10 Things to Know Before Using an Online Pharmacy

(This article previously appeared on NerdWallet.com.)

Are you looking to save money on prescription drugs and considering online pharmacies?
 
It’s no surprise: Americans spend more than $300 billion a year on prescription drugs. It makes sense to try and save money in any way possible, including navigating the myriad online vendors that promise to sell your drugs for a fraction of the prices you’re currently paying. However, with all the media buzz and online options, it can be hard to know how to proceed — starting with who you can trust.

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Here are 10 things to know before you start using an online pharmacy:
 
1. What an online pharmacy is and how it works  Simply put, an online pharmacy is an Internet-based vendor of prescription drugs, and the term encompasses both legitimate and illegitimate pharmacies. Online pharmacies can sell drugs cheaper than drugstores because they can serve a large clientele from one central location and cut out the cost of a network of local pharmacies.

In the case of foreign online pharmacies, drug costs in other countries are cheaper, so the potential for savings is even greater. This is because the U.S. Food and Drug Administration (FDA) does not regulate drug prices, but most other countries do. In most cases, the free-market price of a drug in the U.S. is higher than the price cap in other countries.

2. Not every online pharmacy is the same  Because drug costs are so high in the U.S., many people seek to save money by purchasing drugs online, but there are thousands of options. Many of these online pharmacies are legal and legitimate, but most are not.

Illegitimacy means that nobody is keeping the pharmacy in check to ensure it complies with laws and regulations, not to mention sending the correct product. These pharmacies are considered to be fraudulent, and most of them are based in other countries — or claim to be.

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Fraudulent pharmacies are well-known and so are their dangers. Some might just send you a non-U.S. version of your drug, an incorrect dosage or a generic when your doctor has prescribed a brand name. Other times, labeling is incomplete or missing, so if you order more than one drug you may not know which is which or how to take it and what foods to avoid.

In some cases, you might get a completely different drug than you were originally prescribed, or a sugar pill with no active ingredients at all.

3. What the FDA says about online pharmacies  The role of the FDA is to protect consumers by regulating consumable products. No law explicitly forbids importing prescription drugs from other countries, so long as they are not controlled substances and the purchase is done with the knowledge and approval of a licensed physician. Even so, the FDA recommends against buying drugs from other countries because their safety can't be confirmed and because consumers who have adverse reactions have no recourse against the manufacturer.

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Since 2008, the FDA has intercepted and seized a number of drugs ordered by illegal online pharmacies through the mail. These busts were annual crackdowns called Operation Pangaea, done in collaboration with 110 other countries through INTERPOL, an international police organization. Operation Pangaea VII, which resulted in the seizure of 19,618 packages worldwide ordered from illegal online pharmacies (domestic and foreign), lasted one week during May 2014; 583 of the packages were seized in the U.S. alone. During that week, the FDA also identified 1,975 U.S.-based websites selling drugs illegally and shut them down.

The FDA cracks down on other agencies for promoting unlawful websites, too. Back in 2011, the FDA sued and settled with Google for $500 million for Google’s placement of illegal Canadian online pharmacy ads. Many people trust Canadian pharmacies, but purchasing drugs from other countries is not always legal, and the FDA does not allow U.S. companies to post their ads.

4. What is definitely illegal  We know the FDA strongly discourages buying drugs from other countries, but specific laws on the subject are not always clear.

Here are things related to some online pharmacies that are definitely illegal:

• Purchasing controlled substances without a prescription written by a licensed doctor This includes all prescription narcotic painkillers, sedatives, stimulants and anabolic steroids. Many online pharmacies offer these drugs without requiring a prescription.
• When importing prescription medications, the patient must also provide that physician’s contact information to authorities at customs. This applies to importation by mail.
• Purchasing prescription drugs in the U.S. that are not FDA-approved (but may be legal in other countries).

So, what if you can meet all of these requirements and want to save money by purchasing from a foreign pharmacy? Well, you’ll be held to that country’s laws as well. In order to legally purchase a controlled medicine from a Mexican online pharmacy, for example, you’ll need a prescription from a licensed Mexican physician in addition to the prescription from your local doc.

5. What is definitely legal  It is definitely legal to purchase drugs through a U.S.-based online pharmacy that has been certified by the National Association of Boards of Pharmacy (NABP). The NABP is an impartial professional organization that supports state pharmacy boards and is recognizd by the FDA as the leading pharmacy authority.

Some online pharmacies that aren’t verified by the NABP have been verified by independently-owned LegitScript, which also certifies online pharmacies. LegitScript is acknowledged by the NABP as recognizing safe practices and complying with federal law; it approves only U.S.-based online pharmacies. Unlike the NABP, however, LegitScript does not require a fee or application from pharmacies for verification. Therefore, LegitScript may certify some pharmacies as legitimate that are not certified by NABP because they have not paid the fee.

6. How a Canadian online pharmacy is different  Canadian pharmacy practices and standards are similar to those of the U.S., and many Canadian pharmacies follow U.S. and Canadian rules when selling to U.S. customers. Legitimate Canadian pharmacies allow U.S. patients to order drugs online and verify prescriptions and don't require a separate Canadian prescription. They also will not sell controlled substances to U.S. patients.

However, the FDA reports that many online pharmacies that appear Canadian are actually operating out of other countries. True Canadian pharmacies are certified by the Canadian International Pharmacy Association (CIPA), which states on its website that CIPA-certified pharmacies follow the “same stringent confidentiality and safety procedures as U.S. pharmacies.” CIPA-certified pharmacies are legitimate and licensed in Canada, but cannot be verified by U.S. pharmacy bodies. Even though research has shown that legitimate Canadian pharmacies sell legitimate drugs at cheaper prices, the FDA still advises against these purchases.

7. What the research says about online pharmacies  Two major studies have been done to assess online pharmacies. The most recent was conducted by NABP in September 2013, which found that 96.7 percent of online pharmacies selling to U.S. citizens were "rogue," meaning they did not comply with U.S. laws and regulations. The report covered 10,642 pharmacies, and only 90 were found to be legitimate, with another 258 classified as potentially legitimate.

The National Bureau of Economic Research did a more comprehensive study in 2012. To assess drug cost and integrity, its researchers acquired samples of five common brand-name prescription drugs in their most popular dose from a variety of online pharmacies: Lipitor, Viagra, Celebrex, Nexium and Zoloft. Some of the findings include:

• All of the U.S. pharmacies required prescription verification, compared with 90 percent of Canadian pharmacies and 67 percent of foreign pharmacies. The researchers found that 10 percent of the drug samples were not what they ordered, including those where a generic had been sent instead of a name brand. This was true for 3 percent of certified U.S. pharmacies, 9 percent of certified Canadian pharmacies and 18 percnt of uncertified pharmacies.
• They verified the FDA’s claim that many uncertified pharmacies claiming to be Canadian actually shipped from other countries.
• Of the drugs that matched the prescriptions, 100 percent of those delivered by certified U.S. pharmacies, 100 percent delivered by Canadian pharmacies, and 89 percent delivered by uncertified online pharmacies had the correct active ingredient.
• Every one of the fraudulent prescriptions delivered was for Viagra.
• Overall, the researchers concluded that although there are many rogue pharmacies online, a blanket ban against certified Canadian pharmacies is not justified and may prevent considerable savings for consumers, since those drugs were 49 percent cheaper than U.S.-bought drugs.

8. There are security concerns with other countries' online pharmacies  The allure of purchasing drugs cheaply from other countries may be strong, but the regulation of drug manufacturing and e-commerce in these countries is lax compared with the U.S. and Canada. Among the most popular countries to purchase drugs from are Mexico and India, since many prescriptions can be purchased at a fraction of the cost.

Many drugs that require a prescription in the U.S. to purchase can be bought over-the-counter from Mexico and aren’t considered controlled in either country. These are the drugs that account for most international prescription purchases­ — antibiotics, acne creams and blood pressure medications. The FDA estimates that up to 40 percent of Mexican pharmaceuticals are counterfeit, and it strongly cautions against their use.

India’s drug laws are incomplete and difficult to navigate, and this is especially true for drugs sold online. Enforcement of these laws is lax, and most online pharmacies based in India do not comply with local laws and regulations. Additionally, there are no current laws on e-commerce in India, meaning there are no requirements to protect your personal information. Due to the lack of stringent manufacturing and privacy guidelines, purchasing drugs from online Indian pharmacies is very risky and not recommended.

9. Guidelines for safely purchasing drugs online  To ensure your safety and security of your personal information online, here are some best-practice guidelines:

To be sure pharmacies follow stringent safety and quality standards, look for NABP-certified or CIPA-certified pharmacies.

Even if the website says a pharmacy is certified, you should cross-check against the NABP and CIPA websites, or start from there.

Don’t buy from sites that sell drugs without a prescription or ones that offer to prescribe the drug for you without seeing a doctor.

Check the privacy and security policies — they should be easy to read and understand. Illegal pharmacies will often sell your personal information.

Make sure the site has a physical address listed and a phone number you can call to talk to a pharmacist.

Do call the phone number and ask for the pharmacist’s license information. U.S.-based pharmacy licenses can be verified online.

10. How to find the best and avoid the worst  To make it even simpler, you can follow these links to find exactly what you're looking for:

The NABP has a listing of recommended sites here.

The NABP’s not recommended sites are here.

LegitScript’s recommended sites are here.

If you’re looking into Canadian pharmacies, verify CIPA certification here.

To find a CIPA recommended site, go here.

PharmacyChecker’s reviews are here.

Lacie Glover writes for NerdWallet Health, a website that empowers consumers to find high quality, affordable health care and insurance. You can follow her on Twitter.