It sounds promising: You boot up your computer, go to one of the new prescription drug Web sites, type in your name, health insurer, credit card number and address, and ask your doctor to call or fax in your prescription.
Presto! Within a day or so, your medication arrives on your doorstep by mail, UPS or Fedex. No driving to the drugstore. No parking. No standing in line while harried druggists fill your order.
A month ago, the first major Internet pharmacy, Soma.com, went on line with a prescription service, which has already filled thousands of orders through a distribution center in Ohio. By the end of the first quarter, PlanetRx.com and Drugstore.com, with distribution centers in Tennessee and Texas respectively, promise to be up and running, too.
The American Association of Retired Persons (AARP), a longtime mail order prescription giant, recently added on-line ordering for its members, at www.rpspharmacy.com. So has Merck-Medco, which provides prescription drug benefits to health plans and employer groups, though it handles only refills, not new prescriptions, on line (www.merck-medco.com).
With prescription drug sales a booming $88-billion-a-year business, virtual pharmacies were probably inevitable. But it’s too soon to tell how well they’ll work and how different they’ll be from mail order services.
The hope is that Internet pharmacies will make drug shopping even easier than by mail order, says Andy Stergachis, director of pharmacy services at Drugstore.com. You’ll be able to order nonprescription items like vitamins and shampoo along with your antibiotics, for instance, and you can ask your virtual pharmacist questions as well. You will also get e-mail reminders when prescriptions need to be refilled, he says.
True, you have to send personal information into cyberspace, but there are at least some assurances of confidentiality. At PlanetRx.com, privacy will be assured with “the highest level” of encryption, says Stephanie Schear,a founder and vice president of business development.
And if all goes according to plan, on-line pharmacies will fill prescriptions as ethically as your local drug store.
At Soma.com, your doctor must call or fax in the prescription. The pharmacists are required to call the doctor to verify that he or she is legit and the prescription is correct. They’re also supposed to make sure your new drugs won’t conflict with what you’re already taking.
In theory, the virtual pharmacies will also be duly licensed in the states from which they distribute drugs and will be licensed or registered in every state where they have customers as well.
In reality, though, cyber pharmacies, which are expected to be fiercely competitive, are springing up in a regulatory limbo. Is there anyone minding the virtual store?
“There’s not, in my opinion,” says Dr. James Winn, executive vice president of the Federation of State Medical Boards.
The Federal Trade Commission is concerned mostly with deceptive practices, not violations of standards of care, he notes. The Food and Drug Administration’s job is to oversee drug quality, not the practice of medicine by doctors and pharmacists, who, like pharmacies, are licensed state by state.
And therein lies the rub.
In some states, including Massachusetts, the state has no jurisdiction over out-of-state pharmacies, including the mail order firms that have been around a while, because it has no law requiring they be registered, says Chuck Young, director of the state’s Board of Registration in Pharmacy. If there were such a law, the state could initiate legal action if a Massachusetts resident were harmed by prescription drugs shipped from out of state.
“This whole issue is just exploding right now,” says Young. “We’re doing the best we can. But electronic changes are occurring at a faster rate than regulatory boards can keep up, given the resources they’re provided. I would want to be convinced these drugs are being packaged in conformity with federal and state law.”
Another problem is that it may be difficult for consumers to distinguish between on-line pharmacies that are legitimate and those that aren’t, says Carmen Catizone, executive director of the National Association of Boards of Pharmacy.
Some Web sites have already been criticized for having doctors write prescriptions, most notably for the potency pill Viagra, for patients they have never even seen, a medical practice widely viewed as unethical.
“We’re trying to come up with some system for consumers to differentiate between legitimate on-line pharmacies and the not-so-legitimate,” Catizone adds. “In the meantime, consumers should not order any medications over the Internet from sites that don’t assure you that your doctor has been contacted.” (You can also check with your doctor.)
It also may be risky to get some prescription drugs on the Web and others at your local drugstore. “So if you’re switching to an on-line pharmacy, that pharmacy needs to know what else” you’re taking because of potential drug interactions, says Susan Winckler, director of policy and legislation for the American Pharmaceutical Association.
To guard against this danger, new customers at Drugstore.com must fill out a form indicating what other medications they’re taking and what allergies and medical conditions they have. All prescriptions are checked against this information.
Another issue is how Internet pharmacies will deal with controlled substances, says Dr. Helga Rippen, director of the Health Information Technology Institute at Mitretek Systems, Inc., a nonprofit technology think tank in McLean, Va.
Drugstore.com won’t fill prescriptions for narcotics such as Percodan and Demerol, though this type of prescription can be filled at neighborhood drugstores, says pharmacist Stergachis. Drugstore.com will fill prescriptions for some painkillers and sleeping pills, however, after checking with your doctor.
In general, Stergachis says, the on-line service plans to call the patient’s physician “if there is any reason to suspect any type of a problem or if clarification is needed,” just as pharmacists are supposed to do already in local drugstores. (With the on-line service, just as in the current system, there’s no automatic way to tell if this consultation does occur.)
Despite such concerns, ordering prescription drugs on line may not turn out to be all that revolutionary. After all, says Schear, PlanetRx’s founder, “We’re not changing anything about the existing system. You go to a doctor. You say you want your prescription filled from PlanetRx. They fax or call us just as they do today.”
“We plan to verify prescriptions,” she adds, precisely how she won’t say, for competitive reasons, until the site is launched.
Stergachis agrees that in many ways, on-line pharmacy services will be “similar to mail order services,” which account for about 13 percent of the prescription drug business.
In fact, if there’s a downside to all this, that may be it.
Even with the net, there will “still have to be contact between the pharmacist and the physician,” says Ed Spearbeck, senior vice president of corporate and pharmacy affairs for the AARP. “That is time-consuming. I’m not sure people are prepared to understand that fully.”
Using an on-line pharmacy
– Check to see whether the on-line service is willing to contact your doctor to verify prescriptions, especially for controlled substances such as painkillers and sleeping pills.
- If you have any doubts about whether your personal medical information will be kept confidential, don’t use that site.
- Call the board that licenses pharmacies in your state and ask if they have received any complaints about the site you want to use; also ask whether your state has a law giving it jurisdiction over out-of-state pharmacies.
- If there’s anything that doesn’t look right when you get the medication, don’t take it. If your current medication is green and you get red pills, for instance, don’t take them.
- If the package looks like it’s been opened or tampered with, don’t take the medication.
- If you order some medications on line and others from your regular pharmacy, tell both pharmacists what other medications, vitamins, herbal supplements and the like you are taking, to minimize the danger of adverse interactions.