Medical associations, policy groups organize to fight counterfeit drugs and rogue online pharmacies

Somewhat like the little Dutch boy with his finger in the leaking dike, the Alliance for Safe Online Pharmacies (ASOP Global; Washington) is redoubling its efforts to educate both medical professionals and consumers about the risks of illicit online pharmacies, most of which cross national borders to sell either unauthorized or counterfeit drugs, or to fill orders without a valid prescription. The problem is a well-recognized one, and gets addressed routinely by such intergovernmental efforts as the annual Pangea campaigns by Interpol, FDA and others, but all signs are that the illicit business is stable if not thriving. A surge of “legal highs” from unregulated websites is drawing more consumers into online purchases of psychoactive drugs as the availability of obtaining legitimate opioid drugs gets restricted. In an era of when “fake news” makes many doubtful of the truth of much online information, recommendations on safe online prescription fulfillment become so much roadkill on the internet highway. Behind most of this, though, is the sometimes desperate efforts of consumers to find needed drugs at affordable prices.

All that being said, ASOP Global has garnered the support of the American Medical Assn., the American Pharmacists Assn., and 14 other health or consumer organizations (including HDA, NACDS, NABP and USP) to launch a new campaign, “Buy SafeRX,” (and also launching a new website, www.BuySafeRx.pharmacy) to raise awareness. Earlier, it also began a campaign to help educate healthcare providers to counsel their patients on the risks of online pharmacies; to date, 1,000 providers have participated in the free, online continuing education program. Of those, less than 10% said that they had been aware of the risks, and ever fewer (1.4%) that they counseled patients on the subject, and both measures are expected to dramatically improve after taking the course. (There are, however, somewhere between 500,000 and 750,000 prescribers, depending on how HCPs are measured.)

“Healthcare providers can play a significant role in educating patients about the risks associated with purchasing medications online and how to stay safe,” said ASOP Global executive director Libby Baney in a statement.

BuySafeRx.pharmacy is part of the initial wave of websites being rebranded with the “.pharmacy” top-level domain (TLD) managed by the National Assn. of Boards of Pharmacy. The .pharmacy TLD is supposed to be the guarantee that an online pharmacy is operating by legal processes, but since its adoption a couple years ago, only 53 US pharmacies, a lesser number of veterinary pharmacies, and a smattering of state or national organizations have acquired that designation. (Some interesting positions can be seen among the big PBM-driven and other mail-order pharmacies: while CVS Health has three .pharmacy designations for Caremark and other brands, Express Scripts has 13 [including its Accredo pharmacy]. Hardly any other PBM mail-order pharmacy has the designation. Among chains, Rite Aid and Longs have it, while Walgreens does not. A handful of specialty pharmacies, including Diplomat and Avella, have the designation.) If the pharmacy operators themselves are only slowly adopting the .pharmacy designation, it’s hard to make the case that consumers should stick to it.

BuySafeRx is including a verification service, powered by data from LegitScript, Inc., a private company that has been employed by federal agencies and others to investigate online-pharmacy operations. LegitScript, in turn, has worked with the Center for Safe Meds Online, a nonprofit funded by leading search engines and credit card firms to police online pharmacy business practices. A January report commissioned by the Center and conducted by LegitScript found that even though “this report recognizes public education and demand reduction as an indispensable counterpart” to addressing rogue pharmacies, “illegal online pharmacies will continue to exist—nobody should realistically expect the problem of illicit online sales to disappear — and to pose a risk to Internet users seeking to obtain a prescription drug online.”

For the past year or so, ASOP Global has been sounding the alarm that the increasing numbers of seniors in the US—who tend to require substantially more pharmaceuticals than younger consumers—combined with their more-limited incomes and therefore a higher propensity to shop online for value, the need to police illicit online pharmacies will grow. Whether or not the trend is age-related, a survey by the Kaiser Health Foundation in November found that 8% of adults in the US had used a foreign online pharmacy in the past year—a number considerably higher than estimates in past studies. (That survey, by the way, performed mostly to reveal the public’s mood on healthcare reform and the Affordable Care Act just after the national election, found a 44%/45% split between “favorable/unfavorable” opinions.)

If those 8% of consumer purchasers acquired all of their prescriptions abroad (an admittedly dubious claim), that translates into $32 billion of the projected $405 billion 2016 net revenue in the US drug market—a very rough calculation of how much revenue is leaking out of US conventional drug sales. However accurate that number might be, it’s enough to give pharma industry leaders pause. The loose talk in the past election year of authorizing drug importation adds more to worry about.