Copyright 1999 Times Mirror Company
Los Angeles
Times
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September 20, 1999, Monday, Home Edition
SECTION: Health; Part S; Page 1; View Desk
LENGTH: 2213 words
HEADLINE:
YOUR FRIENDLY NEIGHBORHOOD E-DRUGSTORE;
THE NEW ONLINE PHARMACIES
OFFER PROMPT, HASSLE-FREE SERVICE, BUT HEALTH EXPERTS WORRY THAT THE SITES ALSO
POSE SERIOUS POTENTIAL FOR MISUSE.
BYLINE: SHARI ROAN,
TIMES HEALTH WRITER
BODY:
"Convenience"
isn't a word most people would apply to purchasing prescription medications.
With doctors writing more prescriptions than ever--a record 2.2 billion
last year in the United States--long waits at drugstore pharmacy counters are
commonplace. And managed-care restrictions on the amount of medicine you can
buy--often just a 30-day supply--can mean frequent trips to the store.
But the emergence of online pharmacies may offer salvation to consumers
sick of the drugstore rat race.
Following on the heels of other
e-commerce success stories, both entrepreneurs and drugstore chains are racing
to establish online pharmacies. By one unofficial count, the number of such
pharmacies has soared this year from a couple dozen to more than 400. "Within
the last six months, it has really exploded," said Carmen Catizone, executive
director of the National Assn. of Boards of Pharmacy, a professional association
representing all state pharmacy boards. "A few people were beginning to look at
online pharmacies last year. But over the last holiday season, retailers saw how
sales at such places as Amazon.com really took off. That's what got online
pharmacies going."
While a clear boon to consumers--offering
convenience, privacy and the opportunity to compare prices--the trend is not
without serious problems. In particular, a growing number of online pharmacy
sites will sell medications without a prescription, a development that could be
unlawful and is widely viewed as unethical and dangerous.
*
Lawmakers and health professionals have expressed concern that consumers
will confuse legitimate, state-licensed "pharmacy-based" sites that require a
doctor's prescription, with "prescribing-based" sites that dish out drugs for a
price after a cursory cyberspace consultation.
"The Internet can be an
extremely valuable medical resource under certain circumstances," said Dr.
Herman Abromowitz of the American Medical Assn. in congressional testimony in
July. "The AMA, however, is gravely concerned about the current misuse of the
Internet for prescribing purposes. . . . Every day patients are endangered when
they are permitted to receive prescription medications via the Internet without
adherence to proper safeguards that ensure good medical practice."
Others are worried, too. The Federal Trade Commission, the National
Assn. of Boards of Pharmacy, several states' attorneys general and executives
for the nation's largest chain drugstores (such as CVS and Rite Aid) have called
for heightened oversight of online pharmacies.
Even Pfizer, maker of the
impotence remedy Viagra, has filed a complaint with the Federal Trade Commission
(one of several state or federal agencies with some authority over Internet
prescribing) to stop the prescribing of Viagra without adequate safeguards.
"The appropriate parties should just crack down on these people, and
crack down hard because lives are at stake," said Mitchell Reed, vice president
of brand strategy and communications for the new online pharmacy-based CVS.com.
However, consumers can safely navigate online pharmacies with a little knowledge
and common sense.
To begin, consumers--especially those without a lot of
Internet experience--need to distinguish between the pharmacy-based and
prescribing-based sites. Many online shoppers may be surprised to find that
typing the words "online pharmacy" into a search engine will probably land them
in the world of prescribing-based pharmacies.
*
One such
pharmacy offers eight popular medications to consumers willing to fill out a
short personal health questionnaire and pay with a credit card. The available
medications include Viagra, Propecia (for hair loss), Xenical (weight loss),
Zyban (smoking cessation), Celebrex (arthritis treatment) and Preven (emergency
contraceptive).
The transaction costs $ 75 for the consultation, which,
the site attests, is reviewed by a doctor, plus fees for the medication (ranging
from $ 105 for 10 50-milligram Viagra pills to $ 48 for one Preven kit) and
overnight shipping charges of about $ 18. Shoppers are referred to other sites
for information on what the medication does and who it is best suited for.
The risks in using these prescribing sites are overwhelming, said the
AMA's Abromowitz. He said that the AMA objects to prescribing-based sites
because of their failure to provide: 1) a patient exam; 2) dialogue with the
patient; 3) completion of a reliable medical history; 4) patient information
about the medication; and 5) follow-up with the patient on the outcome of the
therapy.
*
The Food, Drug and Cosmetic Act, a federal
law passed in 1938, requires physician involvement in making prescription drugs
available, Abromowitz noted. If an online relationship is not viewed as having
true "physician involvement," it could be considered illegal, Catizone said.
Moreover, doctors or pharmacists involved in prescribing-based operations could
be subject to fines and disciplinary action by a state board of pharmacy or
state attorney general if they do not meet the requirements for selling
medications in the states where they do business. Some states, such as Kansas,
have aggressively filed lawsuits to shut down sites operating illegally.
But the explosion of such sites indicates that they are popular with
consumers, perhaps even people who know the sites may be illegal, Catizone said.
"There is a real problem of people who don't have the time to go to the
doctor, or who may not want to talk to their doctor about a problem, going to
these sites. And, even though they know it's not right, they may be tempted to
use it," he said.
Many of the sites are believed to be foreign-based and
may ship medications that are adulterated--either super-potent or sub-potent,
Catizone said. "I'm afraid we'll probably see consumers harmed."
Both
the Food and Drug Administration and state authorities have the legal tools
necessary to crack down on prescribing sites. But testimony at the July
congressional hearings suggests that effective investigations will be difficult
and costly because so few prescribing-based sites list addresses or identifying
information.
And, Catizone said: "The foreign-based sites are going to
be almost impossible to monitor."
Officials at the Federal Trade
Commission and other authorities have recommended legislation that would require
operators of online pharmacies to post identifying information about doctors,
pharmacists and addresses. Rep. Ron Klink (D-Pa.) has introduced such a bill.
In the absence of legislation, experts say consumers should avoid sites
that do not post identifying information, such as an address. Moreover, the
National Assn. of Boards of Pharmacy this month began issuing a seal of approval
to online pharmacies that meet its criteria for quality, safety and legality.
Sites that earn the seal, called the Verified Internet Pharmacy Practice Site,
can be identified on the NABP Web site, http://www.nabp.net.
*
Leading the field of legitimate online pharmacies are the big chain
drugstores, such as CVS and Rite Aid. Although many start-up online pharmacy
companies are working quickly to contract with health insurers for coverage of
online sales, the chain stores have been able to simply transfer their existing
insurance contracts to cover online transactions.
"For the stores with
established contracts, this will be a seamless transition," Catizone said.
Most online pharmacies operate in a similar manner. Consumers can mail a
prescription, have their doctors call it in or have it transferred from another
pharmacy.
New patients to a particular pharmacy also fill out a
questionnaire on their health history and any medications they are taking.
The prescription is then processed and can be mailed (which typically
takes three to five days), sent by overnight delivery or picked up at a local
store. Several sites, such as CVS.com and drugstore.com (in which Rite Aid has a
partial interest), offer free mail delivery for prescription medications.
"The convenience is a big part of this," said CVS' Reed. "If you think
of a senior who is not very mobile, it's ideal for that person to receive health
aids directly to their door."
Because they are not housing medications
in storefronts, online pharmacies hope to lower overhead costs and pass on lower
prices to consumers.
"Our price levels are very competitive, even with
the largest pharmaceutical providers, like Wal-Mart," Reed said.
Many
online pharmacies also expect to strike a chord with consumers by offering
extensive health libraries with information on various problems and conditions.
Drug Emporium (http://www.DrugEmporium.com), for example, has teamed up with
http://www.drkoop.com, the highly praised health site founded by former Surgeon
General C. Everett Koop. Walgreens (http://www.walgreens.com) is pairing with
the Mayo Clinic to provide health information.
Most sites also offer
free, round-the-clock, cyberspace consultation with a pharmacist.
"With
the amount of prescriptions filled today, it has caused this production-line
type of atmosphere in the pharmacy," said Douglas Callihan, a pharmacist and
vice president of merchandising and pharmacy for CVS.com. "Consumers don't get a
lot of time with the pharmacist or they have other consumers behind them and
don't have much privacy. At home, they'll have time and privacy."
Other
online pharmacy services include e-mail reminders when it's time to refill
prescriptions and safety checks to ensure that a patient's medications don't
interact. Most online pharmacies use secure software with encrypted personal
information to protect the privacy of patient records.
*
Just how successful online pharmacies will become, however, is pure
speculation. While a study by the Internet marketing firm Cyber Dialogue found
that 23% of Web surfers are interested in the idea of purchasing medications
online, others point out that traditional mail-order medications have only
captured about 4% of the marketplace.
According to Catizone, many
industry insiders expect about 5% of prescriptions to shift to online
processing.
"It remains to be seen whether or not the Internet will
detract from mail-order or store purchases. It's too soon to gauge long-term
trends," said Phil Schneider, a spokesman for the National Assn. of Chain Drug
Stores.
Online pharmacies offering nonprescription items, such as
aspirin and vitamins, may also draw customers. For example, Drugstore.com and
Rite Aid recently announced a partnership with General Nutrition Centers Inc. to
provide a wide array of prescription and alternative health products online.
Combined with nonprescription sales, online pharmacies could generate
sales of more than $ 6 billion within five years--up from $ 213 million last
year, according to an analysis by Forrester Research Inc., which tracks business
trends.
Still, other observers say one last cyberspace link is needed to
solidify use of online pharmacies: a system by which doctors can transmit
prescriptions electronically from their offices to pharmacies. That is slated to
happen later this year. Last week, CVS.com announced it would employ such
technology from MedicaLogic Inc. Doctors and patients can also communicate
privately in cyberspace using the technology.
A Quality Seal for Online
Drugstores
A seal of approval designed to assure consumers of high
quality on online pharmacies was awarded for the first time last week to three
such pharmacies: drugstore.com (http://www.drugstore.com), Merck-Medco Rx
Services (http://www.merck-medco.com) and PlanetRx.com
(http://www.planetrx.com).
The seal, called the Verified Internet
Pharmacy Practice Site, has no legal effect, but is awarded by the National
Assn. of Boards of Pharmacy to guide consumers to online pharmacies that have
met its criteria for quality, safety and legality.
Online pharmacies can
apply to earn the distinction and can post the seal on their home pages.
Additional sites are expected to earn the seal. An updated list can be found on
the association's Web site, http://www.nabp.net.
What to Watch For
* Avoid buying medications from sites that offer to prescribe drugs
outside the context of a doctor-patient relationship.
* Do not buy
medications that are not approved for use in the United States.
* Do not
buy medications from sites that require linking with another site to make the
purchase.
* Avoid purchasing medications from sites that do not list a
U.S. phone number and address.
* Check with the National Assn. of Boards
of Pharmacy to see if an online pharmacy has a valid pharmacy license and meets
state standards. Look for the National Assn. of Boards of Pharmacy's seal of
approval for online pharmacies, called the Verified Internet Pharmacy Practice
Site (http://www.nabp.net).
* Look for sites that provide free consumer
information, including searchable databases of medical conditions.
*
Look for sites that offer a choice of regular mail or next-day delivery service.
* Ask if handling fees are charged in addition to delivery fees.
* Check the site for assurances that safeguards exist to guard patient
privacy.
Source: National Assn. of Boards of Pharmacy; CVS.com.
GRAPHIC: GRAPHIC-DRAWING: (no caption), STEPHEN SEDAM /
Los Angeles Times
LOAD-DATE: September 20, 1999
