Online Pharmacy FAQS: Is your internet pharmacy safe and legal?

Is online pharmacy illegal?

2006-08-11T13:42:00.000-07:00

Several state governors don't think so.

"The latest GOP governor to break ranks is Minnesota's Tim Pawlenty, who last week initiated a program that permits state employees to order prescription drugs from a state-inspected Canadian company. By requiring pre-inspection, Minnesota's state workers can be confident these drugs are of identical quality and safety to their U.S. counterparts, despite being much cheaper. This approach could save taxpayers millions of dollars by lowering the cost of providing prescription benefits for state workers. "

To read the full article, go to http://gadflyer.com/articles/?ArticleID=107.

What is Big Pharma's position on online pharmacy

2006-08-11T13:26:00.000-07:00

My belief is that pharmaceutical manufacturers, like another other business enterprise, will seek the best advantage for their company. That edge can come from a superior product, cheaper pricing, more efficient production or regulatory and legislative environments that work to their advantage.

In fact, by law companies sole goal is to provide the maximum return to their shareholders. To expect anything else from companies is simply wishful thinking.

However, a company's reality is not the only reality. A politician has the incentive to give the voters what they want. An individual faced with high medication bills has incentive to look elsewhere for cheaper medications.

All these realities battle for supremacy. And the winner is...? To mix metaphors, "the jury is still out." But if you would like to read a balanced view of Big Pharma's role in the process, you can check out the following article.

"Of Pills and Profits: In Defense of Big Pharma

Peter W. Huber

The more our health depends on their little pills, the more we seem to hate big drug companies. In The Constant Gardener (2000), John le Carré assigns to the pharmaceutical industry the role played by the KGB in his earlier novels. A villainous pharmaceutical company is using Kenya as a testing ground for a lethally defective drug, and people who find out about it die, too. Four recent, non-fiction indictments of the industry tell a similar story.* Conflating the four into one, one might title them collectively How Big Pharma Deceives, Endangers, and Rips Us Off, with the Complicity of Doctors. More..."

Another reason to only use online pharmacies that require a valid prescription

2006-08-11T13:06:00.000-07:00

Doctors are not just an inconvenience in the health care system. They act as gatekeepers of responsible health care.

Are they perfect? Of course not. Doctors are human and they can make mistakes. But patients are human too, and have a lot less medical knowledge than their doctor. The following article is another reminder of how important the doctor/prescription link can be.

"Professor, wife sue online pharmaceuticals company

In an effort to shed light on the largely unregulated Internet market of drugs and pharmacies, structural biology Prof. David McKay, and his wife, Sheila, are suing a Colorado physician and an online pharmacy for negligence and wrongful death one year after their 19-year-old son committed suicide as the result of a prescription given without a doctor consultation. More..."

Unfortunately, the young man in the story paid with his life in order to avoid the inconvenience of seeing his doctor for a prescription.

Don't make the same mistake.

Can you get specially compounded medications online?

2006-08-11T13:05:00.000-07:00

I hadn't really thought about this issue before until a news item crossed my desk today.

FDA Warns Three Pharmacies To Stop Mass-Producing unproven Inhalation Drugs

The Food and Drug Administration (FDA) has warned three firms, RoTech Healthcare, Inc., CCS Medical, and Reliant Pharmacy Services, to stop manufacturing and distributing thousands of doses of compounded, unapproved inhalation drugs nation-wide. More..."

So the answer to the question is yes, but the real question is should you? When a pharmacist compounds a medication, it is usually for very specific reasons. For example, you may be allergic to some of the ingredients in the regular version of a drug, or swallowing may be difficult so the pharmacy will compound a liquid or suspension instead of a pill.

The problem? You are really only making the best of a bad situation. A compounded medication may be the only way you can take a much needed medication. Unfortunately, compounded prescriptions are not held to the same standards of good manufacturing practice as those produced by drug manufacturers. There is no testing done to show that these compounded products are safe or effective when compared to standard dosage formats. You might absorb too little or too much of the drug. Compounding pharmacists are taking a calculated risk with your health.

The pharmacies involved in shipping compounded preparations across the country may save you a bit of money by using economies of scale to control their pricing but this practice makes it much more difficult for your doctor to follow the progress of your treatment.

In any case, it looks like the FDA is ready to shut down these pharmacies.

I recommend you continue to use your local pharmacy if you need specially compounded drugs.

Counterfeit Drugs in America: The Empire Strikes Back

2006-08-03T11:30:00.000-07:00

The Pharmaceutical and Research Manufacturers Association of America responds to a Canadian online pharmacy's claim that the U.S. has a major problem with counterfeit drugs within their own borders.

However, their response was hardly reassuring as you can see below.

"Alan Goldhammer, PhRMA`s associate vice president for regulatory affairs, told United Press International that information about the level of counterfeiting in the United States is difficult to come by.
'I don`t know that anybody has, as far as I know, published statistics in that area,' Goldhammer said. 'I`m not sure that information exists,' he added."

And yet the FDA estimates that 35 million prescriptions were filled with fake drugs last year in the U.S.

The spokesman for PhRMA went on to say...

"...when new FDA regulations go into effect in December requiring drug distributors to provide documentation of the chain of custody of medications, Canadian firms would be unable to comply.
'I don`t know how any of these Internet sites could be in compliance with that,' he said, noting that they have to provide documentation tracing the source of their drugs back to a U.S. manufacturer."

In other words, he admits that the regulations governing drug distribution in the States will continue to be ineffective until the new legislation takes effect in December 2006. Well, that is good news!

As for Canadian pharmacies documenting the source of drugs back to the U.S., that is a red herring. Drugs sourced from reliable countries such as Canada, western Europe, Israel, Australia and New Zealand are not the issue. These countries already have excellent drug distribution legislation that keeps counterfeit medications off the market and out of the supply chain. What the PhMRA is really trying to say is "Buy American". Very patriotic to be sure, but not very practical when the pharmaceutical business is international.

In this case, 'Buy American" translates into "Support your local monoply!"

Go here to see the full article.

Maine eases the pain of Medicare Part D

2006-08-03T10:50:00.000-07:00

Maine's response shows the "doughnut holes" in Medicare's Part D drug plan.

Part D safety net helps Maine seniors Wednesday, August 02, 2006 - Bangor Daily News

By Jude Walsh

"Maine has a long tradition of being responsive to the prescription drug needs of its citizens. The Medicaid program in Maine, known as MaineCare, serves more than 270,000 low-income Maine people. The Drugs for the Elderly Program was created in 1978 to serve low-income elderly and disabled people that are not eligible for MaineCare.When Congress passed the federal Medicare Modernization Act, which created the federal Medicare Part D program, I was encouraged that Medicare recipients would finally get a prescription drug benefit under the program. However, I was concerned with Part D's complexity and how it would impact Maine seniors on our state programs, which had been working well for a generation.With Medicare Part D, Maine is outlawed from continuing Medicaid coverage for people that are dually eligible for Medicaid and Medicare. Now seniors would need to choose from one of 16 drug plans, each with different drugs covered and costs. There was potential for significant confusion. In response, the state took several precautions to ensure no senior would go without their prescriptions. Click here for the full article.

For more information on which states are providing a safety net for patient falling through the Part D cracks see my earlier post.

Online Pharmacy and Counterfeit Drugs - what are the risks?

2006-08-02T09:23:00.000-07:00

Faking it: Counterfeit Drugs at your local pharmacy!

In a recent press release by a Canadian internet pharmacy called Doctor Solve, "the book "Dangerous Doses" by Katherine Eban states that from 2000 to 2004, the FDA's criminal cases that involved counterfeiting increased almost tenfold, from six a year to 58. By the end of October 2004, 91 cases were open. The FDA conservatively estimates that about 35 million prescriptions annually are filled with something other than the prescribed drug."

The really interesting part is that these are prescriptions filled by their local pharmacies.

The article goes on to describe problems with the U.S. supply chain:

" 'One of the problems is the unregulated supply chain,' states Zickler. 'There is a large network of wholesalers who buy and sell drugs, and laws governing them are very loose. In some cases, one can set up shop with a nominal fee and a promise to adhere to storage rules.'

Recently, the FDA announced new rules that require medicines to be tracked every time they change hands from the manufacturer all the way to the pharmacy. Known as the "pedigree," the strict licensing process will involve background checks and a trackable paper trail. The new, long-overdue rules go into effect December 2006."

Canada's supply chain, on the other hand, is already heavily regulated. The chance of receiving counterfeit medications from an online internet pharmacy based in Canada is almost nil. In fact, according to their website, Doctor Solve regularly sends samples of the medications they dispense to an independant lab for testing. They probably don't have to do this but with the number of counterfeit drugs on the U.S. market, it's a good way to reassure their customers.

As with any press release, you have to watch for bias but you can certainly check out their sources which include the book mentioned above and NBC's dateline episode "Bitter Pills".

Five Simple Rules for Choosing an Online Internet Pharmacy

2006-07-31T15:51:00.000-07:00

The Rules

********************************************

Your Online pharmacy should follow these 5 Simple Rules...

Rule # 1

Requires a prescription from your doctor

Rule # 2

Requires a medical/drug history

Rule # 3

No narcotics, controlled or targeted medications

Rule # 4

Supplies a full range of pharmaceuticals (not just "lifestyle" drugs)

Rule # 5

Pharmacies are located in Canada, U.S., western Europe, Australia and N.Z.

*****

If you use these 5 Simple Rules when choosing an online pharmacy, you will eliminate 99% of the risk involved with purchasing your medications over the internet.

Renagel® will be covered by Manufacturer for Medicare Part D Patients

2006-07-31T15:40:00.000-07:00

Genzyme covers patients caught by Part D co-payments.

"The American Kidney Fund and Genzyme Corp. announced today that they have launched a new program to provide Renagel® (sevelamer hydrochloride) free of charge to patients who are enrolled in a Medicare prescription drug plan, but cannot afford their co-payments or co-insurance payments for Renagel." More...

Another indication that the transition to Medicare's Plan D prescription insurance program has been a difficult one for patients.

Don't wait for the other pharmaceutical companies to follow suit, though.

Humana's Profit Rides Medicare Part D Wave

2006-07-31T15:21:00.000-07:00

Well, at least the insurers like Part D - f0r now.

Bloomberg.com reports...

"July 31 (Bloomberg) -- Humana Inc.'s second-quarter profit rose 9.9 percent as the health insurer gained customers in the U.S. Medicare insurance program and commercial and military plans. The shares rose as much as 4.8 percent in early trading.
Net income rose to $89.5 million, or 53 cents a share, from $81.4 million, or 49 cents, a year earlier, Louisville, Kentucky-based Humana said today in a statement. Revenue jumped 52 percent to $5.41 billion.
Chief Executive Officer Michael McCallister has centered a campaign to add customers on Medicare's new Part D drug benefit, and Humana today said it will increase marketing spending in the second half of the year to help do that. The company's Medicare Advantage program -- which combines health and drug benefits -- meanwhile grew faster than Humana had estimated, almost doubling its customers in a year, to 959,800 at June 30.
For 2006, Humana's ``earnings on a year-over-year basis are going to be up substantially, in my view, because of the seasonality of the Part D business,'' said Peter Costa, an analyst in the Boston office of FTN Midwest Securities Inc., in a telephone interview on July 28."

I like the reference to "seasonality" of Plan D. They are referring of course to the so-called "doughnut hole" where your coverage quits after the first $2000 and doesn't resume until you hit over $5100 in annual drug costs.

Your best defense is to know how much you spend in a year on prescription drugs. If it's more than $2000 but less than $5100, you might have to pay for up to $3000 extra for your medications.

That's a lot of money that could be spent getting your scripts from an online pharmacy, at least after the first couple of grand.

For the complete article, go here.

It's interesting to note that the Bloomberg article hints at troubled waters ahead for insurers because of the same doughnut hole effect. The year may start well but the Plan D cash wave heads for the rocks part way through the year for many of Humana's customers. And where the customers go, there goes Humana.

Medicare Part D cost update

2006-07-31T12:02:00.000-07:00

Further to my post earlier today on Medicare Part D savings, below is a link to the full report.

When asked whether they were saving on prescription costs, 46% of the survey respondants replied that they did save while 51% said they paid more or the same as before. (3% of those surveyed didn't know.)

The Kaiser June 2006 report on Medicare Plan D

Are my prescriptions now fully coverered under Medicare Part D?

2006-07-31T11:41:00.000-07:00

Medicare Part D does not mean universal or total coverage.

The new Plan D introduced by the U.S. Federal government in January 2006 has suffered a few teething pains.

In some cases, patients whose medications were previously covered under Medicaid found themselves having to shell out large co-payments or the full cost up-front because pharmacies and insurers were confused about the actual coverage offered by the federal plan.

The threat to patients' health was considered so severe that 44 states passed various forms of emergency coverage legislation to safeguard patients' access to their prescriptions. Click here for a list of states that have adopted this legislation.

A recent Kaiser Medical report dated June 11 2006 also shows that up to 25% of people who are eligible to receive Part D benefits have not registered to receive them. They may have been unaware of the program deadline of May 15, or they may have looked at the program and decided they could save more by buying their meds through online pharmacies.

The following is taken from the Medical News Today website...

"The survey also examined all seniors' knowledge of the May 15 deadline for enrolling in the drug benefit to avoid incurring a financial penalty. According to the survey, 55% of seniors know the deadline is May 15 (AP/St. Petersburg Times, 4/26). Thirty-eight percent of seniors do not know the correct deadline and 6% said there is no deadline (Kaiser Family Foundation, "Seniors' Early Experiences with the Medicare Prescription Drug Benefit," 4/25). Fifty-three percent of seniors know that enrolling after the deadline will result in a financial penalty of a 1% increase in monthly premiums for each month of late enrollment (Wolf, USA Today, 4/26). Forty-seven percent of seniors do not know there is a penalty for late enrollment (AP/St. Petersburg Times, 4/26). The survey has a margin of error of plus or minus 5 percentage points for respondents 65 and older (Kaiser Family Foundation release, 4/25). "

So even if you are registered, you may be facing extra costs as pharmacies and insurers wait for clarification.

Hopefully these are just the normal problems associated with a new plan. Only time will tell.

Will Medicare D save you money compared to online pharmacies?

2006-07-31T10:25:00.000-07:00

A new report by Kaiser Medical says that 80% of patients enrolled in the Medicare D plan are happy with it, but....they aren't saving any money!

Excuse me for being confused but wasn't that the point of having the plan in the first place!

I will try to source out more information, but until then, here is the link to the initial article by Sarah Batista.

What about Indian online pharmacy?

2006-07-26T11:41:00.000-07:00

Can the world's largest democracy be a legal and safe source for your online prescription medications?

India certainly has the ability to do so. What it lacks are the safeguards to protect the patient from fraud or counterfeit products.

As this headline shows, buying from Indian internet pharmacies can be illegal and dangerous.

"Member of International Internet Drug Member of International Internet Drug
Special Agent in Charge James M. Kasson announced today that Sanseev Srivastan was found guilty July 17, 2006 on all counts for his involvement in an international Internet pharmacy network that imported and distributed millions of dollars worth of non-controlled and controlled drugs into the United States from India." More...

The irony is that India has one of the most largest and most sophisticated pharmaceutical industries in the world. Brand drug manufacturers regularly buy their raw materials (the active ingredient) from India. India also has a thriving generic drug industry that is beginning to compete internationally in countries such as Canada and the U.S.

At this time, I recommend using Indian products that can be purchased through Canadian or American online pharmacies. Buying direct from Indian internet drug stores is not a good idea.

Online pharmacies - Canadian, American or other?

2006-07-26T11:05:00.000-07:00

With over 400 online pharmacies out there, finding one that is legal, professional patient-focused can seem like playing Russian roulette with a gun set on full-auto.

Strangely enough, the US government issued a report in 2004 on the state of internet pharmacy practice that gives you some "ammunition" to filter out the good internet drugstores from the bad.

The report by the U.S. General Accounting Office in June 2004 tested American, Canadian and other "foreign" online pharmacy operations by placing orders for 13 different medications including narcotics and other controlled substances. (The report divides the testing geographically into three groups: American, Canadian and Foreign. )

Here are some of the highlights:

Prescription required? Despite the fact that this is a legal necessity for any prescription medication, only 5 of the 29 American internet pharmacies required a prescription to process the order. On-line drug stores outside of North America neglected this basic cornerstone of pharmaceutical care with zero of the 21 pharmacies tested asking for a script. By contrast, all of the 18 Canadian online pharmacies followed good pharmacy practice and the law by requiring a prescription.

Counterfeit drugs? Almost 10% of drugs imported from foreign online operation were considered counterfeit or contained completely different active ingredients.

Complete scam? Six of the sixty-eight order placed with foreign pharmacies were paid for but never received. Once again, that's almost 10%.

Under investigation? Twenty-one percent of all the pharmacies studied by the GAO were under investigation by either the FDA or the DEA for violations of federal or international laws. Nine were American-based, one was Canadian and all the rest were foreign online pharmacies.

While no country was perfect, it seems clear that your best choice would clearly be Canadian first, then the U.S. I would choose foreign only if the pharmacy was based in Europe, New Zealand or Australia.*

To see the complete report click here.

*The GAO report only tested foreign pharmacies from places like Turkey and Pakistan which probably skewed the test results a little.

The FDA Drug Database link

2006-07-24T17:35:00.000-07:00

The FDA Drug Database

I forgot to give you the link for the FDA drug index in my post on generic drug availability. Like the ones from NZ and Oz, this is interactive. You can also download the entire database to your computer. This would be convenient if you have a lot of different prescriptions to check out.

Here is the link.

http://www.accessdata.fda.gov/scripts/cder/drugsatfda/

Bill 102: lower generic drug prices from Canadian online pharmacy?

2006-07-24T17:01:00.000-07:00

Bill 102, the "Transparent Drug System for Patients" Act is the Ontario government's latest attempt to force lower generic drug prices in Canada.

But will it meaner lower prices for Americans looking for cheaper medications over the internet?

I doubt it. Although I can't find any confirmation on the 'net, I've already been told by one pharmacy owner that the price reductions are dead in the water.

Current generic pricing mandates that a single source generic be at least 10% less than the brand. If there is more than one generic available, the price drops to 25% less than the brand.

Bill 102 wanted to drop the price of all generics to at least half the brand cost. But my source tells me the government is already backing off that demand.

Why? Well, the mind of your typical politician is a scary place but let's just say that the economic health of Canadian pharmacy and the huge population of voting patients they serve might have been adversely affected by the proposed changes.

Generic companies in Canada compete in the market by offering incentives to their customers, the pharmacies. These incentives now comprise a signficant source of revenue to Canadian pharmacies, without which many might have to close their doors. Patients - those pesky voters - wouldn't like having their local pharmacy disappear because some bureaucrat wanted to get their hands on the generic companies' rebates.

Hell is paved with good intentions, and in this case you could say the government's intentions were good. Since the province of Ontario foots the bill for a large percentage of prescriptions, and that money comes from the taxpayer, it seems like a good idea. But the devil is in the details. I'm sure the Ontario Pharmacy Association has met with the Health Minister to explain the financial and "political" repercussions of this legislation.

I have no doubt some sort of acceptable compromise is on its way: in other words, business as usual.

In short, we may see some minor price reductions in the coming months, but nothing worth writing home about.

Online Pharmacy Brand Name Confusion?

2006-07-20T15:22:00.000-07:00

"A drug by another other name would smell as sweet..."

What's in a name? When it comes to brand names for pharmaceutical products, the answer can be a whole lot of confusion.

For various trademark and copyright reasons, a brand name in one country may actually be a totally different drug in another.

To see some examples identified by the FDA, click here.

Is this really a problem for online pharmacies? I doubt it. As long as they follow good pharmacy practice, all pharmacies, not just internet pharmacies, have long dealt with international visitors and their prescription needs. Pharmacies always have reference texts and other on-line resources to check the names of drugs prescribed in other countries.

Is there a potential for mistakes? Sure, but that risk is not limited to international online pharmacies. Your local pharmacist can make this kind of mistake just as easily. As long as you choose a reputable online drug store, it is unlikely you will have any problems with drug identification.

The bottom line: be aware of the possibility for confusion, have your doctor write your prescriptions using the generic name of the drug and review your medications with your internet pharmacist.

How can I find the latest generic drugs?

2006-07-20T14:42:00.000-07:00

Here are some resources you can use to stay on top of the latest in new generic products from countries you can trust.

Canada: This is where you can find the most recent Notices of Compliance issued by Health Canada to generic companies. An NOC recognizes that a generic company has met all of Health Canada's requirements with regards to safety and efficacy. With an NOC in hand, the generic company can take the drug to market.

(Bear in mind that it may take up to eight weeks for a generic company to gear up production to meet demand after receiving their NOC.)

If the U.S. market doesn't have a generic available, this is where you could see some big savings.

Click here to go to Health Canada Notices of Compliance

New Zealand: You can use this interactive site to see if a generic equivalent for your medication exists in NZ. Be sure to use the generic name for your medications to avoid confusion. There are some brand name medications that contain different pharmaceutical active ingredients in different countries.

If there is a generic available, your search will return more than one manufacturer.

While there is pricing shown on this site, don't count on getting that price online. Firstly, this is the price the New Zealand government is willing to reimburse a patient for this drug: a pharmacy may include a co-payment or a dispensing fee, or both.

Secondly, online international pharmacies set their prices based on what their market can bear, and what the competition is doing. They will be working down from high U.S. prices rather than up from the lowest prices available in New Zealand.

The same holds for Australia.

Click here to go to the New Zealand Drug Schedule

Click here to go to the Australian Drug Schedule

A word of caution: don't base your decision on which internet pharmacy to use solely on the availability of new generics. It's important to have an online pharmacy that knows all the medications you are taking. Remember that all prescription medications can have side effects. Interactions with other drugs can cause serious health problems.

If you split your business among numerous internet pharmacies, they have no way of knowing your complete medication history. You are putting your health at risk, even if the individual pharmacies you use follow good pharmacy practice guidelines.

Also, many internet pharmacies are now sourcing your prescriptions internationally. Many Canadian pharmacies routinely have some of their medications sent directly to the patient from countries such as England and New Zealand. (I will explain why in another post.) As long as your prescriptions are sent from trustworthy countries such as those I've mentioned in previous posts, you can get the latest generics and still be confident the product is safe.

Mail Order Prescriptions?

2006-07-20T13:45:00.000-07:00

What's the difference between mail order prescription pharmacies and online pharmacies?

Not much. Mail order and online internet pharmacies both deliver their medications by mail or courier.

The filling of prescriptions by mail pre-dates the rise of the international internet pharmacy industry. Some of the larger pharmacy chains recognized they could save money by filling and shipping prescriptions from a central location. Private insurance companies covering the cost of prescription medication for their customers often insist that patients get their drugs from approved mail order pharmacies to cut costs. Although the way the patient's medications changed, these pharmacies were for the most part still located in the same country or state as their patients.

By comparison, internet drug stores usually concentrate on international business, in particular, the American market. The U.S. has the highest drug costs in the world, and a currency against which all others are based. Toss in the fact that many countries now control drug pricing, and you have a recipe for a great business in cross-border pharmacy. The internet simply provided the means to develop the opportunity.

Free Mexican Online Pharmacy? A good idea?

2006-07-20T13:08:00.000-07:00

Should you use a Mexican online pharmacy?

Are you nuts!?

Don't get me wrong. I love Mexico - the fishing in Cabo, the margaritas in Cozumel. But would I get my prescription medication from an internet pharmacy south of the border? No way. I wouldn't even buy my drugs from a regular Mexican pharmacy. You just don't know what you're getting.

Sure, Mexico has a growing economy, increasing international investment, and a growing middle class. But, let's face it. Mexico is still too "wild west" to be risking your health and your money buying your medications from Jose, your friendly neighbourhood internet pharmacist.

I understand the appeal. Cheaper meds, no prescription needed, and Tijauna is so much like Los Angeles that I know I can trust the quality of the product I order. Of course, it's difficult to ask Jose questions about my medications because he is so hard to get hold of. But that is just his laid-back latin charm. He's probably just having a little trouble with the Mexican phone lines processing my VISA. Sure, shipping is a little slow but Jose's web site explains that his cousin Juan is taking swimming lessons right now to improve his time across the Rio Grande. ;>)

Seriously, Mexico has great potential, but right now is not the time to trust your health to a country that has serious organized crime problems that infect every aspect of government.

The only drug you want to get from Mexico is tequila. I recommend the Blue Agave!

Salut!

Online Pharmacy Scams

2006-07-20T12:34:00.000-07:00

What kinds of online pharmacy scams do you have to watch out for?

Practically anyone who can set up a web site can start an online internet pharmacy. While there are many legitimate online pharmacy operations, the internet makes it very easy for criminals to set up an online store front. They can look slick, but it is only a facade.

These "pharmacies" aren't really pharmacies at all. They certainly won't have pharmacists or other medical staff on hand. They could very well send you counterfeit drugs with little if any active ingredients. They may be a front for organized crime that uses online pharmacy as a way to collect your VISA and Mastercard credit card information.

Here's an example of the kind of internet pharmacy you want to avoid.

"Drug Enforcement Administration (DEA) Administrator Karen P. Tandy today announced the results of Operation “Cyber Chase”, a year-long Organized Crime Drug Enforcement Task Force (OCDETF) investigation that targeted international Internet pharmaceutical traffickers operating in the United States, India, Asia, Europe and the Caribbean. These e-traffickers distributed drugs world-wide using “rogue” Internet pharmacies...more.

Basic Defenses: Use your common sense. If it sounds too good to be true, it probably is.

Do your homework. Is it a full service on line pharmacy? Is it easy to contact them and get answers to questions? Are they registered with their local College of Pharmacy or Pharmacy Association? Do they require a prescription? Is the country where they pharmacy is located have a well established regulatory environment for pharmaceutical practice, distribution and GMP (Good manufacturing Practice)?

Pharmacy scams only work with your help. You may really need that less expensive medication but don't throw common sense out the window. Protect yourself.

For more information on how to spot an online internet pharmacy scam, go to the DEA (Drug Enforcement Agency).

In the end, it comes down to doing the research and following your gut. I will eventually make some recommendations based on my own experience working with various online pharmacies in Canada. Until then, be careful and follow the guidelines I've talked about on this site.

Online Pharmacy Dictionary - Terms you should know

2006-07-20T10:13:00.000-07:00

Here are some words you need to know to navigate the heavy seas of information in the world of online pharmacy.

Online pharmacy: Simply a drug store that will process your prescription drug needs over the internet. It could be a regular bricks-and-mortar pharmacy that wants to tap a new market or improve its local service.

It could also be a large pharmacy chain that want to benefit from the economies of scale by shipping some of it's prescriptions from a central warehouse.

It can also be a pharmacy dedicated solely to business over the internet. These are usually internationally-based in Canada or elsewhere.

And finally, they can be a criminal front for unscrupulous businesses that will take your money while providing little or no service while possibly sending you counterfeit drugs as well.

Brand (brand-name, branded) drugs: These are drugs produced by the so-called "innovative" or "ethical" drug companies that produce new pharmaceuticals for the market, and receive patents to protect their investment in research and development.

Generic drugs: Sometimes called copycat drugs, these are drugs manufactured by competitors to brand drugs once the patent has expired. They usually provide major savings over the cost of the original manufacturer's product. In Canada, the U.S., western Europe, New Zealand and Australia regulate the entry of generics onto the market place with strict requirements that the generic be identical (bio-equivalent) to the brand product. Other countries may not have the same stringent regulations.

Bio-Equivalent: The short version - a generic drug is bio-equivalent if it contains not only the same quantity of active ingredient (raw material) but also is absorbed and eliminated by the body at the same rate as the brand drug it is compared to.

Prescription: That little piece of paper that your doctor gives you to take to the pharmacy to get your medications. A prescription is also a link in the chain of medical responsibility from doctor to pharmacist to patient.

Prescription drugs: In simple terms, a drug that needs a prescription from your doctor before you can get it from your pharmacy. But life isn't simple. Drugs that require a prescription in one country may not need it in another. Mexican pharmacies comes to mind. In some countries, you don't need a prescription for anything. On the other hand, those same countries might be hard pressed to provide any real protection to the patient regarding quality of the drug or pharmaceutical care.

The best plan when choosing an online pharmacy is to buy from countries that have the same or similar regulatory guidelines on what pharmaceuticals require a prescription.

Unfortunately, many internet pharmacies advertise "no prescription needed" which may lead some patients to think that a prescription is optional. It's not! Pharmacies that don't ask for a prescription are operating illegally, at least in Canada, the U.S. and most of the developed world. This is a RED FLAG: do not use online pharmacies that do not require you to provide a prescription from your doctor.

Drug cost: If you're ordering from an international pharmacy such as a Canadian online drugstore, the drug cost calculation will include the actual cost of the drug plus any shipping and handling fees, the current exchange rate and other miscellaneous changes that vary from pharmacy to pharmacy. Make sure you look at all of these factors.

Pharmaceutical care: One of the current buzzwords in the pharmacy industry, pharmaceutical care means that pharmacies should provide care that is patient-centered rather than revolving around the needs of the pharmacy business. It sounds fancy, but it really boils down to service and the responsibilities of the online pharmacy.

In terms of service, you should be able to contact the online drugstore by a variety of means" email, phone and fax. The response time should be short. Shipping should be fast and inexpensive. There should be clear policies concerning cases of disagreement.

As for responsibilities, a proper online pharmacy will have pharmacists on staff, not just pharmacy technicians. They will require a valid prescription from your doctor. They may also request a medical/drug history although it is often assumed that if you provide a valid prescription, your doctor has already evaluated your medical history. The internet pharmacy should also be registered with the local regulatory body and be in good standing.

FDA: The Food and Drug Administration has oversight over the importation of pharmaceutical products into the U.S. At the moment, the FDA believes that the importation of prescription drugs into the U.S. from other countries is illegal but they have found this position difficult to enforce. As a general rule, you are probably ok with importing up to 90 days of medication through an online pharmacy.

Medicare - D: A new U.S. Federal drug insurance plan introduced in the spring of 2006 that was supposed to put the nail in the coffin of the international online pharmacy industry. Well...Maybe. It is a "government" insurance plan after all, and we all know how well the government has looked after our health in the past. Here in Canada, our benevolent leaders regularly squander billions tinkering with our public health care system. For now, I will take a wait-and-see attitude to Medicare - D. Let me know how it's working for you.

Lifestyle drugs: These are drugs that have less to do with actual health problems and more with quality of life. Think Viagra. Some internet drug operations limit themselves to lifestyle drugs. This is another RED FLAG . These pharmacies are not interested in your health; they are very interested in your wallet. This is not to say that these pharmacies are operating in an illegal manner. Most are, a few aren't. But why take the chance. All prescription drugs have side effects. Choose an online pharmacy that provides a full line of products, just like your local pharmacy would. The internet should make things easier, not more complicated, right?

That's all for now but I'll probably add to this online pharmacy dictionary in the days and weeks ahead.

Which online pharmacy has the best prices on the internet?

2006-07-18T21:58:00.000-07:00

I did a quick check of internet drug prices and discovered that you practically have to make it a full time job if you want to always get the lowest price for your online medications.

First, some basic information that you need when comparing online prices for pharmaceuticals.

1. Brand Drugs: As a general rule, prices for brand-name drugs that do not have a generic equivalent available in the United States are more expensive than the same brand-drug for sale in Canadian internet pharmacies, or many other countries for that matter.

Why? The U.S. is very protectionist when it comes to guarding drug patent rights. The drug companies have exclusivity in the marketplace longer than elsewhere which gives them a monopoly where they can charge the highest price they can get away with.

Canada, on the other hand, regulates the cost of brand drugs coming into the Canadian market.

Example: I checked out the cost of Accupril (brand) 10 mg for 90 pills. The price varied from $0.67 - $1.51 per pill. When you factor in shipping costs, the cost for 90 Accupril ranged from $65 - $130.94 with Canadian and New Zealand internet pharmacies being the clear winners at almost half the cost of the American online pharmacies.*

Your choice? When it comes to brand pharmaceuticals, you'll find the best deal on the international pharmacy market on the internet.

2. Generic Drugs: This is where things get a little confusing. Because the Canadian pharmacy drug market has been more open to generic competition for the past quarter century, Canada has a lot more generic equivalents than the U.S. So, if you can't find a generic version of the brand drug in the States, you will find savings as much as 70-80% by buying through online pharmacy in Canada. The situation is similar with internet pharmacy in Australia, New Zealand and some countries in Europe.

However (this is the confusing bit!), if there is a generic available in the U.S., it will often be less expensive than the same generic from a cross-border or international pharmacy. What's going on?

A brief history of generics....

In the States, the first generic to market is given 6 months of exclusivity to market at what ever price the market will bear. Once that 6 months is over, all the other competitors who have been whining like a pack of wild dogs in the wings will rush out in a frenzy of cost-cutting until the price of the generic has been driven down to almost nothing - hence the low price in the U.S. for generic drugs with multiple competitors.

In Canada, the government or private insurance picks up drug costs so generic manufacturers have no incentive to lower prices. In Canada, "educational incentives" are used to woo pharmacies to choose one generic company over another. (I'm not saying it's a bad system, but as a taxpayer I know I haven't seen any of those incentives comes my way! ;>)

Let's take a look at a couple of examples:

Generic Prozac is called fluoxetine hydrochloride generically. Fluoxetine 20 mg costs the least at U.S. online pharmacies with a lowest price of $0.12 per capsule vs a high at a Canadian internet drugstore of $1.30 - more than ten times the cost! Taking into consideration shipping fees, the field was evened somewhat with the lowest being $14.25/100 capsules compared to $129.36 but even so - which would you rather pay?!

The short and sweet version:

No generic = TIME TO GO SHOPPING ON THE INTERNET

U.S. Generic = BE PROUD AND BUY AMERICAN

No U.S. Generic but available elsewhere = MAKE THAT MOUSE SQUEAK

As I mentioned in passing, drug cost is not the only factor to consider when choosing an online pharmacy. When costing your decision, include shipping and handling charges, exchange rates, membership fees and other other hidden charges that may apply.

You also have to consider the quality of the pharmacy services available over the internet. The last time I checked, there were over 400 online pharmacies on the internet. Maybe one tenth of those could be called legitimate businesses truly concerned with your healthcare. The rest are just out for a fast buck.

Take care out there!

*I limited my choices of online pharmacies to only those that follow good pharmacy practice guidelines including the requirement of a doctor's prescription. A posting on good pharmacy practice will follow later.

What exactly is online or internet pharmacy?

2006-07-18T20:51:00.000-07:00

A simple question, right? Well, sort of. At its most basic, online pharmacy is just what you would imagine - a drugstore that operates through a website on the internet. Just one more storefront that is moving from a bricks-and-mortar tradition to create a virtual pharmacy where you can order the drugs you need and they will be sent to you by invisible hands to your doorstep.

While that describes the nuts-and-bolts of the process, online pharmacy exists in a very complicated and dynamic "web" of conflicting priorities that include local regulatory environments for pharmacies and pharmacists, the legal implications of cross-border international drug importation by individuals, free trade and patent laws, money laundering, criminal gangs, and the responsibility of the medical establishment to the patient. Mix well with a liberal (or should I say Conservative) dash of politics, and the resulting stew is not one that many patients find palatable.

Online drugstores can provide excellent service with good health information, opportunities for saving a significant amount of money and a friendly secure environment. In fact, internet pharmacies and their cousins, mail-order pharmacies found a niche in the marketplace not just because prices are lower online, but also because these drugstores often provided service that was as good, if not better than regular pharmacies.

Pharmacy is a highly regulated profession, at least in Canada, the United States, western Europe, New Zealand and Australia. And, like many professions, pharmacy often used its stranglehold on the profession's regulatory bodies to ensure a steady supply of patients through their doors while providing mere lip service to highest standards of care.

But we live in a competitive world, and some pharmacists recognized that the customer - or the patient - is much more discriminating now. Patients are taking the time to learn about their health, and they are no longer satisfied with the same old "take two aspirin, and call me in the morning" approach to healthcare that previous generations accepted without a murmur of protest. Patients know too much now to accept that kind of service.

Online pharmacy is stepping up to fill that need for more information, faster service and less cost. But there are growing pains. Traditional pharmacies don't like the increased competition from some of the internet drugstores that are often right next door and familiar - Costco and Wal-mart come to mind. I can remember when I started my career as a drug rep that 95% of the pharmacies I called on still used typewriters to print their labels. Even some of the largest chains in Canada resisted computers for years until they were forced to respond to the marketplace.

Today all pharmacies are computerized. They could not handle the speed of the market or the complexity of adjudicating hundreds of insurance plans without them. Now pharmacies are feeling pressure from outside their own national borders. Like GM running scared from Toyota and Honda, your neighbourhood pharmacy has to compete against online pharmacies based in Canada, Europe, Asia and the south Pacific countries of New Zealand and Australia.

This is neither good or bad. It simply is. Like the buggy whip manufacturer of the 19th century whose business died with the rise of the automobile, the old-fashioned corner drugstore could become a thing of the past. And like the automobile, the decisions you make when choosing an online pharmacy can improve your health and quality of life or make you sicker - medically, legally and financially!