Copyright 1999 Globe Newspaper Company
The Boston
Globe
February 15, 1999, Monday ,City Edition
SECTION: SCIENCE & TECHNOLOGY; Pg. E1
LENGTH: 1443 words
HEADLINE:
No one's watching on-line druggists;
HEALTH SCENSE / JUDY FOREMAN
BYLINE: By Judy Foreman, Globe Staff
BODY:
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."
Judy Foreman is a member of the Globe staff. Her e-mail address is:
foreman(AT SIGN SYMBOL)globe.com.
Previous "Health Sense" columns are
available through the Globe Online searchable archives at www.boston.com. Use
the keyword columnists and then click on Judy Foreman's name.
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.
GRAPHIC: PHOTO, Andy
Stergachis says on-line pharmacy will call physicians.
LOAD-DATE: February 17, 1999 
