Almost All Online Pharmacies Are Unsafe, Unlawful

About 96% of online pharmacies are noncompliant with federal and state laws or National Association of Boards of Pharmacy (NABP) safety and pharmacy practice standards.

In its July 2015 report, the NABP’s Internet Drug Outlet Identification Program revealed that 10,588 of the 11,015 online drug outlets it analyzed were noncompliant. The remaining outlets were considered potentially legitimate (2.33%) or accredited through NABP’s verified programs (1.54%): the Verified Internet Pharmacy Practice Sites (VIPPS), Veterinary-VIPPS, or the e-Advertiser Approval Program.

NABP Executive Director Carmen Catizone, MS, RPh, DPh, told Pharmacy Times that pharmacists in brick-and-mortar stores can play a significant role in educating patients about these potentially dangerous websites.

He suggested pharmacists may advise patients who want to use an online pharmacy to steer toward sites that are licensed in their state.

“This will provide a mechanism for the patient to report problems and have in place a state regulatory agency (predominantly a state board of pharmacy) for oversight and information that the patient will need to know before allowing the pharmacy to dispense their medications,” Catizone said.

Pharmacists can also warn patients about online pharmacies that do not list a physical address or a method of contacting a pharmacist.

“The overall best advice, although it sounds cliché, is that if something sounds too good to be true, then it probably is,” he said.

The online pharmacies violating safety practice standards and/or laws were most commonly dispensing medications without valid prescriptions (85%). Some of the websites selling prescription medications asked patients to fill out an online questionnaire or participate in an online consultation (56.3%).

Almost 12% provided controlled substances. Other sites also provided foreign and unapproved drugs (48%).

The severs for these non-recommended websites were located outside of the United States about 40% of the time, while around 51% were located within the country. The remaining sites had unknown server locations.

The report noted that many of these websites had registered domain names that were listed as anonymous, and the majority did not contain a physical address.

Beyond illicit medication dispensing, the NABP report found that nearly 16% of the sites were not secure, meaning customers could be at risk for financial fraud and identity theft.

In light of these findings, the NABP advised patients to use online pharmacies that have been approved through VIPPS or Vet-VIPPS, which indicates that the websites’ pharmacy services have successfully passed a review of all policies and procedures. NABP’s vetting process also includes an on-site inspection of facilities used by the website to receive and dispense medication.

There are currently 63 VIPPS or Vet-VIPPS sites, but more applications are in progress.

NABP also recommends online pharmacies that have been vetted through the e-Advertiser Approval program, which reviews websites that accept refill requests from existing customers, provide pharmacy and drug information, and offer other prescription drug-related services. NABP stands by these sites as being safe and lawful.

There are 107 entities listed as e-Advertiser approved, but there are more applications being processed, as well.

“The accountability of licensed pharmacies is evident in the laws and regulations of the jurisdictions that license them,” the report said. “These laws are no less applicable to transactions conducted online.”

In June 2015, the FDA admonished 1040 online pharmacies selling unapproved prescription medications and devices. The owners of these websites received regulatory warnings and faced seizure of illegal products. Some of the unapproved prescription drugs found during the FDA’s operation included generic version of Valium, Truvada, and Meridia.

The online pharmacies that the NABP does not recommend are available on its website.