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Helping Americans Get The Truth About Prescription Drug Savings
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Tens of millions of Americans cannot afford medication, which can lead to more sickness, hospitalizations, and even death. Despite this public health crisis, our trusted regulatory authorities, the pharmaceutical industry, and U.S. pharmacy trade groups work together to scare Americans away from ordering much more affordable medications from foreign pharmacies. Is that right or wrong?

This week, in our continuing quest to get the truth out and for our elected leaders in Congress to take bold action to protect online access to safe and affordable medication, we’re publishing the next section of our report called Online Pharmacies, Personal Drug Importation, and Public Health

Properly and Ethically Educating Consumers about Online Pharmacies

The GAO was tasked under Section 1127 to report on efforts to educate consumers about the dangers of buying drugs online. Educating consumers about the dangers of rogue online pharmacies is another important measure to protect the public health. The programs and outreach of FDA and several GAO stakeholder entities created to educate consumers about online pharmacies are identified but not fully examined in the GAO report. In considering the benefits and risks of online pharmacies, the public health and interest are best served when consumers are provided the most accurate information on how to avoid rogue pharmacy websites and find safe and affordable medication on the Internet.

In warning them against rogue online pharmacies, the public education programs identified in the GAO report communicate the message that the only safe online pharmacy options are domestic ones. That message is inaccurate and inimical to public health imperatives. Independent studies, consumer testimonials, fifteen years of experience, and numerous state drug importation programs show that there are safe international options for obtaining affordable and safe medication. The GAO report appears to actually criticize the U.S. states that implemented programs to help their residents find affordable medication online from international pharmacies. It is here where GAO’s analysis is perhaps most flawed:

More recently, some state and local governments implemented programs that provided residents or employees and retirees with access to prescription drugs from Canadian Internet pharmacies. Despite FDA warnings to consumers that the agency could not ensure the safety of drugs not approved for sale in the United States that are purchased from other countries, the prevalence of such programs may have contributed to a perception among U.S. consumers that they can readily save money and obtain safe prescription drugs by purchasing them from Canada.

Since U.S. consumers do readily save money and obtain prescription drugs by purchasing them from Canada and other countries, the GAO’s analysis is misguided. GAO’s own research tested Canadian Internet pharmacies and found that they all sold genuine medication and required a prescription.

As reported by GAO, through its “BeSafeRx” program, the FDA advises Americans about dangers associated with buying medication online, how to avoid rogue online pharmacies, and how to identify legitimate ones. The FDA’s program overreaches by scaring Americans away from safe international online pharmacies. In an article published on ABC News’ website, FDA Commissioner Margaret Hamburg is quoted as saying:

If the price is bedrock cheap and it seems too good to be true, it probably is too good to be true. And if it is not located in the United States and it’s offering to ship drugs worldwide, another red flag; don’t go there.

The drug prices at safe international online pharmacies, which are often much lower than domestic prices, are true and are sometimes the only affordable ones for Americans shopping online.[1] Since prescription drug utilization is price elastic, meaning high drug costs are associated with Americans not taking prescribed medications, consumers who are scared away from a lower cost international online pharmacy that sells genuine, safe and effective medication may unnecessarily go without their prescribed treatments. In effect, FDA’s public education program, which warns Americans against buying from any non-U.S. online pharmacy, may exacerbate problems of prescription non-adherence and financial hardship.

The GAO report mentions NABP’s application to the Internet Corporation for Assigned Names and Numbers (ICANN) to operate a registry, generic top-level domain (i.e., .com, .edu, .gov, etc) called .pharmacy. NABP plans to set global standards for any website selling medication; of a non-profit group that focuses on pharmacy-related issues; and providing information about medication for those wishing to obtain the .pharmacy gTLD. The .pharmacy application was funded by Eli Lilly, Gilead, Jansen Therapeutics, Merck and Pfizer.[2] NABP’s standards exclude any international online pharmacy that sells into the U.S. from obtaining .pharmacy. Consumer advocates and public health activists, as well as Internet freedom activists, have protested NABP’s application for .pharmacy.[3] Congress should eschew legislation that would codify this standard and also consider blocking funding to public education campaigns that would employ NABP’s .pharmacy as a means to scare Americans away from every online pharmacy that does not end in .pharmacy.

[1] Supra note 21. The peer-reviewed literature showing the safety of credentialed international online pharmacies is important but not necessary to prove that the prices listed on are for genuine medications are therefore true.

[2] Funding sources transparently disclosed by NABP: [Last accessed 10/30/2014].

[3] Masnick, Mike, “Big Pharma Firms Seeking Pharmacy Domain to Crowd Out Legitimate Foreign Pharmacies,” May 17, 2013, TechDirt; see [Last accessed 10/30/2014]. Also see, “Opposition Grows to Pharma-Funded Application by NABP for .Pharmacy to ICANN,” see [Last accessed 10/30/2014].

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