buying your pills online may save you money
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Buying Your Pills Online May Save You
Money, But Who's Selling Them?By SANA SIWOLOP
Published: September 29, 2002
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WHEN Lor i Levine went online last November to order two pr escr iption drugs for
pr eventing seizur es and tr eating depr ession, she was pleased. Ms. Levine, 49, then ar egister ed nur se in El Sobr ante, Calif ., whose insur ance did not cover the $200-a-month cost
of the drugs, found an Inter net phar macy, Canadameds.com, that sold them at half the pr ice. She was a satisfied customer ² until a few months ago.
After moving to Bismar ck, N.D., in ear ly August and order ing r efills, Ms. Levine said, shewaited ² and waited. After thr ee weeks, the order hadn't arr ived in the mail, she said, so sher epeatedly called Canadameds.com and was put on hold each time. Then she sent an e-mailmessage to the company, which had pr omised to r espond to any e-mail quer y within 48hour s, but she said she r eceived no r eply. It was only after she complained to a phar macyindustr y tr ade gr ou p, she said, that the company called her back, apologized and r efilled her
pr escr iptions.
Ms. Levine's account r eflects both the impr ovements in the online phar macy industr y sinceits bir th in the 1990's and the pitfalls and conf usion that r emain in order ing pr escr iption drugsonline.
Because of gr owing scrutiny by both feder al and state author ities, some online phar macieshave gone out of business. But some r egulator s say they continue to have ser ious concer ns
about the ways some companies oper ate. And they ar e worr ied about a lar ge number of Websites that still list only an e-mail addr ess, as well as a r apidly gr owing number of online
phar macies that ar e based in Canada, beyond United States r egulator y contr ol, that cater toAmer icans seeking cheaper pr ices outside their own countr y.
Pr icing continues to be an issue as well. Some studies have found that Inter net shopper s cansave 25 per cent on the cost of pr escr iption drugs, but the Califor nia State Board of Phar macy,in a r ecent online shopping tr ip, found that some drugs cost u p to five times as much on theInter net as they did at the local phar macy.
Some r egulator s say they have also noticed a new slickness in the online phar macy industr y. They point to Web sites that now r equir e a customer to r elease them f r om liability befor e theymail pr escr iption drugs, as well as those that make a customer agr ee not to consume any
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prescr i pti drug wit ut f irst consulting a local physician. Some Web sites descr i bethemsel es as unbiased "information exchanges" for consumers who want to share ti ps about
par ticular pharmacies, but the sites have no information about where they are based or whomthey represent.
"Online pharmacies have gotten much more sophisticated than they were in 1999," said
R ichar d Cleland, assistant director of the division of adver tising practices for the Federal Trade Commission.
Carmen A. Cati one, the executive director of the National Association of Boar ds of Pharmacy, a professional group that represents pharmacy licensing boar ds in the 50 states,said his organi ation was receiving about two dozen consumer complaints a month about online pharmacies, with most of the complaints directed at roughly three dozen companiesthat have blanketed the Internet with hundreds, if not thousands, of Web sites.
Thousands of Amer icans are now regular ly doing business online with Canadian pharmacies.The laws governing the sale of prescr i ption drugs by foreign pharmacies to Amer ican
consumers are murky; it is sometimes har d to tell what falls under any ban. Under some
circumstances, the Food and Drug Administration does allow the impor tation of prescr i ptiondrugs.
In Canada, complaints from Amer ican consumers appear to be growing. Ronald F. Guse, theregistrar for the Manitoba Pharmaceutical Association, said his regulatory group had received 10 such complaints over the last 12 months.
"It s not a large number, but it s signif icant when you compare it to the 25 to 35 complaintsthat we get about the entire industry in a normal year," Mr. Guse said. Most complaints sofar, he said, have been from consumers on service issues, like getting bills for medications 30to 90 days before they are sent. Some consumers have also complained about medicationerrors.
What constitutes a legal or illegal online prescr i ption is confusing. In Canada, prescr i ptionscannot be f illed unless wr itten by a physician licensed in that country. So Canadian
pharmacies that receive or ders online from Amer ican consumers generally have Canadiandoctors co-sign prescr i ptions wr itten by Amer ican doctors, which are sent to the pharmacies
by mail or fax.
In the United States, federal law prohi bits online pharmacies from dispensing prescr i ptiondrugs without a prescr i ption but does not specif ically bar the pharmacies from prescr i bingdrugs based on online consultations or medical questionnaires.
Accor ding to the Federation of State Medical Boar ds, a professional group, only one state,Kentucky, has passed legislation that specif ically prohi bits prescr i ptions based only on onlinequestionnaires, while 22 states, including New York, have rules that essentially require a
physical exam before an online prescr i ption can be f illed. Enforcement of these rules isgrowing, but online pharmacies that bypass or dinary doctor visits are still rampant on theInternet.
Louella Neel, a retired real estate broker in Apple Valley, Calif., said she was shocked by thetwo or three e-mail messages that she, her husband and son each receive daily from online
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pharmacies. They offer service without prescr i ptions, she said, or announce that their customers need only agree to a telephone consultation with a doctor, usually in another state.
"These companies are offer ing very ser ious drugs," Ms. Neel said.
Last January, the Flor ida attorney general s off ice sued B&G Wholesale Inc., an online
pharmacy based in Deerf ield Beach, accusing it of bypassing a prescr i ption requirement byask ing customers to list current or past medical problems. But the space to answer that question was automatically f illed in with the wor d "none," and customers had to delete thewor d to answer the question, the lawsuit said. Accor ding to Travis Berry, an assistant attorney general in Flor ida, the company's Web site has been shut down. B&G Wholesale'slawyer, Rober t Roundtree, could not be reached for comment.
Oversight of online pharmacies is growing within the pharmacy industry. The National Association of Boar ds of Pharmacy lists on its Web site, www.nabp.net, 12 online
pharmacies that have passed a voluntary cer tif ication program, which includes an on-siteinspection visit. Once pharmacies are cer tif ied, they are allowed to post the program's seal of
approval on their Web sites. The approved list includes Drugstore.com, Familymeds.com and
CVS.com. Mr. Catizone said his association was reviewing 10 more pharmacies for possi bleinclusion.
SOME companies in the online pharmacy industry have begun their own accreditation programs. One, star ted last fall by a group of online pharmacies that calls itself the Nor thAmer ican Pharmacy Accreditation Commission (www.napac.org), now has 68 members ² most of them Canadian. Accor ding to Paul Fischer, a Tampa, Fla., businessman who hel ped to found the commission, members adhere to a code of service standar ds for the r ight to post the commission's seal of approval on their Web sites.
"A lot of people are look ing at customer service issues in this industry, so we act as a go- between," he said.
Mr. Fischer said his group hoped to gain the suppor t of Canadian pharmacy regulators.Another group, the Council for Responsi ble Telemedicine in Washington, founded last June,has also established a code of conduct. So far, its members include only online physicianconsultation services.
Cr itics like Mr. Catizone say such self-regulatory effor ts in the online pharmacy industrywere nothing more than thinly veiled marketing aimed at bolster ing credi bility withcustomers. Still, some consumers say they welcome the idea.
Consider Ms. Levine, who said she had service problems with Canadameds.com. On Sept. 2,
she sent an e-mail message with her complaints to the Nor th Amer ican PharmacyAccreditation Commission. The next day, she received a phone call from Canadameds, whichdisplays the commission's seal of approval on its Web site, informing her that her medicinehad just been mailed to her.
Brandy O'Reilly, the assistant director of operations at Canadmeds.com, said Ms. Levine'sor der had been stalled by a computer upgrade at the company and a boom in business. WhenCanadameds.com opened in 2000, she said, it was shi pping just 5 packages a day, compared with 600 to 700 now.
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Ms. O'Reilly said Canadameds.com strove to deliver packages to consumers within 21 days.As for answer ing consumer inquir ies, however, the stated goal is now to do so within 72
hours, instead of the 48 hours the company or iginally promised to Ms. Levine.
"We've had a very unrealistic amount of growth," Ms. O'Reilly said. "We've got everythingunder control now."
HEN Lor i Levine went online last November to or der two prescr i ption drugs for preventingseizures and treating depression, she was pleased. Ms. Levine, 49, then a registered nurse inEl Sobrante, Calif., whose insurance did not cover the $200-a-month cost of the drugs, found an Internet pharmacy, Canadameds.com, that sold them at half the pr ice. She was a satisf ied customer ² until a few months ago.
Af ter moving to Bismarck, N.D., in ear ly August and or der ing ref ills, Ms. Levine said, shewaited ² and waited. Af ter three weeks, the or der hadn't arr ived in the mail, she said, so she
repeatedly called Canadameds.com and was put on hold each time. Then she sent an e-mail message to the company, which had promised to respond to any e-mail query within 48
hours, but she said she received no reply. It was only af ter she complained to a pharmacy
industry trade group, she said, that the company called her back, apologized and ref illed her prescr i ptions.
Ms. Levine's account ref lects both the improvements in the online pharmacy industry sinceits bir th in the 1990's and the pitfalls and confusion that remain in or der ing prescr i ption drugsonline.
Because of growing scrutiny by both federal and state author ities, some online pharmacieshave gone out of business. But some regulators say they continue to have ser ious concernsabout the ways some companies operate. And they are worr ied about a large number of Websites that still list only an e-mail address, as well as a rapidly growing number of online
pharmacies that are based in Canada, beyond United States regulatory control, that cater toAmer icans seek ing cheaper pr ices outside their own country.
Pr icing continues to be an issue as well. Some studies have found that Internet shoppers cansave 25 percent on the cost of prescr i ption drugs, but the California State Boar d of Pharmacy,in a recent online shopping tr i p, found that some drugs cost up to f ive times as much on theInternet as they did at the local pharmacy.
Some regulators say they have also noticed a new slickness in the online pharmacy industry.They point to Web sites that now require a customer to release them from liability before theymail prescr i ption drugs, as well as those that make a customer agree not to consume any
prescr i ption drug without f irst consulting a local physician. Some Web sites descr i be
themselves as unbiased "information exchanges" for consumers who want to share ti ps about par ticular pharmacies, but the sites have no information about where they are based or whomthey represent.
"Online pharmacies have gotten much more sophisticated than they were in 1999," said R ichar d Cleland, assistant director of the division of adver tising practices for the Federal Trade Commission.
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Carmen A. Catizone, the executive director of the National Association of Boar ds of Pharmacy, a professional group that represents pharmacy licensing boar ds in the 50 states,
said his organization was receiving about two dozen consumer complaints a month about online pharmacies, with most of the complaints directed at roughly three dozen companies
that have blanketed the Internet with hundreds, if not thousands, of Web sites.
Thousands of Amer icans are now regular ly doing business online with Canadian pharmacies.The laws governing the sale of prescr i ption drugs by foreign pharmacies to Amer icanconsumers are murky; it is sometimes har d to tell what falls under any ban. Under somecircumstances, the Food and Drug Administration does allow the impor tation of prescr i ptiondrugs.
In Canada, complaints from Amer ican consumers appear to be growing. Ronald F. Guse, theregistrar for the Manitoba Pharmaceutical Association, said his regulatory group had received 10 such complaints over the last 12 months.
"It's not a large number, but it's signif icant when you compare it to the 25 to 35 complaints
that we get about the entire industry in a normal year," Mr. Guse said. Most complaints so
far, he said, have been from consumers on service issues, like getting bills for medications 30to 90 days before they are sent. Some consumers have also complained about medicationerrors.
What constitutes a legal or illegal online prescr i ption is confusing. In Canada, prescr i ptionscannot be f illed unless wr itten by a physician licensed in that country. So Canadian
pharmacies that receive or ders online from Amer ican consumers generally have Canadiandoctors co-sign prescr i ptions wr itten by Amer ican doctors, which are sent to the pharmacies
by mail or fax.
In the United States, federal law prohi bits online pharmacies from dispensing prescr i ptiondrugs without a prescr i ption but does not specif ically bar the pharmacies from prescr i bingdrugs based on online consultations or medical questionnaires.
Accor ding to the Federation of State Medical Boar ds, a professional group, only one state,Kentucky, has passed legislation that specif ically prohi bits prescr i ptions based only on onlinequestionnaires, while 22 states, including New York, have rules that essentially require a
physical exam before an online prescr i ption can be f illed. Enforcement of these rules isgrowing, but online pharmacies that bypass or dinary doctor visits are still rampant on theInternet.
Louella Neel, a retired real estate broker in Apple Valley, Calif., said she was shocked by thetwo or three e-mail messages that she, her husband and son each receive daily from online
pharmacies. They offer service without prescr i ptions, she said, or announce that their customers need only agree to a telephone consultation with a doctor, usually in another state.
"These companies are offer ing very ser ious drugs," Ms. Neel said.
Last January, the Flor ida attorney general's off ice sued B&G Wholesale Inc., an online pharmacy based in Deerf ield Beach, accusing it of bypassing a prescr i ption requirement byask ing customers to list current or past medical problems. But the space to answer that question was automatically f illed in with the wor d "none," and customers had to delete the
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