While the number of Americans who purchase medicines from online pharmacies is relatively small—4 to 6 percent of adults—the market is significant in dollar terms. While exact numbers are hard to come by, sales from Canadian (or seemingly Canadian) website alone are around half a billion Canadian dollars annually. Safety is the biggest issue involved in buying medicines online. Websites can sell fake medications while stealing consumers’ information for the purposes of identity theft. While the FDA doesn’t certify online pharmacies, several third-party organizations do.
My colleagues Ginger Zhe Jin from the University of Maryland College Park and Aparna Mathur from the American Enterprise Institute and I published an article that assesses the quality of medicines purchased from online pharmacies based on the type of certification those online pharmacies possess. Furthermore, to better understand the demand side of the online pharmacy market, we surveyed Americans who purchase medicines from online pharmacies to see if certification provides consumers with information they use to reduce the risk that they will buy fake medicines online. The study was published in the Berkeley Electronic Journal of Economic Analysis & Policy.
You can download the study here.
The FDA advises consumers to avoid foreign pharmacy websites and to only purchase websites in the US that have been approved by the National Association of Boards of Pharmacy. However, there are at least four certification agencies that verify the credentials and business practices of online pharmacies: the NABP, CIPA (the Canadian International Pharmacy Association), LegitScript.com and PharmacyChecker.com. By definition, NABP and LegitScript.com only approve US websites, CIPA only approves Canada-based websites, and PharmacyChecker.com covers websites operating in US, Canada, and other countries.
We classified websites approved by the NABP and LegitScript.com as Tier 1, websites certified by CIPA and PharmacyChecker.com as Tier 2, and other websites without these certifications as Tier 3. Most Tier 2 and Tier 3 websites were registered outside the U.S.
Of the 328 samples that we purchased online and were delivered, all passed a Raman spectrometry test that verified authenticity except for 8 samples of Viagra purchased from Tier 3 websites. Of all the samples we were able to test and authenticate, Tier 2 websites were 49.2% cheaper and Tier 3 websites were 54.8% cheaper than Tier 1 websites.
To better understand the demand side of the online pharmaceutical market, we designed a survey that was distributed by the group RxRights—a group concerned with the price of pharmaceuticals in the U.S. Among the 2,522 people who responded to the survey, 61.5% said that they purchase drugs online and mostly from foreign websites, citing cost savings as the primary reason. Of those that shop online, 41% said that they check with a credentialing agency when deciding where to make their purchases.
The study, then, shows that certification agencies do provide useful information for foreign websites and for consumers who purchase medicines online.
Furthermore, while the FDA is justified in warning consumers against the dangers of purchasing from rogue websites, our findings suggest that a blanket ban on all foreign websites—which currently exists but is enforced mostly for large purchases and for purchases of controlled substances—may deny consumers substantial savings from purchasing medicines from foreign websites that are certified by third parties.