Online Pharmacies: Are They Created Equal?

Lauren Eichstadt Forsythe, PharmD, DICVP, FSVHP, University of California, Davis, Veterinary Medical Teaching Hospital, Davis, California
Online Pharmacies Are They Created Equal

Online pharmacies are a dime a dozen and a quick internet search will return many options. Well-meaning veterinary clients sometimes turn to the internet to find less expensive medications for their pet; however, although it is understandable that clients want to save money, it is important that patient care is not sacrificed with the use of poor quality medications. Most online pharmacies do provide clients with less expensive options, increased medication variety, and convenience, but some may provide medications that are counterfeit, expired, contaminated, or otherwise substandard.

The veterinarian and other practice team members are well-placed to help clients select the best pharmacy for their pet’s needs. However, how does the team deduce which online options are valid medication sources and which should be avoided?

Domain Name


The National Association of Boards of Pharmacy (NABP) works to help consumers and prescribers identify legitimate online pharmacies and offers programs that promote safe pharmacy practices. These programs, previously known as Verified Internet Pharmacy Practice Sites (VIPPS) and Veterinary-Verified Internet Pharmacy Practice Sites (Vet-VIPPS), continue to operate but have transitioned into .pharmacy domain-verified websites. A logo indicating VIPPS status is easy for a non-legitimate pharmacy to duplicate, but websites with a .pharmacy domain name cannot be duplicated.

NABP Approval


An online pharmacy must submit an application to NABP and receive its approval to obtain the .pharmacy domain name. NABP reviews the online pharmacy website prior to approval and then annually to verify compliance with the .pharmacy standards. This program is used to verify both human and veterinary pharmacies.1 (See Resources.)

At the end of 2017, NABP had reviewed 11,749 online pharmacies and found that 95.7% were out of compliance with its patient safety and practice standards and/or federal and state laws. The most common reasons sites were found to be noncompliant were:

  • Not requiring a valid prescription (89%)
  • Affiliation with rogue drug outlets (86%)
  • Undisclosed location (63%)
  • Issuing prescriptions based only on online questionnaires and consultations (56%)
  • Offering foreign or non-FDA-approved medications (52%).2
  • The Center for Safe Internet Pharmacies reported that approximately 20 illegal pharmacies are added to the internet each day.3

Beware of Counterfeits


Counterfeit medications (ie, medications that look almost identical to approved drugs but contain little or no active ingredients and may contain harmful ingredients) are a major concern with online pharmacies.

The World Health Organization estimated that 50% of medications purchased from online sites that do not provide a physical address and 1% of all medications sold in developed countries are counterfeit.4 Buying from legitimate, regulated, online pharmacies decreases the risk of receiving counterfeit medications.

Check on Canada


Despite these statistics, many people believe that Canadian pharmacies are well-regulated and safe places to obtain discounted medications. Licensed Canadian pharmacies are regulated by Health Canada.

However, the FDA prohibits non-US pharmacies from shipping medications into the United States. Not all online pharmacies that appear to be Canadian are actually based in Canada and some pharmacies present themselves as Canadian to gain customers’ trust. Also, even if a company is located in Canada, it may not be regulated by Health Canada if it is selling drugs only to people outside Canada.5

The Takeaway


When evaluating an online pharmacy as a potential medication source, these 5 requirements must be met:

  • The pharmacy has a pharmacist or veterinarian available to answer questions.
  • The pharmacy is licensed in every state where medications will be shipped; the state(s) the veterinarian is licensed in is not important.
  • A valid prescription is required for all prescription medications.
  • The pharmacy has a physical address and valid phone number in the U.S.
  • The web address includes .pharmacy and the pharmacy is not on NABP’s “Not Recommended” list (see Resources).

Conclusion


Online pharmacies may provide clients with less expensive options, increased medication variety, and convenience. However, as the number of these pharmacies continues to grow, it is important that both the veterinary team and clients are educated on how to recognize pharmacies that provide regulated, authentic medications versus those that may provide substandard medications that will hurt, not help, their clients’ pets.

When prescribing medications that will be obtained from an online pharmacy, make sure the pharmacy is reputable and that clients are aware how important it is to select a high-quality online pharmacy.

RESOURCES

REFERENCES


1. Pharmacy Verified Websites. Program Eligibility and Policies. National Associations of Boards of Pharmacy. https://nabp.pharmacy/programs/dotpharmacy/standards. Published 2018. Accessed September 2018.
2. Internet Drug Outlet Identification Program Progress Report for State and Federal Regulators: February 2018. National Associations of Boards of Pharmacy. https://nabp.pharmacy/wp-content/uploads/2018/02/Internet-Drug-Report-Feb-2018.pdf. Published February 2018. Accessed September 2018.
3. The Internet Pharmacy Market in 2016: Trends, Challenges, and Opportunities. LegitScript.com for The Center for Safe Internet Pharmacies. http://safemedsonline.org/wp-content/uploads/2016/01/The-Internet-Pharmacy-Market-in-2016.pdf. Published January 2016. Accessed September 2018.
4. The Counterfeiting Superhighway. European Alliance for Access to Safe Medicines. Published 2008. Accessed September 2018.
5. Imported Drugs Raise Safety Concerns. U.S. Food and Drug Administration. https://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143561.htm. Published March 1, 2018. Accessed September 2018.

AUTHOR


Lauren Eichstadt Forsythe
PharmD, DICVP, FSVHPUniversity of California, Davis, Veterinary Medical Teaching Hospital, Davis, California

Lauren Eichstadt Forsythe, PharmD, DICVP, FSVHP, is a veterinary clinical pharmacist at the University of California, Davis, Veterinary Medical Teaching Hospital. She graduated from the University of Findlay College of Pharmacy and completed her residency at the Purdue University Veterinary Teaching Hospital. Her research interests include the safety and efficacy of compounded products and behavioral medications. Lauren enjoys teaching both pharmacy and veterinary students and is active in providing continuing education to both professions through a variety of avenues, including presentations at ACVIM and AVMA in 2018.

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