There are good reasons for filling prescriptions online — but also some good reasons for being cautious.
Online Pharmacies: Why Bother?
As explained in the separate page “Background to the Online Prescription Drug Controversy”, due to the absence of pricing regulation in the U.S., American consumers pay far higher prices for their prescription medications than Italians, French, Swedes, Germans, Swiss, British, and many others. Increasingly, U.S. consumers are looking to online discount pharmacies in the United States or even to pharmacies overseas to escape the aggressive pricing practices of large pharmaceutical companies. I strongly believe in individual choice and freedom and the notion of voting with one’s pocketbook — but there are also many reasons for caution, reasons which have become more compelling in recent years as the number of fake online pharmacies has skyrocketed.
Note also that the United States Food and Drug Administration (FDA) has recently produced a list of medications (PDF) which it specifically recommends against buying on the internet.
General Factors When Comparing Online Prescription Drug Services
As with any online service, there’s a fair bit of work to be done to make sure you are getting the best deal from an online pharmacy.
Comparing Drug Discounts
When shopping for medications online at discount pharmacies, it is obviously worth doing some comparison shopping: who offers the best prices on the specific medications you are interested in, and who offers the best overall cost for your order? Free overnight delivery may be great, but only if the pharmacy offers a sufficient level of discount on the drug itself; likewise, the absolutely cheapest prices on drugs are not very helpful if you have to pay substantially more for delivery.
But even more important than discounts and free overnight delivery is the level of quality, service and reliability which the merchant offers.
Beyond Discounts: Comparing Safety and Quality, Service and Reliability
The quality of online discount pharmacies varies greatly, much like other online discount businesses: and free delivery and cheap drug prices are worthless if you never see your money again, or if the product being shipped is of low quality or even fake.
It’s worth checking some or all of the following before being persuaded by the financial attractiveness of a particular online prescription drug service:
- Do they provide a real physical address or at least a toll-free telephone number for customer service? (Or do they only provide an email address?)
- Do they provide evidence either that they are a licensed pharmacy themselves, or that they fulfil orders via a licensed pharmacy? (Or are orders put together by unlicensed personnel who may or may not know anything about the drugs they are providing?) Also see the section on VIPPS at the end of this article.
- What is their policy on verifying prescriptions; or, alternatively, do they provide actual medical consultations and online prescriptions? (This one is open to debate, as ultimately it is your responsibility to obtain medications only when they have been appropriately prescribed for you; some online services do ship medications without a prescription.)
The bottom line when searching out cheap prescription drugs from an online pharmacy is: buyer beware! It is your health on the line — as well as your pocketbook. I believe it is possible to meet the needs of both health and pocketbook, and some time invested in comparing and evaluating the available options will be well spent.
Comparing Types of Online Prescription Drug Services
Essentially three different types of online prescription drug services will be of interest to consumers in the United States and other Western countries. The discussion below specifically separates out the U.S.-only suppliers simply because while U.S. consumers may also buy abroad, few if any U.S. suppliers also ship outside the U.S.; therefore, the U.S. suppliers will be of less interest to those living outside the U.S.
Comparing U.S. Medicine-Only Pharmacies
The most well known online pharmacies in the United States supply only medications and require a prior prescription from your own doctor. You must organize and pay for the consultation with your doctor, and you must fax or mail a copy of your prescription to the online service concerned.
- Low prices for the medication itself
- Longer operating history
- Large medication selection
- Higher prices when the medical consultation is factored in
- Inconvenience of scheduling face-to-face medical appointment
- Slower turnaround time when a prescription must be forwarded
Recent feedback from a variety of sources has consistently indicated that brick-and-mortar discount chains, such as Costco and WalMart, now offer prices which are just as competitive as the online services, with the added benefit of face-to-face contact and without the extra delays involved with shipping prescription medications.
Comparing U.S. Online Pharmacies Offering Online Prescriptions
Possibly the most innovative category of United States online pharmacies (or, more precisely, pharmaceutical ordering services) includes those which provide actual medical oversight of the process, normally incorporating an online medical consultation with a doctor resulting in a so-called ‘online prescription’. Pharmacies of this type can offer greater savings when compared to the total price of a medication and a separate face-to-face medical consultation, although they normally carry a much narrower range of medications because doctors will only prescribe certain medicines without seeing a patient face-to-face. They are also very controversial due to the fact that prescribing online without a prior physical examination contravenes recommendations published by the American Medical Association; the legal standing of such pharmaceutical ordering services grows more puzzling and uncertain almost by the day.
- Low combined price for the medication together with the consultation
- Convenient and private ordering online
- Rapid response time
- Higher overall price compared to medication only
- Shorter operating history
- Narrow medication selection
For customers who value the overall package of a medical consultation and resulting online prescription, together with the medicine itself, these types of pharmacies may provide a worthwhile service, particularly if privacy and/or speed is important.
Comparing Foreign or Offshore Online Prescription Drug Services
As explained in the separate page on the U.S. government’s personal importation policy (see “Understanding FDA Personal Importation Policy”), importing prescription drugs into the United States for personal use may be tolerated at the discretion of individual officials, but it remains technically illegal. If you live within the United States, this stands as probably the best reason for choosing an online pharmacy which is also in the United States. However, it is undeniable that many people do choose to purchase prescription medications from a Canadian pharmacy, a Mexican pharmacy, or an online pharmacy in another country — see below for separate sections on foreign pharmacies.
- Low prices for branded medications
- Shorter operating history
- Large medication selection
- Prices may be higher than the U.S. for generic medications
- Uncertain legal status in case of order disputes
- Uncertain legal status of FDA Personal Importation Policy
- Slower turnaround time when a prescription must be forwarded
- Longer shipping times and higher shipping charges
Note that some foreign online pharmacies do still require a prescription, while others (notably Mexican pharmacies) do not. When ordering from a pharmacy which neither requires a prescription nor provides medical consultations resulting in prescriptions, the onus is entirely on the customer to make safe, accurate, and appropriate purchasing decisions.
Even in the case of U.S.-based online discount pharmacies, making legal claims across state lines may be difficult — although this is essentially no different from other types of interstate commerce. But in the case of international discount pharmacies, taking successful action in the event of a disputed order may be virtually impossible. It is unclear what — if any — legal recourse consumers may have should a problem arise when dealing with an online pharmacy based in another country.
In addition, orders from online pharmacies based outside the United States may attract higher shipping charges and take longer to arrive. (Many U.S.-based pharmacies offer overnight delivery.)
Comparing Discount Online Pharmacies in Europe
Foreign and offshore online pharmacies are not exclusively populated by suppliers of low-cost generic drugs of sometimes questionable quality or authenticity. In at least some cases, online pharmacy services — particularly in Europe — go to great lengths to reassure customers that their medications are only genuine branded products sourced directly from the manufacturer or approved distributors.
Comparing Discount Canadian Pharmacies
Despite the caveats described above with regard to foreign and offshore pharmacies, prices are very frequently lower for branded drugs almost anywhere but the United States, and the Canadian government’s prescription drug price controls ensure that Canadian drugs are amongst the cheapest available. Some organizations for retired people living near the border with Canada are even sponsoring bus trips across the Canadian border for people to purchase medications at much lower Canadian prices, and the states of Wisconsin and Minnesota have launched dedicated Canadian pharmacy web sites to help their residents buy Canadian drugs.
Increased competition within the U.S. discount drug market for generics, however, does mean that the price advantage for Canadian or other foreign pharmacies has been somewhat eroded for these less expensive drugs.
Comparing Discount Mexican Pharmacies
In contrast to the comparatively well-developed Canadian online discount drug market — an area which was initially flooded with carbon copy ‘me too’ sites attempting to cash in on the U.S. rush to buy discount drugs abroad, but which has since matured and consolidated significantly — the Mexican online market is comparatively under-developed. Like Canada, Mexico has long attracted regular forays from U.S. citizens living along the border who journey a few miles to make big savings on prescription drugs, and this business continues to thrive. (Beware the widespread scams offering to sell you special ‘members only’ access to lists of Mexican pharmacies for this purpose, complete with addresses and telephone numbers. Legitimate businesses make every effort to ensure their names and contact details are as widely available as possible. They do not hide them in special ‘members only’ lists!)
But as far as the online trade in discount Mexican drugs is concerned, true quality merchants have yet to distinguish themselves. (And one which I previously commented on favourably here I have had to remove due to negative feedback about its operations.)
Note that drug laws in Mexico permit many drugs to be dispensed without a prior prescription; this enables Mexican pharmacies to ship (legally, in accordance with Mexican law) many medications which neither U.S. pharmacies nor Canadian pharmaices would be able to ship without a prescription.
Why I Have Removed Specific Suggestions for Trustworthy Online Pharmacies
Although I previously provided suggestions for online pharmacies which appeared to be trustworthy and reliable, I have now removed all those recommendations. Why? The field is changing so rapidly — with online pharmacies going out of business, reappearing, being acquired, and so forth — that it is difficult, if not impossible, to keep abreast of it all. In addition, the regulatory landscape is shifting continually, with the general theme being one of increasing restrictions on the online pharmacy business.
On the one hand, I believe this is actually good for consumers. Rather a lot of what was being sold as genuine pharmaceutical product turned out to be unabashed junk, and it can only be good when government and law enforcement step in to eliminate the trade in potentially harmful substances.
On the other hand, however, the increasing focus on eliminating junk seems to have overshadowed the original reason why consumers turned to online pharmacies (and particularly Canadian pharmacies) in the first place: American consumers are being price-gouged.
Unfortunately, many of those with the loudest and most self-righteous voices in this area — and whose professional background is almost invariably characterized more by political lobbying or high-paid marketing consulting than actual medical competence — seem unable or simply unwilling to hold these two considerations in awareness simultaneously.
For more on one industry-backed attempt to separate the junk from legitimate online pharmacies, see the VIPPS accreditation program from the National Association of Boards of Pharmacy.
The NABP also provides a (brief!) list of legitimate online pharmacies which have passed their accreditation requirements.
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