We recommend that you look for the following before using any online pharmacy:
View a list of some PharmacyChecker.com-approved online pharmacies.
Using an online pharmacy can save you a great deal of money and provide other benefits. However, there are also potential risks of which you need to be aware but can avoid.
PharmacyChecker.com maintains a list of Rogue Pharmacy Websites. By no means a complete list, these sites are known to not follow safe online pharmacy practices.
*Savings based on lowest price listed on PharmacyChecker.com compared to U.S. bricks and mortar pharmacy price (8/15/12).
Websites selling prescription medication fall into different categories based on their prescription (Rx) requirements:
Most legitimate online pharmacies require you to provide a prescription obtained from an in-person examination with your doctor. Prices from these pharmacies are often lower than those from pharmacies that offer or accept prescriptions based on remote consultations. Pharmacies in this category can include major U.S. national chains; neighborhood pharmacies in the U.S. and Canada, and some in Australia, India, Israel, New Zealand, and the United Kingdom; large domestic and international mail-order prescription fulfillment centers. Most pharmacies with a traditional prescription requirement carry the full stock of prescription drugs you would find in your neighborhood pharmacy.
You may be looking to obtain a prescription online, rather than in person with a doctor. Websites offering this service, generally known as online consultation pharmacies, remote consulting pharmacies, or prescribing pharmacies, work with physicians who review a patient’s self-reported medical history and then write a prescription if deemed appropriate but many are not adequately safeguarding their customers’ health . Their focus is usually on "lifestyle" drugs that are non-addictive and less likely to require physician monitoring. In the past, the American Medical Association and the U.S. Food and Drug Administration (FDA) have issued statements asserting that remote consultations are a substandard medical practice when there is no prior doctor-patient relationship, one established by an in-person physical exam. However, several popular health insurance programs now offer such services following high standards of what is referred to as telemedicine. Furthermore, a Mayo Clinic study found that remote consultations done properly for erectile dysfunction are as safe as or safer than traditional medical consultations.
PharmacyChecker.com urges consumers to avoid most pharmacy websites that offer online medical consultations towards the issuance of a new prescription because such sites are usually less trustworthy than sites requiring a prescription written by a doctor you have seen in person. U.S. states have different laws on what constitutes a valid doctor-patient medical consultation. Many states do not prohibit remote medical consultations as a basis for prescribing while a handful of states do. Two states have passed laws or granted express permissions that are directly supportive of remote medical consultations. In 2009, it became expressly legal in Hawaii for a doctor to prescribe non-controlled drugs based on a remote medical consultation, as long as the consultation is conducted in real-time, such as by phone or video conference. The State of Utah has granted express permission for certain companies to offer remote consultation for prescribing a limited number of, mostly lifestyle, non-controlled prescription drugs.
Except where expressly permitted by law in the U.S., the PharmacyChecker.com Verification Program does not approve remote consultation sites. Additionally, federal law prohibits remote consultations as a basis for prescribing controlled substances. See more information on controlled substances below.
Some rogue websites will sell you prescription medication without requiring any prescription at all, which can be extremely dangerous. Other websites that offer to sell you drugs without a prescription pose as legitimate pharmacies for the purpose of stealing your credit card information. Ordering from such sites isn’t only risky to your health, but could lead to unauthorized use of your credit card or, even worse, identity theft. For more information on rogue online pharmacies, see the next section
A rogue online pharmacy is a website that will sell you fake, adulterated or even real medication but without safeguards in place to protect your health. Most rogue online pharmacies will either not require your prescription, or offer you a remote medication consultation, sometimes for a fee, towards the issuance of a prescription, one allegedly written by a doctor associated with the pharmacy site. Sometimes there are actually licensed doctors reviewing health data that you submit through filling out an online questionnaire and, therefore, some oversight by a prescriber: but too often it’s just window dressing and a prescription mill so that the rogue can make the sale under the guise of legitimacy. If you take a prescription medication that is not right for you it could make you sick or kill you: that’s why having a prescription is critical.
Here’s a convenient check list of rogue online pharmacy behavior. Rogue online pharmacies:
The best way to avoid buying from a rogue online pharmacy is to say no to those websites that are not credentialed by known regulators or online pharmacy credentialing programs. Programs that we believe offer you a very high level of safety include our own program, the PharmacyChecker.com Verification Program, Verified Internet Pharmacy Practice Sites program, run by the National Association of Boards of Pharmacy, LegitScript.com, a private Internet monitoring and investigations company, and the Canadian International Pharmacy Association, a trade association of Canadian pharmacies that run international online pharmacy websites.
Of the programs listed above ours is the only one accepting both U.S. and international online pharmacies that sell to Americans and comparing drug prices to help you save the most money. All of the above programs were the subject of an important study published in the National Bureau of Economic Research. The study concludes that sites credentialed by those programs sell safe medication and require prescriptions, with the international online pharmacies charging much lower prices on the same medicines sold in U.S. pharmacies.
See our list of Rogue Pharmacies for more information.
In the U.S., unlike regular prescription drugs, which are regulated by the FDA, most products with a high potential for addiction and abuse are regulated by the U.S. DEA and called controlled substances. U.S. pharmacies that sell controlled substances must have a license to do so, which is issued by the DEA. View a list of controlled substances.
Unfortunately, some “rogue” pharmacies sell controlled substances to consumers without requiring a prescription. Americans with a valid prescription may legally order controlled substances online if they are dispensed from a licensed U.S. pharmacy. Reputable Canadian and other non-U.S. pharmacies will not ship controlled substances to Americans into the U.S. The PharmacyChecker.com Verification Program is closed to all foreign pharmacies that offer to ship controlled substances into the United States.
The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (“Ryan Haight Act”) regulates the practice of online pharmacy at the federal level by making it “unambiguous that it is a per se violation of the [Controlled Substances Act] for a practitioner to issue a prescription for a controlled substance by means of the Internet without having conducted at least one in-person medical evaluation.” (Federal Register/Vol. 74 No. 64, April 6th, 2009, p. 15599).
The PharmacyChecker.com Verification Program requires, and verifies, that online pharmacies adhere to the requirements of the Ryan Haight Act.
While all websites that sell controlled substances are subject to the Ryan Haight Act’s ban on prescribing controlled substances solely based on a remote medical consultation, only those sites that sell products in the schedule II category, the most highly addictive drugs, must include specific disclosures on their websites and apply for a special modification of their DEA registrations. Learn more about the specific requirements.
For more information on controlled substances visit the Drug Enforcement Agency.
Range of Medications Sold By Online Pharmacies
Not all online pharmacies sell the broad range of prescription drugs that you would expect to find in your neighborhood pharmacy. Their product range typically falls into one of the following categories:
To help you find licensed and safe pharmacies on the Internet, we operate the PharmacyChecker.com Verification Program. Only online pharmacies meeting high standards of practice are eligible for membership in our program, and apply to the program under the following membership types:
Pharmacy members have a bricks and mortar presence.Some are walk-in pharmacies and others are prescription fulfillment centers that operate through mail-order only. Some pharmacies operate their own websites, while others fill orders for other online pharmacies. An Affiliate website does not have a bricks and mortar pharmacy presence but refers orders to one or more pharmacies. Affiliate online pharmacies are only eligible for PharmacyChecker.com’s programs if they refer prescription orders to PharmacyChecker.com-approved pharmacies. Note that some pharmacies will provide the option to have your prescription filled by another licensed pharmacy in a different country so that you can take advantage of lower international prices, in which case they operate as both Pharmacy and Affiliate.
Pharmacy applicants must meet specific qualifications to be eligible for and approved in the PharmacyChecker Verification Program and to publish the PharmacyChecker.com seal on their websites. PharmacyChecker.com verifies the following qualifications:
Additionally, to ensure compliance with the Verification Program prescription requirements, PharmacyChecker.com conducts periodic “mystery shopping,” by posing as a consumer attempting to purchase medication without a prescription. PharmacyChecker.com employs Dr. Ram Kamath, PharmD, a licensed U.S. pharmacist and expert in international pharmacy safety, to inspect pharmacies in countries with strong pharmacy regulations but less enforcement to be sure that they adhere to high standards of practice. Dr. Kamath was the lead pharmacist in developing operational standards for international pharmacies as part of a state drug importation program called I-SaveRx. The program, which is no longer in operation, was adopted by Kansas, Missouri, Vermont, and Wisconsin.
Members of the PharmacyChecker.com Verification Program — pharmacy websited that meet the safety requirements identified above — can display a PharmacyChecker.com “Valid Member” seal. Look for this seal before ordering medication online, especially if the company is not generally well known or from a different country. To check the validity of a seal, consumers should check that it links to a profile that is hosted on www.PharmacyChecker.com. You can click on the seal below to see how this works.
In the U.S., the Food and Drug Administration (FDA), a division of the U.S. Department of Health and Human Services, is responsible for regulating medication sold in the United States. New drug reviews, post-market surveillance, and drug recalls are carried out by the FDA. The U.S. FDA is not responsible for regulating medication sold in other countries.
Pharmacies and pharmacists are regulated and licensed by states. Pharmacy regulations can differ a little from state-to-state but all require the presence and management of licensed pharmacists, and strict enforcement of safe dispensing practices and storage requirements. The regulation of controlled substances, drug products with stronger and addictive ingredients (discussed in detail above), is the responsibility of the Drug Enforcement Agency (DEA). U.S. pharmacies must have a DEA-issued license to sell controlled substances.
The National Association of Boards of Pharmacy (NABP), the umbrella trade group representing state pharmacy boards, created the Verified Internet Pharmacy Practice Site (VIPPS) program in 1999 responding to public concerns about websites selling drugs without abiding by federal and state laws. As of May 22nd , 2013, there are 33 VIPPS-certified online pharmacies, approximately 30% of which are members-only pharmacy benefit programs. Most other VIPPS members are national chain and specialty pharmacies. The NABP’s VIPPS program is closed to all Canadian and other non-US pharmacies that serve the American market.
For people living in the U.S., the potential benefits of buying from a U.S. online pharmacy rather than a foreign online pharmacy often include:
If you do not have insurance, or your insurance does not cover the brand name drugs you need, U.S. pharmacies are almost always far more expensive than their foreign counterpartsforeign pharmacies, especially for brand name prescription medication.
Personal Drug Importation:
Since 2000, millions of Americans with inadequate or no drug coverage, as well as those seeking critical medications that are not available domestically, have purchased medication online from Canadian and other foreign pharmacies. This process is known as personal drug importation. The U.S. government generally does not stop individuals from importing medication for their own use (usually up to a three-month supply of non-controlled drugs), however it is technically illegal. According to the FDA, no one has ever been prosecuted for personal drug importation.
The FDA provides personal drug importation guidelines for its personnel.
While the law allows U.S. Customs and Border Patrol to seize international prescription orders, less than one percent are actually seized. In these cases, under U.S. law, you will be informed by the FDA that your drug order has been seized. There is a greater prevalence of drug import seizures from non-Canadian countries, especially from countries that are less economically developed than the U.S.
Wholesale Drug Importation
Unlike personal drug importation, wholesale drug importation is dedicated to the domestic re-sale of imported pharmaceuticals. Businesses and people engaging in illegal wholesale drug importation are often the focus of serious criminal enforcement action by the FDA. Due to the unusually high drug prices in the U.S., safe wholesale drug importation could help lower drug prices in U.S. pharmacies. The safety challenges of wholesale drug importation, however, are beyond the purview of PharmacyChecker.com's programs, which are designed to provide information to help individuals seeking safe and affordable medication online for their own use only.
International Pharmacies: Different Pharmaceutical Regulatory Systems
If you buy medication from a foreign country, then you want to know that the dispensing source is regulated and licensed by the appropriate governing authority. While the FDA does not usually prevent Americans from importing medication for personal use, consumers should use good judgment in determining from which pharmacies and countries they feel most comfortable ordering medications. For this reason, PharmacyChecker.com verifies the licenses of pharmacies in foreign countries.
A decade ago most non-U.S. pharmacies selling prescription drugs to Americans were Canadian. The growth in demand for lower cost prescription drugs among Americans, and the supply problems faced by Canadian international pharmacies, largely a product of restrictive selling practices of drug companies, has led to an increasing number of countries entering the industry. Today, pharmacies in other countries, such as Australia, Barbados, India, Israel, Italy, Mauritius, New Zealand, Singapore, South Africa, Switzerland, Turkey, and the United Kingdom play a larger role in meeting this demand. To better educate our visitors, many of whom are looking internationally for lower drug prices, below is an overview of the agencies and the laws that regulate drugs and pharmacies that participate in PharmacyChecker.com’s programs.
Generally, countries with the most advanced and safe systems for regulating pharmaceuticals possess the following:
Overview of Pharmaceutical Regulation: By Country
Canada:Drug and Pharmacy Regulation in Canada
Canada’s systems for regulating drug products are very similar to those in the United States. At the federal level, the Therapeutic Products Directorate, an agency of Health Canada that regulates Canada's drug supply, is Canada's counterpart to the FDA. All drug products sold in Canada must be approved by the Therapeutic Products Directorate. Pharmacies in Canada are regulated by the provinces; a similar system to the U.S. in which states regulate pharmacies.
To operate a pharmacy in Canada, the premises must be licensed by the provincial pharmacy authority, managed by a licensed pharmacist, and meet stringent standards for the storage and dispensing of medication.
A report written for the State of Illinois in 2003 found that Canadian pharmacies in Manitoba were as safe if not safer than those in Illinois, and that the U.S. and Canadian systems for ensuring safety and efficacy of drug products were very similar.
In Australia drugs are regulated by the Therapeutic Goods Administration, Australia's counterpart to the U.S. FDA. Australia uses the same standards as the European Union (EU) for the regulation of prescription drugs.
As in Canada and the U.S., pharmacies are registered at the state/province level, and pharmacists must be registered in the states in which they practice. The state boards are incorporated in a federation called the Pharmaceutical Society of Australia that guides and proposes policies and standards for the safe practice of pharmacy.
Over 80% of Australia’s pharmacies belong to an organization called the Pharmacy Guild of Australia. the Guild’s role is to support its pharmacy and pharmacist members on workplace issues and training. The Guild also negotiates on behalf of its members with the government and drug manufacturers, wholesalers, and other organizations responsible for the provision of health products.
The Government of Barbados allows and licenses qualified companies to operate as international mail-order pharmacies. Such licensure can be granted to pharmacies that are inspected by the Barbados Drug Service, a division of the Barbados Ministry of Health, and meet all requirements of the Pharmacy and Drug Services Act. Among the requirements is that a licensed pharmacist is on the pharmacy premises and oversees the dispensing process. These international mail-order pharmacies operate in a free trade zone.
While pharmacies operating in a Barbados free trade zone are subject to the same requirements of licensed pharmacies in the home jurisdiction, they import prescription products outside the national drug supply. For approval in the PharmacyChecker Verification Program, international mail-order pharmacies in Barbados can only import from licensed wholesale pharmacies based in countries with strong pharmaceutical regulations
Pharmacies in free trade zones must undergo a rigorous inspection by PharmacyChecker.com before approval in its Verification Program. Additionally, PharmacyChecker.com verifies the licenses of exporting wholesale pharmacies that supply these pharmacies.
The Central Drugs Standards Control Organization (CDSCO), a division of the Indian Ministry of Health and Family Welfare, is responsible for drug approval and regulation, as well as for the licensure of pharmacies in India. CDSCO, India’s counterpart to the U.S. FDA, is responsible for approving new drugs for the Indian market, post-market surveillance, and enforcement actions to protect the Indian drug supply.
Under the CDSCO, the Drugs Control Administration is responsible for regulating pharmacies. They do so through the State Drug Control Offices, also called Food and Drug Administration offices, which inspect and license pharmacies, and enforce the Pharmacy Act of 1940, which require pharmacies to meet rigorous safety standards.
Pharmacies in India must comply with similar regulations as those in the U.S., such as having a licensed pharmacist on the premises during hours of operation, safe storage of drugs, particularly those with special requirements (such as insulin), and safeguarding of controlled substances. However, India's enforcement standards are generally lower than they are in the United States. Indian pharmacy members are inspected by PharmacyChecker.com to verify that they are meeting safe standards of mail-order pharmacy practice.
India has a very large and highly sophisticated pharmaceutical industry. In fact, a sizable portion of the world’s pharmaceutical active ingredients and finished products are manufactured in India. These ingredients and finished products are then exported to other countries such as the U.S. and the EU for the manufacture of final drug products or sale of finished products in local pharmacies. India is the world’s largest exporter of generic drugs.
Many drugs in India are manufactured in FDA-approved or inspected facilities. In fact, the U.S. FDA inspects more drug manufacturing plants in India than any other country outside the United States. However, the drug supply in India is not as strongly regulated as it is in the U.S. and some other high-income countries, such as Canada and the United Kingdom. Consequently, it has a higher rate of counterfeit and substandard medication. PharmacyChecker.com inspections and policies greatly minimize the risk that Indian pharmacies approved in the verification program would sell a counterfeit or substandard drug.
The Pharmacology Department of the Israeli Ministry of Health regulates that country’s drug supply, pharmacists, and pharmacies. Israel’s system for pharmaceutical regulation is strongly based on both U.S. and EU pharmaceutical regulations. To become a pharmacist in Israel, one must meet stringent education, training, and testing requirements.
Under its pharmaceutical regulations, drugs approved for sale in Israel must be manufactured using U.S. or EU standards for Good Manufacturing Practices. Additionally, drugs approved for use in Israel are generally already approved for use in the U.S. or EU. Israeli pharmaceutical companies are major suppliers of generic drug products to the United States.
Under Israeli law, drug labels must be in Hebrew and English.
The Government of Mauritius permits qualified companies to operate international mail-order pharmacies in a free trade zone. Such pharmacies must employ licensed pharmacists to oversee the dispensing process, comply with all pharmacy regulations in Mauritius promulgated by the Ministry of Health and Quality of Life, such as the requirement that a prescription be produced for all dispensed items, and ensuring that effective sanitary and safety measures are implemented in the dispensing area.
While pharmacies operating in a Mauritius free trade zone are subject to the same requirements of licensed pharmacies in the home jurisdiction, they import prescription products outside the national drug supply. For approval in the PharmacyChecker Verification Program, international mail-order pharmacies can only import from licensed wholesale pharmacies based in countries with strong pharmaceutical regulations.
Pharmacies in free trade zones must undergo a rigorous inspection by PharmacyChecker.com before approval in its Verification Program. Additionally, PharmacyChecker.com verifies the licenses of exporting wholesale pharmacies that supply these pharmacies.
The drug supply of New Zealand is regulated by Medsafe, that country’s counterpart to the U.S. FDA. Medsafe determines which drugs are safe and effective for New Zealand’s citizens: it administers the application process for new drugs and is charged with post-market surveillance. Under the Medicines Amendment Act 2003, Medsafe is also responsible for issuing pharmacy licenses. Pharmacies in New Zealand are held to similar standards of practice as in Canada, the United Kingdom, and the United States.
The Pharmaceutical Society of New Zealand is New Zealand’s professional pharmacist’s association. It provides education, training, and career development for pharmacists to achieve high standards of pharmacy practice. The Pharmacy Council is the national regulatory body for licensing pharmacist.
Singapore is among the most economically developed countries, one with exceedingly strong regulations in all industry sectors, on a par with the United States, the United Kingdom, and the countries that comprise the EU. It has very high pharmacy and pharmaceutical regulatory standards. Singapore is recognized by the World Health Organization Collaborating Centers in the areas of Transfusion Medicine, Drug Quality Assurance and Food Contaminants Monitoring.
Pharmacies in Singapore are licensed at the national level by the Health Sciences Authority (HSA), a division of the Ministry of Health. As in the U.S., pharmacies must meet stringent standards before licensure is granted. Pharmacies must be under the management of a licensed pharmacist registered with the Singapore Pharmacy Council. Among other requirements, safe dispensing equipment and storage facilities, requisite professional reference materials, and an adequate system for record keeping are all checked before a pharmacy is licensed in Singapore.
The regulation of drug products in Singapore is the responsibility of the Therapeutics Products Division, which operates as part of the Health Sciences Authority. Only products licensed by the Health Products Regulation Group are approved for the market. The drug approval process takes nine months, unless the product is already approved in the United States, EU, and Australia, in which case there is an expedited process.
Some retail pharmacies in Singapore are also licensed to operate as exporters. However, the Therapeutics Products Division does not guarantee the safety of exported products and they may not be approved for sale in Singapore. PharmacyChecker.com verifies the licenses of exporting wholesale pharmacies that supply these retail pharmacies.
According to the World Health Organization, Turkey's drug licensing standards closely resemble the countries of the European Union. However, unregistered generic products remain a problem in the rural and eastern region of the country, and PharmacyChecker has not permitted pharmacies from such areas to participate in its program. PharmacyChecker.com also conducts its own inspections of pharmacies in Turkey that participate in its Verification Program.
As guided by The Law of Pharmaceutics and Medical Products, drugs sold in Turkey must be approved by a division of the Ministry of Health, called Drugs and Pharmacy General Management, which is Turkey's counterpart to the U.S. FDA. The process for drug approval is administered by the Advisory Commission For the Registration of Medicinal Products For Human Use, a Commission of the Ministry's Scientific Advisory Board. The Commission is comprised of pharmaceutical research experts, clinicians, a pharmaceutical technologist, a pharmacologist, and a Ministry of Health representative.
Under the Pharmacists and Pharmacies Law, Turkey mandates that all pharmacies meet high standards of pharmacy practice, such as having a licensed pharmacist on the premises during hours of operation, safe storage of drugs, and a clean, sanitary area for dispensing.
Some pharmacies in Turkey are licensed as exporters and exported products may not be approved for sale in Turkey. PharmacyChecker.com verifies the licenses of pharmaceutical wholesalers that supply such pharmacies in Turkey.
Drug products sold in the UK are regulated by the Medical and Healthcare Products Regulatory Agency (MHRA) and the European Medicines Evaluation Agency (EMEA). The MHRA is the United Kingdom’s counterpart to the U.S. FDA and decides which drugs are safe and effective for sale with the UK. The EMEA is in an agency of the EU charged with evaluating the safety of new products for members of the EU. Drugs that are approved by the EMEA can be sold throughout the EU, including the UK.
On a national level, pharmacists and pharmacies are registered with and regulated by the General Pharmaceutical Council. Pharmacies must be operated by a licensed pharmacist, maintain safe storage conditions and a sanitary dispensing area. The Council issues an online seal for its registered pharmacies to place on their websites for those pharmacies that wish to do so.
Counterfeit drugs are a global problem and the chance of receiving them through unverified online pharmacies is higher than from local bricks and mortar pharmacies in the U.S. and other high income countries. Independent studies demonstrate that the risks of buying counterfeit drugs online are greatly reduced when consumers stick to credentialed websites, such as those approved by PharmacyChecker.com. For more information, see “In Whom We Trust: The Role of Certification Agencies In Online Drug Markets” – published by the National Bureau for Economic Research in March 2012
Counterfeit drugs include those with the wrong ingredients; too little or too much of the active ingredients, dangerous ingredients, as well as those with the right ingredients but fake packaging. The World Health Organization reports that 50% of drugs ordered online from websites that don’t publish a physical address are counterfeit. It is not clear on what study this statistic is based but its warning should be heeded. One of PharmacyChecker.com’s requirements is that a website publishes a verifiable mailing address and phone number
For more detailed information on counterfeit drugs see the following document published by the World Health Organization.
Countries have different laws for protecting the intellectual property rights (patents) of drug companies. For example, the United States allows the sponsor of a new drug to have exclusive sales and marketing rights for that product for 20 years. After that time, other companies may manufacture, market, and sell a generic version of that drug. Other countries might only protect the patent of a new drug for 10, 5, or no years at all.
Some foreign pharmacies sell generic versions of drugs that are still under patents in the U.S. and are, therefore, not available for sale in U.S. pharmacies
View the U.S. Food and Drug Administration information on patents.
To find out more about and differing perspectives on intellectual property rights see the following websites: