International online pharmacies process orders for prescription drugs that are mailed across borders. That’s a simple definition for myriad websites, good, bad and in between, that can be found selling medicine on the Internet. Patients looking online for affordable medicine from another country want to know they will receive a lawfully-manufactured medicine that works. At PharmacyChecker, we believe we’ve developed a system of standards, rules and policies, for evaluating such websites to determine if they are safe and the businesses involved properly licensed. Those online pharmacies that are not only eligible but also willing to accept our monitoring and oversight are verified in our Verification Program. Verified means that an online pharmacy meets our online pharmacy standards of practice and agrees to our monitoring and oversight protocols. PharmacyChecker-verified online pharmacies are eligible to publish a PharmacyChecker seal on their websites and list their pharmacy information and prices on our website.

The main intention of this post is to explain how we know that PharmacyChecker-verified international online pharmacies are superior in safety to unverified international online pharmacies.

Respectfully, there may be other companies, organizations, or associations, that vouch for international online pharmacies with their approvals or seals, but we believe we do much more independently and rigorously.

When we receive an application from an international online pharmacy, the applicant signs a program contract in which they agree to meet our pharmacy standards. Within those standards are basic rules pertaining to pharmaceutical and pharmacy safety. Paramount among them is that a customer must have a valid prescription in order to buy and receive a medication that requires a prescription where the customer is located. Another is that the pharmacy dispensing the medication must be permitted to do so under the laws governing that pharmacy. Customers who have placed an order must have access to a licensed pharmacist to speak to about their medication order. Finally, within the context of the U.S., where PharmacyChecker is located, online pharmacies are banned from our program that sell controlled drugs (meaning addictive prescription drugs), as defined by U.S. law.

Over a decade ago, pharmacies in Canada began selling medicine to Americans via websites. Those became known as “Canadian online pharmacies.” The verification of those sites was straightforward: one pharmacy with its own website. Just because a website says it’s a Canadian pharmacy, doesn’t mean it only sells medicines that you would get in a Canadian pharmacy or that it’s even Canadian at all. Many Canadian online pharmacies are really just “Canadian” because they are based in Canada, but usually partner with pharmacies (or what they refer to as international prescription fulfillment centers) in other countries.

It’s worth noting that there are still some Canadian-only online pharmacies, which you can find on our list of PharmacyChecker-verified online pharmacies.

For an online pharmacy verified in our program, we must be informed of every pharmacy it partners with to fill a prescription order. Those pharmacies, whether owned by the online pharmacy or not, must also be verified independently in our program. The partner pharmacies must attest to PharmacyChecker that they fill orders processed on the applicant online pharmacy. We keep track and monitor the online pharmacy and partner pharmacy relationships and continue checking them often. Within that application process, the pharmacy partners and the online pharmacies must show us who the responsible pharmacist is for authenticating and dispensing prescriptions, and counseling of patients.

For pharmacies in countries with the strongest regulations, we verify the licenses of the dispensing pharmacies with the relevant governing body (i.e. College of Pharmacists of Manitoba, UK General Pharmaceutical Council, Singapore Ministry of Health, New York Board of Pharmacy). That is the case for Australia, Canada, Israel, New Zealand, United Kingdom and the U.S.

In the following countries, we verify licensure and conduct onsite inspections of pharmacies during the application and every 1-2 years thereafter: India, Mauritius, Turkey and Singapore. PharmacyChecker inspection program standards are public and we welcome comments on them. Those pharmacies subject to inspection must provide us with all relevant details related to how they work with online pharmacy partners for safe dispensing of medicine. We use those details to cross reference when we inspect and re-inspect them.

Permitted medicines are those approved for sale in Australia, Canada, India, Israel, New Zealand, Singapore, Turkey, United Kingdom, and United States. In the case of India, qualified medicines are subject to our Indian pharmaceuticals policy. In short, the Indian pharmaceuticals policy prohibits pharmacies in India or pharmacies that may be located in a free-trade zone from selling medicines made by manufacturers in India that do not have a global presence (such as Cipla, Torrent and Sun) or are not made in an establishment registered with the U.S. FDA or its counterparts, including the European Medicines Agency, Health Canada and the UK Medical and Healthcare Products Regulatory Agency. The policy is in place to help patients avoid receiving substandard and lower-quality drugs.

In our verification program, we have created and enforced many other rules that create safety, consistency and accountability for patients buying from verified international online pharmacies, but also to help healthcare providers and regulators distinguish rogue sites from safe international online pharmacies. They include but are not limited to:

Section V: No Exports for Resale

Section X: Maximum Three Months’ Supply Dispensed Internationally

Section XII: Pharmacy Disclosure Requirements

a. Disclosure of Pharmacy Location

b. Website Transparency and Disclosures

Section XIII: Privacy and Confidentiality

Read the full scope of PharmacyChecker Standards, policies, and the inspection program.

Discussion

International online pharmacy is an evolving practice. There is no global pharmacy regulator. Laws and regulations related to pharmacy, pharmaceuticals, and importation differ from country to country. Overlaps occur where it’s lawful in one country for a pharmacy to export medicine to a patient in another country, but not legal for that patient to import it. What is entirely safe for a patient may not be entirely legal. The quintessential example is an American ordering a medicine on a website that is dispensed from a pharmacy in Canada.

What’s most important from a public health standpoint should be that people can obtain medicine they are prescribed by their providers. Too often, Americans can’t afford their prescribed medicines and there’s no gray in the fact that PharmacyChecker-verified international online pharmacies help them.

At PharmacyChecker, we can’t control what pharmacy and drug regulators do to affect online access to safe and affordable medicine. We can only evaluate the online pharmacy options that are currently available and, under professional guidance and authority of licensed pharmacists, verify the best options. We publish this verification information and drug prices on our site. Patients worldwide use it to avoid rogue online pharmacies.

With 50% of our web traffic coming from the U.S., and being U.S.-based (and Americans), our standards give due consideration to pharmacy policies here. However, good standards of pharmacy practice are universal, and we apply those in our program.

The Internet has disrupted the practice of pharmacy, and just about everything else. This disruption is good when it helps people obtain essential medicines they would otherwise go without. Sadly, critics of international online pharmacies that serve patients in the U.S., refer to PharmacyChecker-verified international online pharmacies as unapproved, and even fake and rogue. These critics of PharmacyChecker are usually sponsored by drug companies, and U.S. pharmacies who view safe international online pharmacies as commercial competitors.

Interestingly, some verified online pharmacies don’t even refer to themselves as online pharmacies but rather call themselves “prescription referral services.” Those are online pharmacies based in Canada that don’t operate their own brick-and-mortar pharmacy but take prescription orders and refer them to licensed pharmacies. They call themselves prescription referral services to comply with domestic regulations that govern what entities can call themselves “pharmacy” those that cannot. We evaluate such sites as online pharmacies. What really makes a website an online pharmacy?

How about a neighborhood pharmacy? Is that more of an “online pharmacy” that the “prescription referral service.” Here’s an example: www.glasgowpharmacy.com. That is the website for a single local pharmacy in Newark, Delaware called Glasgow Pharmacy (not surprisingly). I’ve never been there but have every reason to believe it’s a perfectly good place to fill your prescriptions in person. But unless you live nearby, Glasgow Pharmacy is irrelevant for patients seeking medicine online, because Glasgow does not do online sales and mail-order.

We looked up the word pharmacy in the Merriam Website Dictionary online – not the hard copy book some of us used to flip through when we were growing up. The definition of pharmacy includes, simply, the word “drugstore.” That is not a perfect metaphor to this discussion but it’s very telling. Websites selling medicines are online stores that sell drugs. Like it or not, that makes them online pharmacies. But a pharmacy that intentionally sells counterfeit drugs is, of course, not a real online pharmacy.

Our definition of a real “online pharmacy” is “A company that markets and sells lawfully-manufactured prescription medications over the Internet, dispensed by mail to patients by its own pharmacy, or by referring prescriptions to other dispensing pharmacies.”

If you put the word “international” in there it becomes: “A company that markets and sells lawfully-manufactured prescription medications over the Internet, dispensed by mail internationally to patients by its own pharmacy, or by referring prescriptions to other dispensing pharmacies.”

When we talk about international online pharmacy verification and safety, we’re talking about the ones that meet the standards in our program. For reasons that are self-evident, such pharmacies are going to be very safe, at a minimum much safer than the thousands of rogue sites out there if not equally as safe as a U.S. pharmacy. Keep in mind, the verified dispensing pharmacies are regulated by their own governing authorities, too.

We encourage public comment on our standards and foresee the evolution of regulations for safe international online pharmacy. We are proud of the role we have played.