Raising the Bar on Online Pharmacy Verification for 20 Years
In PharmacyChecker’s view, online pharmacy safety exists for patients who purchase medicines from websites that transparently market and sell government-regulated prescription drugs, made in accordance with good manufacturing practices, which are filled by duly inspected and licensed pharmacies that require a valid prescription. Today, such online pharmacies have proliferated in the United States: CVS.com, Amazon Pharmacy, Mark Cuban’s new pharmacy venture, CostPlusDrugs.com, etc. There, too, are safely operated Canadian online pharmacies, ones that sell domestically and internationally. There are also more global online pharmacies, ones that process prescription orders that are filled by pharmacies in more than one country across borders, which we call international online pharmacies.
Drug regulators, such as the U.S. Food and Drug Administration (FDA), European Medicines Agency (EMA), Health Canada, India’s Central Drugs Standard Control Organization (CDSCO), and the UK Medical and Healthcare Products Regulatory Agency (MHRA) are responsible for regulating the prescription drugs sold in their respective regions and countries. Licensed pharmacies in those countries are lawfully obliged to require prescriptions and sell medications approved for their local markets. Where the health of global patient-consumers can benefit from those regulated prescription drugs and pharmacies using a website, we find online pharmacy safety.
History of the Verification Program
PharmacyChecker has operated the PharmacyChecker Verification Program to evaluate the safety practices of online pharmacies for almost 20 years. Back in 2002, we looked at five straightforward criteria for “checking” (hence our name) websites that market and sell prescription drugs, which is our definition of an online pharmacy.
1. Prescription requirement
2. Dispensing pharmacy license
3. Contact information including mailing address and contact phone number
5. Secure-socket layer (SSL) encryption to protect electronically transmitted information.
We rated 12 online pharmacies against those criteria, which included U.S., Canadian, and Mexican online pharmacies. The results were published on what was then called our “online pharmacy ratings” page, issuing this press release about it on April 7, 2003. Half of the online pharmacies had five checks, but others didn’t because we could not verify a pharmacy license or they did not require a prescription, for example. Soon after, we stopped the “ratings” and started only listing online pharmacies that met all five criteria. Today, that list is called our accredited online pharmacies list. The program has evolved to include a far more robust set of pharmacy safety audits and protocols.
For people that compare drug prices on PharmacyChecker.com, you should know the only online pharmacies for which we provide information are those accredited through our verification program.
The Program Evolves.
Additional “checks” today include marketing claims, pharmacist consultation, and pharmacy location transparency practices (such as for those “Canadian online pharmacies” that work with pharmacies in other countries, such as India and the UK), in addition to reviewing the types of drug products sold (some are not suitable for mail order due to temperature sensitivity or are controlled substances, which are drugs for potential abuse), and mystery shopping to ensure compliance.
For a deep dive into PharmacyChecker’s online pharmacy safety rules see our Verification Program Accreditation and Standards Guide.
For pharmacies in countries that we believe can, and in fact do, meet high standards of practice, but where government enforcement of regulations may be less thorough than in Canada, the U.S., or the European Union, for example, we do onsite pharmacy inspections.
Today, there are a possible 86 audits in the PharmacyChecker Verification Program.
International Pharmacy Safety Niche
Over time, our niche has become international online pharmacy safety. There is no other independent organization or company that is internationally noted for verifying online pharmacies that sell prescription drugs internationally to people in the U.S. and other countries. And that’s important because so many Americans and people worldwide are going on the internet to find medicines that are either unaffordable or unavailable at their local pharmacies domestically.
Peer-reviewed research shows that well-credentialed online pharmacies, including those accredited by PharmacyChecker, are safe international mail-order pharmacy services. In contrast, unfortunately, there are many rogue online pharmacies, domestic and foreign, that are not only untrustworthy but can be exceedingly dangerous, either because they don’t require a valid prescription, sell addictive prescription drugs, or counterfeit drugs. Patients, their providers, and caregivers need to have reliable information to avoid dangerous drug-selling websites, and PharmacyChecker excels in that respect.
Continuous Quality Improvement at PharmacyChecker.
This year, our Vice President of Pharmacy Verification and Information, Jeff Poirier, a licensed pharmacist in New Hampshire (“Jeff”), instituted a new continuous quality improvement (CQI) initiative for international pharmacies in our program that are subject to onsite inspections. Some simply did not have a full understanding of the mechanics and the true spirit of CQI. I try and provide an explanation of how this works below, admitting it’s a little technical.
During each inspection, time is made available to review how CQI works and encourages staff participation in process improvements. Several pharmacies have voluntarily developed notable CQI initiatives driven by staff input and have demonstrated to PharmacyChecker that these ideas are improving their processes. Jeff tells me that it’s very rewarding to share this knowledge and see the positive outcomes resulting from CQI initiatives by international pharmacies. The positive aspects of this are also seen in the pharmacy staff as well.
Continuous quality improvement can be summed up very simply: You find a way to measure, objectively, a process you want to improve, you implement the teams’ ideas, then you remeasure using the same methodology. Your goal is to be continuously better at each remeasurement. If not, it is time to implement new ideas and remeasure again. The objectively measured outcomes are shared with staff and demonstrate that their ideas have worked (or not).
CQI can be applied to just about any process that needs improvement, including safety, customer service, and even financial initiatives. A good example of a safety initiative is when a pharmacy tracks all pharmacist or customer feedback and categorizes them on a monthly basis. Safety issues, such as missing information on the submitted prescription, once categorized, can be measured objectively.
One such category that is often part of these programs is an incomplete medication profile or missing drug allergies. Once measured, the team can discuss strategies to improve this process, which may include software enhancements, improved communication with online pharmacy partners, or enhanced review by the dispensing pharmacy.
Sometimes just measuring and sharing the data alerts staff to the significance of a problem. Ideas from staff and management are implemented and the outcome is remeasured using the same methodology as the baseline measurement after a designated period of time.
Let’s say that the baseline measurement indicated that this happens 10 times a month on average. The goal of CQI would be less than 10 on the first measurement and continually less on future measurements. This would indicate the ideas that were implemented are working. There are times when these remeasurements do not show improvement and it’s back to the drawing board for new ideas. When successful and staff can see objectively that the implemented strategies are working, the process can be contagious.
A look toward the future
I wrote this for the benefit of consumer-patients, their caregivers, and providers worldwide who are looking online for prescription drug safety and savings, and want to know more about what safety means, and how PharmacyChecker helps. In doing so, I can’t believe it has been 20 years since starting the research to put this all together. What a journey and one in which we are proud to continuously get better!