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Online Pharmacies, Personal Drug Importation, and the Public Health: History of Online Pharmacies

On February 12th of this year, we sent a comprehensive report about buying medication online to the Senate Committee on Health, Education, Labor and Pensions and House Committee on Energy and Commerce. Our purpose was to correct the public record by challenging a flawed report about Internet pharmacies written by the Government Accountability Office (GAO) back in 2013. The GAO’s report essentially parroted the narrative that the pharmaceutical companies, U.S. pharmacies, and FDA want you to hear, which ignores the existence of safe international online pharmacies that help Americans afford safe medication. Due to the incredible importance of this issue, we are publishing a section of our report each week. For the full report, click Online Pharmacies, Personal Drug Importation and the Public Health.

This week you can read a “History of Online Pharmacies.” It’s not a comprehensive history but gives the reader enough background to digest the larger issues contained in the report. When you think about, online pharmacies are really “mail order pharmacies” with websites. Did you know that mail order pharmacy has been around for well over a hundred years?

The Internet has facilitated a major proliferation of mail-order pharmacy operations. Mail-order pharmacies are not new; they have served Americans since the late 1800s. Internet pharmacies, often referred to as “online pharmacies,” can be defined as websites that market and sell prescription medication over the Internet that is dispensed by mail-order. When they began operating in the mid to late 1990s, online pharmacies quickly became a subject of concern for federal regulators and Congress due to dangerous and illicit practices. The NABP created the Verified Internet Pharmacy Practice Sites (VIPPS) in 1999, a voluntary program open to domestic pharmacies to help consumers identify safe online pharmacies.

Drugstore.com, which launched its website in 1999, was considered a first-mover in the industry and an example of a safe online pharmacy without a bricks-and-mortar presence. It required a valid prescription and dispensed medication from a licensed pharmacy. By the beginning of the last decade, most major chain pharmacies were doing business online by taking new and refill prescription orders, and mailing them across the country. Drugstore.com and most but not all online pharmacies associated with major chain pharmacies and Pharmacy Benefit Management (PBM) companies became VIPPS-approved by 2003.

Around 2000, Canadian pharmacies began online marketing to reach American consumers, which provided Americans with access to low-priced drugs. Previously, personal drug importation from Canada was relegated to those living on border-states. This issue also gained public attention through media coverage of bus trips, which brought seniors up to Canada to buy medication and were sometimes sponsored by U.S. politicians supportive of reforming drug importation laws. Canadian pharmacies later began partnering with licensed pharmacies in other countries, such as Australia, New Zealand, and the UK, and later India and Turkey, as well as those in free trade zones. They did so in part to evade supply restrictions imposed by pharmaceutical companies against Canadian pharmacies, but also to take advantage of even lower drug prices found elsewhere and to increase profits.

In 2002, PharmacyChecker.com began operations to verify both U.S. and foreign online pharmacies – as well as to compare drug prices for consumers seeking the lowest prices for their medications. CIPA was founded that same year. CIPA’s vice president testified at a congressional hearing in 2003 entitled: “International Prescription Drug Parity: Are Americans Being Protected or Gouged?” In 2004, the FDA recognized PharmacyChecker.com’s efforts to help consumers find the lowest prices and directed people to www.pharmacychecker.com as part of media relations efforts to show that U.S. generic drug prices are lower in the U.S. than in Canada.

While the Internet has enabled millions of Americans to find safe and lower cost medication from outside the U.S., it has also created a public health minefield where dangerous websites posing as safe pharmacies, U.S. and foreign, are accessed every day. Such websites sell fake, adulterated and/or low quality medication, or genuine and safe prescription drugs but without requiring a prescription. These rogue online pharmacies are a serious threat to patient safety and have caused sickness and death.

While too many Americans today have online access to and buy from rogue foreign pharmacies, many are benefiting from safe foreign pharmacies. Americans, including elected officials and public health regulators, know that low-priced and safe prescription medication can be found online internationally. For instance, former Health and Human Services Secretary Kathleen Sebelius adopted a personal drug importation program when she was Governor of Kansas that allowed consumers to find international pharmacies over the Internet. The State of Maine recently updated its pharmacy licensure requirements to permit sales from pharmacies that are licensed in Australia, Canada, New Zealand and the United Kingdom, in effect abolishing state restrictions on personal drug imports from those countries.

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TechDirt Founder Mike Masnick Hits the Nail on the Online Pharmacy Head

In writing about the web domain company EasyDNS’ online pharmacy policy, Mike Masnick, founder of award-winning technology and business innovation blog Techdirt, makes the following observation:

“Fake and dangerous drugs from rogue pharmacies are a real (if relatively small) problem. Legitimate foreign pharmacies selling into the US at cheaper prices are a made up problem by US drug companies. But those US drug companies like to take the “small” problem, and blame it on any non-US pharmacy in an attempt to block out the competition.”

Thank you Mike for expressing that so clearly! The essence of TechDirt is to “analyze and offer insight into news stories about changes in government policy, technology and legal issues that affect companies’ ability to innovate and grow.” Innovation via the Internet has allowed consumers who can’t afford their medicine domestically to access it through foreign pharmacies. The pharmaceutical industry and its well-funded agents are getting away with murder by pressuring online “gatekeepers” such as domain registrars, search engines, and credit card companies to disallow service to pharmacies that American consumers have come to rely on.

To some in the public health community and in government, Mike’s expression of rogue online pharmacies as a “relatively small” problem” may come across as flippant and even naïve – but it cuts much deeper than that. The question is relative to what? If he means relative to the public health crisis of high drug prices in America then Mike is entirely correct: rogue online pharmacies are a small problem compared to high drug prices in America. Far more Americans are getting sick and/or dying because they can’t afford medication at home than they are from dangerous online pharmacy purchases.

That does not excuse the actions of rogue pharmacy websites that endanger the health of consumers. That’s precisely why EasyDNS’ decision to only provide service to online pharmacies if they are approved by LegitScript or PharmacyChecker is visionary. It does not let dangerous pharmacy websites exist, but it refuses to succumb to a protectionist, anti-consumer, big pharma initiative to snuff out innovative business models – safe international online pharmacy – that hinder their profit-making machine and grossly disadvantage consumers.

Rock on TechDirt!

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PharmacyChecker.com Vice President Decries Lack of Government Action To Help Americans With High Drug Prices

A popular industry/government blog called Pharmalot, now Pharmalive.com/pharmalot published an op-ed written by our vice president, Gabriel Levitt, explaining why high drug prices are literally making Americans sick, costing taxpayers hundreds of billions of dollars, and how so little is being done by the government. The fact is that American consumers and taxpayers are getting pilloried under the weight of high drug prices. Personal drug importation through safe international online pharmacies is a life saver – sometimes literally because those who go without medication due to cost sometimes die. This won’t change until drug prices come down in America.

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