Want cheaper medicines? Be careful if you order drugs online
BY DR. PATRICK NEUSTATTER
Buying medicines online is convenient and can save you up to 35 percent, Consumer Reports tells us. That’s particularly appealing to seniors, 90 percent of whom rely on prescription medicines on a regular basis, but 12 percent of whom say they have had to forgo them in the past year due to price, according to kaiseredu.org.
But a review of drug-selling websites done by the National Associations of the Board of Pharmacies deemed 97 percent of sites “Not Recommended.” And stories about people getting ripped off or getting the wrong drugs—like the FDA did when it ordered Tamiflu as part of an investigation—tend to put people off.
The supposed Tamiflu (oseltamivir) that the FDA ordered arrived “in an unmarked envelope with a postmark from India” and consisted of unlabeled white tablets that “were found to contain talc and acetaminophen (the ingredient in Tylenol), but none of the active ingredient oselta-mivir,” the FDA said.
So is it possible to get medicines online without getting gypped or poisoned?
The first thing to say is that importing medicines from overseas by mail, or in person, is illegal. But if it is not something dangerous, and appears to be just for personal use, the FDA generally turns a blind eye.
To ensure legitimacy, the FDA, in its slightly compulsive and overprotective way, tells us not to use pharmacies outside the U.S. if we want to avoid medicines of unpredictable strength, with possible dangerous ingredients, that may not be FDA approved and that may be improperly shipped, stored or labeled.
This is not safeguard enough by itself, however. The FDA also tells us to use only pharmacies that have a licensed pharmacist to answer questions and some way to contact them – and that require a prescription from your doctor.
This last point may sound strange, but some sites don’t require a prescription—at all. Others will do a “virtual consultation” with their own doctor online or have you fill out a questionnaire; then their doctor writes you the prescription.
Most everyone seems to agree the best and safest advice is to use only sites that require a prescription from your own doctor. You can mail or fax it to them (or get your doctor’s office to do the honors if they’re feeling charitable).
Another safeguard is to use only sites that are approved by another rather cautious watchdog organization, the National Association of Boards of Pharmacies. Sites approved by the NABP are issued a Verified Internet Pharmacy Practice Site certification, indicated as a lozenge-shaped logo on the site, which you can click on to confirm authenticity.
NEIGHBORS TO THE NORTH
The FDA guidelines about how to shop safely for medicines exclude Canadian pharmacies. This is disturbing as a lot of people go to Canada to get medicines, either in person—on one of these modern-day pilgrimages marauding across the border by the busload—or on the Internet.
But a relaxed view is that Canadian sites are safe if you look for those certified by the Canadian International Pharmacy Association, the equivalent of the NABP. This group also issues verification—with a CIPA seal.
And lest you think the Canadians are a bunch of yahoos and their regulatory body is a joke, be reassured that a U.S. agency—the National Bureau of Economic Research—took a look and “confirms that medications sold online by pharmacies accredited by the CIPA are 100 percent authentic.”
The objection the FDA and NABP have about getting medicines from Canada usually is only that the packaging and labeling don’t comply with FDA standards. Incidentally, the bureau of economic research also tells us that “US pharmacies on average charge 52.5 percent more for the five top-selling brand-name medicines.”
The massive number of online pharmacies makes it confusing to know which are legitimate, but the volume is telling about the number of people looking to reduce the cost of their prescriptions.
Good general advice: Be skeptical about sites offering medicines much cheaper than the average.
I tried simulating a patient on some of these pharmacy sites. I am maybe not the sharpest computer geek, but I have to say I found maneuvering around the actual pharmacy sites themselves very difficult. They all seem to require you to register and seem far more interested in overwhelming you with “useful” information and cautions (as is so often the trend these days) than giving you the straight dope.
But you are likely to find startling differences in prices between non-U.S. and domestic—as pointed out by Sen. Byron Dorgan (D–N.D.) when he co-sponsored an amendment to loosen the crazy restrictions on importing medicines. The effort failed in December 2009.
Sen. Dorgan pointed out that a prescription for Nexium (a heartburn drug) in the U.S. costs $424 but just $67 in France, $40 in the United Kingdom, $37 in Germany and $36 in Spain, according to the Washington Independent.
I spoke to an Anthem representative about ordering medicines online and was told you can submit your receipts to the company. But to know exactly what it’s going to cost depends on your insurance coverage. To find out whether your insurance company will cover all or part of the cost of drugs ordered online, you’d have to speak to your insurer.
If you really want to reduce your drug bill and have medicines as reasonably priced as everyone else in the world—and not have to resort to technically breaking the law—the Sen. Dorgans of this world need our support.
OTHER WAYS TO CUT PRESCRIPTION DRUG COSTS
If you can’t or don’t want to buy your medicines online, other ways to help keep your medicine expenses to a minimum are:
- Get your doctor to prescribe a generic medicine—or at least an older brand medicine if no generic is available.
- Ask if there isn’t something cheaper—either a different prescription medicine or an over-the-counter drug—that would do the same job. Take along a copy of the Walmart $4 prescription list to provide suggestions.
- With some pills, you can get them in a higher milligram than you need and cut them in half —or even quarters. But don’t split your pills in a way that results in you getting a lower dose than you need. Ask the pharmacist to be sure the medicines do not have special coating or delivery system. And use a pill cutter to be sure the pill divides evenly.
As a last resort, you might be tempted to borrow from your pet as I was when my back was hurting and our dog was prescribed Rimadyl for his hip arthritis. The drug is promoted to make your dog, at least, “adventurous, frisky, playful [and] energetic,” and it seemed to do our dog a world of good.
As the London Daily Mail reported, movie star Kristen Johnston admitted, after going through rehab, to resorting to “taking pain killers prescribed to my own sweet dog.”
But I don’t recommend that—leave the drugs to the dog!
BUYING SAFELY ONLINE
The U.S. Food and Drug Administration says people who buy medicines online should use only sites that are located in the United States and licensed by the board of pharmacy in the state where the website is operating. A list of these boards is available at nabp.net/boards-of-pharmacy.
Also, use only sites that:
- Provide contact information and have a licensed pharmacist available to answer questions.
- Require a prescription from your doctor or another health care professional who is licensed to prescribe medicines.
If you choose to order from Canadian pharmacies, you should use sites certified by the Canadian International Pharmacy Association (cipa.com).
—Dr. Patrick Neustatter