This document provides background information and summarizes the debate over the regulation of internet prescriptions. The links to the left will lead you to public documents that we have found.
Since access
to the Internet became widespread, new businesses offering consumers new options
for purchasing goods and services have flourished. Some Internet companies,
such as the online auction site eBay, represent fundamentally new ways of
doing business. Most online businesses, however, encompass web sites that
offer quicker or cheaper options of buying the same goods that could be purchased
if one got in the car and drove to a local store. In most areas of commerce
this has caused little controversy. The best seller purchased at Amazon.com
is the exact same book that can be purchased at the bricks-and-mortar Walden
Books at the mall.
Prescription
drugs have constituted one of the thornier policy issues involving commerce
over the Internet. The prescription drug that one person takes may extend
his or her life; taken by mistake by another person, it can create serious
problems. Three types of online drugstores have emerged to take advantage
the enormous market for medicines and supplements. Some sites, like drugstore.com,
fill orders that are sent to them by individuals who have a prescription from
their own doctor. They offer the convenience of not having to travel to the
drugstore, important for those with limited or no mobility, as well as lower
prices on at least some of their drugs. Second are bona fide online drugstores
in other countries, notably Canada, that also fill orders for those with a
legitimate prescription. Third, are online drugstores that actually prescribe
to those who request a particular medicine. Theoretically, such prescriptions
are filled by doctors and pharmacists working for the websites, who would
review an order and ensure that the recipient does not have a medical condition
that makes the drug inappropriate or even dangerous.
When the 106th
Congress began to confront the issue of the online drugstores, it was the
third type of these websites that they were most concerned about. A congressional
staffer said it was an "eye opener" for legislators to learn about
how some of these prescribing websites worked with their automated, computerized
review of consumer orders. He recalled,
[Some of these sites] are pretty lame even in the goofy filtering systems that they [use] to make themselves look legitimate. You know, "fill out this questionnaire, we'll send it to a doctor." In a few examples, reporters had typed in information that should denied them Viagra or should have denied them the drug that they were seeking, and they got it anyway. I mean one actually said, "I am Buddy. I am a cat. I weigh 15 lbs and I am neutered." You know, "any medical condition we should be aware of? Neutered." And the cat got it. Other instances are "when were you born? 1898, and I have a heart condition, and I want Viagra." He shouldn't have been able to get it under any circumstance.
Another issue
with these online prescribers, many of which operated outside of the United
States, was the integrity of the drugs themselves. Some shady operations sell
imitations of drugs that are not manufactured correctly and in the worst case,
may not be a real drug at all, just something that looks the real thing.
Despite the seriousness
of this problem, Congress was initially hesitant to act. Republicans in particular,
were hesitant to regulate the Internet as they believe strongly in free market
principles that should result in consumers having broader choices and lower
prices. Republicans also for the most part advocated allowing state governments
to deal with the problem, since regulation of pharmacies is covered under
state laws. Democrats were more outspoken in favor of additional federal regulations
to ensure consumer protection. Work began in the 106th with hearings, and
a bipartisan compromise bill that contained some elements favored by both
Democrats and Republicans was introduced just before Congress adjourned for
the 2000 elections. Unfortunately for backers of the bill, there was little
time left in the session and few strong believers in the feasibility of the
bill's goals. The bill was introduced, but never acted upon.
A similar bill
was introduced in the 107th Congress, and again in the 108th Congress, but
in each of these sessions members of Congress focused more attention on the
issue of prescription affordability, and regulation of internet prescriptions
was never acted upon.