackdown on rogue online pharmacies. But we should also expose misinformation being spread by the pharmaceutical industry about safe international online pharmacies. Their misinformation directly leads to Americans going without medication because people are scared away from online pharmacies that sell the medications they need at a price they can afford.
To help protect the ability of Americans to safely import affordable prescription medication, we encourage you to become part of the RxRights.org movement. Join RxRights.org and contact your elected officials now to let them know Americans need access to safe medication that is affordable, including through personal drug importation.
American consumers should be able and encouraged to purchase safe medication at the lowest possible prices, whether domestically or internationally. Federal and state laws that decrease access to safe and affordable medication are neither ethical nor conducive to protecting the public health. Comparing drug prices among licensed and safe pharmacies and making this information available online for consumers helps maximize access while greatly minimizing risks: PharmacyChecker.com will proudly as ever continue to do so in 2013.
Happy Holidays and New Year!
Gabriel Levitt
Vice President
PharmacyChecker.com
by Gabriel Levitt, Vice President, PharmacyChecker.com and Sam Werbalowsky, Pharmacychecker.com | Jul 31, 2012 | Drug Prices, Pharmaceutical Industry, Politics
Picture from CNN coverage of the Medicaid Fraud
The pharmaceutical industry and FDA seem to want us to buy medicine at high prices. They say it’s dangerous to import cheaper medicine, even though it’s been shown to be safe when done through pharmacies approved by PharmacyChecker.com. In fact, recent events show that their supported high drug prices can cause major drug safety problems right here at home.
Forty-eight people in a nationwide Medicaid fraud syndicate were recently arrested for buying prescription drugs from Medicaid recipients and re-selling them. The medications included Zyprexa for Schizophrenia, Atripla and Trivizir for HIV/AIDS, and also asthma medications. As reported in the Wall Street Journal and CNN, the drugs made their way through a black market to a supply chain of “collectors” and “aggregators”, eventually working their way into wholesale companies and pharmacies in New York, New Jersey, Pennsylvania, Massachusetts, Utah, Nevada, Louisiana, and Alabama. The medications were also sold in bodegas on the street.
Medicaid fraud is not new but the scope of this will cost taxpayers $500,000,000. The scariest thing about this fraud is that the drugs made it into licensed pharmacies throughout the United States. These drugs could have been adulterated, mishandled, or improperly stored – they may no longer be safe.
What lessons should we learn from this? Here are two to consider:
- High drug prices helped create this black market, weakening the U.S. drug supply
- As a result, American taxpayers bear the burden of higher healthcare costs.
High drug prices helped create this black market, weakening the U.S. drug supply
Medicaid patients sold their drugs because it was highly profitable, despite consequences to their own health. Pharmacies bought from black market wholesalers because their prices were cheaper. End-users bought medicine they needed from bodegas and street corners because it was cheaper than a trip to the pharmacy.
In countries with much lower drug prices there is less incentive for this type of fraud. We’ve made price comparisons among the types of prescription drugs fraudulently sold in the U.S. by looking at U.S. and international pharmacy prices.
Savings On Popular Medications Found in Fraud
| Drug |
US Bricks-and –Mortar price |
Lowest International Price Found on PharmacyChecker.com |
Savings |
Percent Savings |
1 year savings |
| Atripla |
$18,000.00 |
$4,012.20 |
$13,987.80 |
77.71% |
$55,951.20 |
| Truvada |
$4,500.00 |
$1,716.00 |
$2,784.00 |
61.87% |
$11,136.00 |
| Zyprexa Generic 5mg |
$1,161.00 |
$40.50 |
$1,120.50 |
96.51% |
$4,482.00 |
| Advair 250-50 mcg |
$947.97 |
$139.00 |
$808.97 |
85.34% |
$3,235.88 |
All prices collected on 7/19/2012. Bricks-and-Mortar pharmacy located in New York City
American taxpayers bear the burden of higher healthcare costs:
We paid taxes for Medicaid beneficiaries to not take their medicine as prescribed, and to instead sell their medicine. We paid the costs of hospitalization and emergency room visits for these people who went without needed medication and maybe even the end-users, who took potentially adulterated medicine.
It’s also likely that Medicaid was double-billed for the same exact pills: the first time when a Medicaid recipient received it; the second time when it was dispensed again from another pharmacy that received it from black market channels.
Despite problems with our distribution system, the U.S. has one of the world’s safest pharmaceutical supplies. However, the U.S. is not alone in having safe medication – not even close. The pharmaceutical industry and their supported groups fool consumers, elected officials and the media into believing that online pharmacies outside the United States are all dangerous, which, to be polite, is factually inaccurate. Let’s bring some balance to the issue and look at the drug supply problems in our own backyard. The problems here are serious, too, and fraud like this could even be prevented if there were easier access to safe and affordable medication.
Tagged with: Drug Prices, FDA, Fraud, medicaid
by Tod Cooperman, MD, President, PharmacyChecker.com, and Gabriel Levitt, Vice President, PharmacyChecker.com | Jul 24, 2012 | Advocacy, Drug Importation, Drug Prices, Online Pharmacies, Pharmaceutical Industry
A new organization, the Center for Safe Internet Pharmacies (CSIP) – safemedsonline.org – made its debut yesterday. Unfortunately, the group seems more focused on keeping its big corporate members in the good graces of the pharmaceutical industry and government than on helping American consumers. In fact, its actions may endanger public health.
This should come as no surprise, as the plan to create the Center for Safe Internet Pharmacies was hatched by the White House Office of the U.S. Intellectual Property Enforcement Coordinator in 2010 which, as previously reported here, was handed the plan by the pharmaceutical industry. The plan fit very well with the Stop Online Piracy Act (SOPA) and Protect Intellectual Property Act (PIPA) legislation which was eventually shelved.
The Center for Safe Internet Pharmacies has two main activities. The first is to educate, or more accurately, “scare,” the public away from using “illegal” pharmacies, which appear to include licensed and safe pharmacies outside the U.S. which sell genuine but lower priced medicine to Americans. The second is to work with the U.S. government to “shut down” chosen online pharmacies by blocking their ability to appear in online searches and to accept payments.
CSIP has handed over the job of deciding which online pharmacies are okay to LegitScript, which has its own suspect past and intentions. All non-US online pharmacies are branded “not approved” by LegitScript on the basis that it’s technically illegal to personally import most medications – even though the government, in its wisdom, has permitted it. Moreover, it appears that LegitScript is essentially a private sector extension of the FDA as evidenced by its $2.6 million government contract.
As part of its launch, the Center for Safe Internet Pharmacies produced a scare video showing a caring, young woman go online to research and order lower-priced medication online for an elderly relative. The relative then falls ill and the young woman worries that the medicine may have been fake or even “rat poison” and, through the miracle of video, the clock is rolled back, the medicine is never ordered, and all is somehow well without the medicine.
This far-fetched horror flick is far more likely to scare people away from affordable medicine than keep them safe. It’s an indisputable fact that for more than a decade millions of Americans, many of whom have trouble paying for prescription medication in the United States, have safely filled their prescriptions, at much lower prices, through online pharmacies in Canada and other countries. Independent research has also shown that medicine ordered from sites approved by PharmacyChecker.com or the VIPPS Program is genuine. If CSIP’s well-funded public relations team could have found a person who was actually injured by ordering medicine with a prescription from an online pharmacy, they would not have had to create a fictitious character and story.
It is well document that tens of tens of millions of Americans go without medication each year due to cost and suffer real illness as a result. Keeping them “safe” means helping Americans find affordable medicine – not cutting a lifeline to it.
There are plenty of rogue pharmacies out there which CSIP can help root out – ones that sell fake medicine and don’t require prescriptions. We hope CSIP decides to focus all of its attention on these real dangers. If not, the real horror story could turn out to be CSIP itself when its actions increase the number of people who go without needed medication or are left impoverished due to prices at pharmacies of which CSIP “approves.”
Tagged with: Center for Safe Internet Pharmacies, CSIP, Drug Prices, LegitScript, Online Pharmacies, Online Pharmacy Verification Services, PIPA, SOPA
by Gabriel Levitt, President, PharmacyChecker.com and Prescription Justice | May 30, 2012 | Counterfeit Drugs, FDA, Pharmaceutical Industry
Consumers searching for Adderall online should use extreme caution. The FDA announced that it found fake Adderall, a drug for Attention Deficit Hyperactivity Disorder and Narcolepsy, is being sold online. Adderall is a controlled substance, a prescription drug with greater addictive potential and subject to strict regulatory controls. Reputable international online pharmacies, such as those approved in the PharmacyChecker.com Verification Program, do not sell this product or other controlled substances to Americans.
Sales of controlled substances online are governed by the Ryan Haight Online Pharmacy Consumer Protection Act, which expressly bans the sale to Americans of controlled substances online from pharmacies that are not registered with the U.S. Drug Enforcement Agency. The Act also prohibits pharmacies from dispensing controlled medication based only on a remote medical consultation, meaning the patient’s prescription must be the result of an initial physical exam. For more see PharmacyChecker.com: Controlled Substances and Online Pharmacies – Use Extreme Caution.
The FDA did not identify the websites that are selling the fake Adderall. According to the FDA, the fake Adderall contained Tramadol and acetaminophen, which is medication to treat pain. The FDA’s announcement also included pictures of authentic and fake Adderall.
Legitimate Adderall
Counterfeit Adderall
Whether the problem is lack of supplies, which is a current problem for Adderall, or high costs, it is understandable that Americans are trying to find access online to needed medication that they cannot get at their local drugstores. But it’s critical to use common sense and only buy from credentialed online pharmacies. This will enable you to get most medications you need and protect yourself from falling victim to fake and dangerous drugs.
Tagged with: Adderall, Counterfeit Drugs, FDA, pharmacychecker.com, Ryan Haight
by PharmacyChecker.com | May 16, 2012 | Counterfeit Drugs, Drug Importation, Online Pharmacy Verification Services, Pharmaceutical Industry
On May 14th, an article appeared in ForeignAffairs.com called “Dangerous Doses: Fighting Fraud In The Global Medicine Supply Chain.” Authors Tim Mackey, Bryan Liang, and Tom Cubic simultaneously report on the counterfeit drug threats and tragedies experienced globally while deceptively attempting to link safe international online pharmacies to this problem. Our vice president, Gabriel Levitt responded in Telling the whole truth about online pharmacies. His response is published below.
Telling the whole truth about international online pharmacies
Over a decade of experience and empirical studies [See “Unveiling the Mystery of Online Pharmacies: an Audit Study” in National Bureau of Economic Research] have shown that credentialed international online pharmacies sell safe and affordable medication, not counterfeit drugs, to Americans who otherwise might cut back or not take their medications at all. These credentialed websites work with licensed pharmacies that require a prescription and meet high safety standards for mail-order pharmacy. They just happen not to be located in the United States, which explains their low prices. They are not a part of the counterfeit drug threat but the authors of this article would like you to think that they are
So why do these authors take this position? Although not well disclosed, the two senior authors are directly affiliated with pharmaceutical corporate interests. Pharmaceutical companies in the U.S. do not want their sales undercut by lower cost imports of the same exact medicines they sell here because it negatively affects their profits. No one disputes this. Bryan Liang maintains a leadership position with the Partnership for Safe Medicines (PSM), which is largely funded by pharmaceutical companies and is currently led by the Deputy VP of Public Relations for the Pharmaceutical Researchers and Manufacturers of America (PhRMA). Thomas Cubic is head of the Pharmaceutical Security Institute (PSI), an organization of pharmaceutical company members. I believe the two entities share an office in Virginia.
The pharmaceutical industry has focused a lot of its lobbying muscle against drug importation laws that could help millions of Americans obtain needed medication. The pharmaceutical industry position is advocated on many levels through Liang’s Partnership for Safe Medicines and Cubic’s PSI, as well as through PhRMA and the National Association of Boards of Pharmacy with the goal of preventing non-US online pharmacies from selling to Americans even if they are safe. A careful reader would certainly find their position in this article.
The authors here accurately acknowledge that a majority of the world’s counterfeit drugs and the subsequent sickness and death they cause are found in countries with weak drug regulations and/or enforcement of laws. But they try and equate huge tragedies in developing countries where counterfeit drugs kill hundreds of thousands with the real but different dangers posed by the Internet.
Let’s just make one thing clear: The counterfeit drug problems found through online pharmacies in the rich countries are real but miniscule compared to the tragedies reported about in poorer countries. In fact, examples provided in this article perfectly reflect the sharp dichotomy in the numbers of counterfeit drug victims in the United States and in poorer countries. Eleven years ago one young American named Ryan Haight, 18, tragically died from an overdose of pills purchased online, which he should have never received. But it’s worth noting that the drug, Vicodin, was real – not counterfeit. In this case, the problem was dispensing medications without proper medical supervision – not counterfeit drugs. The people who sold him the Vicodin went to jail. In Niger, a much larger tragedy occurred – 2,500 people died out of 50,000 who were inoculated with bogus medication. Of course this had nothing to do with U.S. drug importation or online pharmacies. One might have expected the authors to mention the 238 Americans who died after ingesting fake Heparin, which was circulating thorough the legal U.S. drug supply in 2007 and 2008. This, too, had nothing to do with online pharmacies but exceeds in victims any reported incidents having to do with the Internet.
The authors would like you to believe that CanadaDrugs.com, a credentialed international online pharmacy, is a part of the counterfeit drug problem so as to foster actions that could block access to such sites. They state that one of its suppliers is responsible for the counterfeit Avastin in the United States. They fail to mention, however that the counterfeit Avastin had nothing to do with online pharmacies, safe or otherwise. As it happens, many pharmacies in the United States have at one time or another unintentionally sold counterfeit medication – including CVS and Walgreens, which is not a reason to shut them down.
The source of the most recent large scale problem with intentionally sold substandard medications distributed in the United States is in fact GlaxoSmithKline. They were fined $750 million for intentionally distributing millions of substandard pills all across the country. These products were manufactured at their facility in Puerto Rico. U.S. Marshalls confiscated $2 billion of products from the plant in 2005, the largest such seizure in history and worth at least four times the value of all drugs imported by Americans from Canada each year.
There is no doubt that companies and people operating websites that purposefully sell fake drugs or even real drugs without a prescription need to be shut down, and in many cases criminally prosecuted. Victims of bogus online pharmacies certainly go underreported and the problem is very serious. But it’s a different problem from the large scale counterfeit operations that are killing hundreds of thousands of people in poorer countries – a crisis that demands immediate action to prevent the next massacre. The UNDOC may in fact be a better venue for international enforcement efforts, as the authors point out, because police actions may exceed the WHO’s mandate. Interpol’s enforcement work in Operation Pangea definitely took out a lot of bad guys – more such efforts are needed. Certainly working in concert, tapping their respective strengths, UNDOC, Interpol, WHO-IMPACT can bring us to a better place where the counterfeit drug threat goes on the decline.
But when it comes to the American pharmaceutical market, we find 48 million Americans not filling a prescription each year due to cost – an underreported crisis from which many die. Some of these Americans seek affordable and genuine medication online from Canada and other countries to acquire needed medication.
To directly address the core of Foreign Affairs readers, we must not allow our foreign policy and multilateral actions to disadvantage American consumers who are struggling or can’t afford prescription medication. So as we ramp up our efforts to stop criminals from infesting the world with fake drugs let’s not enact policies that will block the access of Americans to life saving medications simply because it improves our corporate balance sheets.
Gabriel Levitt
Vice President
PharmacyChecker.com
President
United Nations Association Brooklyn Chapter
Tagged with: Bryan Liang, Counterfeit Drugs, Online Pharmacies, Online Pharmacy Verification Services, personal drug importation, Thomas Cubic
