Online Drugs? Know Your Supplier.

If you are ordering prescription drugs from websites that are not approved by the National Association of Boards of Pharmacy (NABP), you may be disappointed by the results. This is the conclusion of a preliminary study of the inner-workings of the illicit global trade in pharmaceuticals, published by the American Enterprise Institute.

Study researchers ordered the brand-name drugs Lipitor, Viagra, Celebrex, Nexium, and Zoloft from online pharmacies and analyzed how accurately the order was filled. Viagra ordered from websites classified as “highly not recommended” or “unidentifiable” by the National Association of Boards of Pharmacy (NABP) was not Viagra 9 percent of the time. Two of the 24 Viagra orders were not assessed. Though the pills were blue and shaped like Viagra, they weren’t labeled as being manufactured by Pfizer.

Some website pharmacies failed to comply with instructions and sent copy cat drugs rather than brand name drugs. In these cases, the researchers could not say whether the pills received were fakes or whether they were generics likely to work well for most people.

Some pharmacies sent Nexium tablets, approved for sale in Europe and much of the rest of the world, but not approved for sale in the U.S., suggesting that drug diversion is alive and well. Three orders of “Neksium,” allegedly manufactured for AstraZeneca India in Bangalore, did not appear to contain esomeprazole, the active ingredient in Nexium. Three pharmacies sent “Daxid” tablets in place of Zoloft tablets. Daxid is manufactured in India.

Of the 88 drug orders received, 33 came from pharmacies outside North America and 37 were of unknown origin. One pharmacy claiming to be based in Ontario, Canada, had package receipts stating that the drugs had been shipped from Australia, India, and the United States. According to the authors, research by Cyveillance, an online risk monitoring and management firm, found that only 214 of 11,000 sites designed to appear as Canadian pharmacy websites were actually based in Canada.

Some pharmacies claimed to be U.S. or Canada-based but posted charges to the credit cards used to buy the drugs in Chinese or Indian currency. A pharmacy describing itself as an “off-shore company based in Cyprus” listed a contact address in British Columbia and had the initial transfer of funds sent to Panama. The Viagra ordered from this website arrived wrapped in aluminum foil and was postmarked Shanghai. Analysis suggested that the pills were not Viagra.

A Citibank MasterCard was used to pay for study drug orders. In some cases Citibank refused to allow transactions presumably, the authors say, “because the pharmacies were known or suspected criminal entities.”

As economic theory would suggest, prices were slightly higher at the less risky NABP-approved websites. The web based prices were noticeably lower than those offered by pharmacies located near the lead author’s home in Washington, DC. However, it is not clear whether the local prices quoted are list prices or the much lower prices available to customers who are members of an insurer’s purchasing network.

Prices for Viagra were much higher at the least reputable web pharmacies. Many of them accepted faxed or emailed copies of prescriptions. Since these can be easily falsified, the drug is essentially available without prescription. Its price averaged $17.75 for 100mgX4 at a local (US) pharmacy to $16.56 at NAPB “approved” pharmacies, to $24.44 at “highly not recommended” pharmacies.

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