PharmacyChecker Advocacy on Drug Prices

There is a prescription drug price crisis in the United States. As a result, millions of Americans are forced to choose between taking the medicine they need, paying the rent, or buying food for their families.

PharmacyChecker advocates for expanding patient access to safe, effective and affordable medications. We believe that it's completely unacceptable and unnecessary for tens of millions of Americans to skip filling prescriptions each year because of cost – and yet they do: 45 million in 2016.

Promoting online access to safe and affordable medication, which is dispensed internationally, is not a liberal or conservative, Democratic or Republican, effort. It's a non-partisan issue that draws consumers from across the United States who are quite literally sick of skyrocketing, unaffordable drug prices. When the cost of life-saving medications becomes unaffordable locally, consumers should have online access to lower-cost medications in Canada and other countries.

If you have a story to tell about your experiences with high drug prices, then please write to us at yourstories@pharmacychecker.com.

Online Access & Personal Drug Importation

PharmacyChecker's main advocacy focus is – not surprisingly – online access to lower-cost and safe imported medications for Americans. This requires an open and free Internet environment through which consumers can buy their prescription medication from safe international online pharmacies and federal policies that do not prevent patients from importing medications they need. Consumers deserve a choice when it comes to their medications and should enjoy the commonsense systems and competition the Internet has fueled across all industry sectors.

An "open Internet" does not mean that rogue online pharmacies should be allowed to operate. The work that we do protects consumers from dangerous websites that sell counterfeit, adulterated, or otherwise unsafe medication. Rigorous testing and analysis from independent studies show that patients receive lawfully-manufactured, high-quality medication when orders are placed with online pharmacies accredited through the PharmacyChecker Verification Program.

Consumer Advocacy

For nearly eight years, Gabriel Levitt, president of PharmacyChecker.com, has published blog posts via the PharmacyChecker Blog on behalf of Americans who are struggling with the cost of medication. Whether the topic is online pharmacies, importation, drug prices or safety you'll find us advocating on the blog!

As a badge of honor, the Pharmaceutical Researchers and Manufacturers of America (PhRMA), "Big Pharma," was found advertising against our advocacy work in Washington, DC.

Mr. Levitt has testified before Congress on issues relating to access to affordable medicines and Internet freedom; published an op-ed in the New York Times about online pharmacies and personal drug importation; and is the proud author of a chapter in an anthology about defeating the Stop Online Piracy Act (SOPA). He also brought together advocates for access to medicines and Internet freedom at the Rightscon Brussels Conference in March 2016 to draft what have become the Brussels Principles on Medication Sales over the Internet.

Prescription Justice

PharmacyChecker recognizes that online pharmacies and importation are not a long-term solution to the overall crisis of high pharmaceutical costs. In 2015, with funding from PharmacyChecker, Mr. Levitt founded a non-profit organization called Prescription Justice. Prescription Justice brings together those dedicated to lowering drug prices in the United States and supports Americans who import medicine for personal use.

PharmacyChecker also wishes to acknowledge the important advocacy work of the group RxRights until it closed its doors earlier this year. We were part of the RxRights alliance, which rallied Americans to defend their own right to affordable medication, including by ordering it online and importing it for personal use.

Global Public Health

Access to affordable medication is a global public health priority. To many countries and people, it's considered a human right. We strongly believe that much more can and should be done at the global level to help citizens of developing countries obtain safe and affordable life-saving medicines. According to the World Health Organization, ten million deaths could be prevented by improving access to safe and affordable medication.

Benefits and Risks of Using an Online Pharmacy

Using an online pharmacy can save you a great deal of money and provide other benefits. However, without taking the proper precautions, there can be serious risks of shopping for medication online. Do your research and avoid websites that display common warning signs. If you're unsure, please get in touch with PharmacyChecker. We're here to help.

Benefits:

• Lower prices — Savings of 90% aren't uncommon when shopping for medicine online. Lower drug prices in other countries, lower generic drug prices in the U.S., lower overhead costs compared to brick-and-mortar pharmacies, and lower price mark-ups by discount pharmacies often result in savings compared to local pharmacy prices. You can quickly shop around for the lowest prices online.
• Privacy/Anonymity — Some people understandably feel more comfortable purchasing medication online due to concerns of privacy. In this day and age, it's common to want to speak to a pharmacist about prescriptions and health online or over the phone rather than in person. However, to prevent the use of your personal information for unauthorized purposes, make sure the pharmacy has an appropriate privacy policy; this is one of the things that PharmacyChecker.com checks for you.
• Convenience — If you find it physically difficult to make it to the pharmacy, live in a remote rural area, or have a busy schedule, online and mail-order pharmacies enable you to avoid travel so you can save time. Many online pharmacies will also remind you when you are able to order a refill to help you maintain your regimen.
• Medical information — Some online pharmacies provide useful information about medications and diseases as well as links to medical resources such as universities, government agencies, and health associations.

Risks:

• Some do not dispense drugs through licensed pharmacies — Licensed, regulated and properly inspected pharmacies require safe dispensing practices and the oversight of licensed pharmacists. Purchasing drugs from an unlicensed pharmacy can greatly increase your chances of buying counterfeit, substandard, or adulterated products. Some international pharmacies are licensed specifically to import and export prescription medication in a free trade zone area, but not within the domestic jurisdiction: PharmacyChecker.com inspects these international pharmacies and only approves those meeting stringent safety requirements.
• Some online pharmacies don't adequately safeguard your health — By failing to require a prescription, you could take medication that is not appropriate for you. It could make you sick or kill you. PharmacyChecker.com- accredited pharmacies must require prescriptions.
• Some do not adequately protect your personal and financial information — It's important for pharmacy websites to publish their privacy policy, one that promises not to share your personal information with third parties. Online financial transactions should be secured through adequate use of encryption technology. PharmacyChecker.com verifies whether privacy is promised and transmittal of financial information is secured.
• Some do not give their address and/or telephone number — Pharmacy websites that do not publish their contact information or, even worse, publish false information, are more likely to sell counterfeit, substandard, adulterated products or even not send you anything. PharmacyChecker.com verifies contact information and provides it in the profile of each online pharmacy listed on this site. If you have a complaint, question, or concern about an online pharmacy, you want to be sure you can make contact by phone, mail, and email.
• Additional fees are typically added to the drug price — There is often a shipping fee and there could also be a medical fee, and/or an account set up fee, but it's not very common. Our price comparison pages show you these fees, so you are better informed about the final price of a prescription order.
• Prices can change quickly — Some pharmacy sites post lowball prices to attract customers, and then raise them. We make sure prices listed on our site are as up-to-date and accurate as possible.
• Some may sell medications that can be extremely dangerous, if not taken under medical supervision — In the U.S., these drugs are known as controlled substances, such as hydrocodone, Valium, or Xanax. Don't order from a website offering to sell you controlled substances without a prescription or to write you a prescription for them based on your responses to an online questionnaire. Other drugs, known as restricted distribution drugs, such as such as Accutane, Mifeprex or Thalomidare, are not controlled substances, but are also dangerous if taken without the appropriate medical supervision.

PharmacyChecker.com maintains a list of Rogue Pharmacy Websites. By no means a complete list, but these sites are known to not follow safe online pharmacy practices.

Counterfeit Medication

Countries with the strongest regulations, such as Canada, the UK, and the U.S., rarely experience counterfeit drugs within the legitimate supply chain. The problem of counterfeit drugs is much greater in poor countries.

People in all countries need to be careful. The chance of receiving counterfeit medication internationally through unaccredited online pharmacies is higher than from local brick-and-mortar pharmacies. 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.

Independent studies demonstrate that the risks of buying counterfeit drugs online are exceedingly low when consumers stick to properly credentialed websites, such as those accredited by PharmacyChecker.com. Hundreds of prescription orders were tested by independent researchers and zero were found to be counterfeit.

For a summary and analysis of peer-reviewed research focused on Internet pharmacy safety, please see: https://www.pharmacycheckerblog.com/credentialed-online-pharmacies-imported-meds-safe.

See:

• "In Whom We Trust: The Role of Certification Agencies In Online Drug Markets" – 2013.
• "Web Pharmacies: A field study of ciprofloxacin and atorvastatin" – 2017.

For more detailed information on counterfeit drugs see the following document published by the World Health Organization.

Drug Companies and Intellectual Property Rights

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:

• World Intellectual Property Organization
• Intellectual Property Watch

International Pharmacy Regulations

If you buy medication from a foreign country, then you want to know how the dispensing source is regulated and licensed by the appropriate governing authorities. While the FDA does not usually prevent Americans from importing medication for personal use, consumers must use good judgment in determining from which pharmacies and countries they feel most comfortable ordering medications. For this reason, PharmacyChecker verifies the licenses of pharmacies in different countries, and in some cases inspects pharmacies for quality standards.

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, led to an increasing number of countries entering the industry. Today, pharmacies in other countries, such as Australia, 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's programs.

Generally, countries with the most advanced and safe systems for regulating pharmaceuticals possess the following:

• An agency that approves drugs for the national market through a:
  • Review of scientific evidence from clinical trials
  • Post-market surveillance to monitor unforeseen effects of drug utilization
• National laws and standards for labeling, storing, and distributing prescription drug products
• A national system and/or state/provisional systems for regulating pharmacies that:
  • Require pharmacy practitioners to have a top-level education and rigorous training
  • Mandate safety requirements for the handling and dispensing of medications
  • Require a doctor's prescription for drugs that are determined to have potentially serious side-effects
  • Regularly inspects pharmacies
• Drug manufacturing laws that require all approved products to be produced under Good Manufacturing Practices

Overview of Pharmaceutical Regulation: By Country

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.

Useful Links

• Health Canada
• Drug Importation from Canada: "Report On Feasibility Of Employees and Retirees Safely and Effectively Purchasing Drugs from Canadian Pharmacies." State of Illinois, Department of Central Management Services. October 27, 2003
• The National Association of Pharmacy Regulatory Authorities (NAPRA)

Australia

In Australia drugs are regulated by the Therapeutic Goods Administration, Australia's counterpart to the U.S. FDA. Australia uses very similar 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.

Useful Links

• Therapeutic Goods Administration, Department of Health and Aging
• The Pharmacy Guild of Australia
• The Pharmaceutical Society of Australia
• Australia and New Zealand: Recommended Expansion of the Illinois Personal Importation Program
• Pharmacy Board of Australia

India

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 and 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. PharmacyChecker-accredited pharmacies are routinely inspected by PharmacyChecker 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 inspections and policies greatly minimize the risk that Indian pharmacies approved in the verification program would sell a counterfeit or substandard drug.

Click here for up to date information on Indian pharmacy and drug safety issues.

Useful Links

• Central Drugs Standards Control Organization
• Pharmacy Council of India

Israel

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.

Useful Links

• Pharmaceutical Administration, Israeli Ministry of Health

Mauritius

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.

New Zealand

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.

Useful Links

• Medsafe
• Pharmaceutical Society of New Zealand
• New Zealand Pharmacy Council
• Pharmacy Guild of New Zealand
• Australia and New Zealand: Recommended Expansion of the Illinois Personal Importation Program

Singapore

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 verifies the licenses of exporting wholesale pharmacies that supply these retail pharmacies.

Useful Links

• Health Sciences Authority (Registration of Pharmacies)
• Singapore Pharmacy Council
• Therapeutics Products Division

Turkey

The Turkish Medicines and Medical Devices Agency (TMMDA) is recognized internationally as having high standards of pharmaceutical regulation through its membership in The Pharmaceutical Inspection Co-operation Scheme (PIC/S), along with 52 other health authorities including the U.K and the U.S. The mission of the PIC/S is to develop strong Good Manufacturing Practices and pharmaceutical standards that are common to countries worldwide.

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 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 verifies the licenses of pharmaceutical wholesalers that supply such pharmacies in Turkey.

Useful Links

• Ministry of Health Turkey
• The Pharmaceutical Inspection Co-operation Scheme Members
• New Drug Approval Procedure in Different Countries: A Review
• The Turkish Medicines and Medical Devices Agency: Comparison of Its Registration Process with Australia, Canada, Saudi Arabia, and Singapore

United Kingdom

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.

Useful Links

• Medical and Healthcare Products Regulatory Agency (MHRA)
• The European Medicines Agency
• General Pharmaceutical Council
• Royal Pharmaceutical Society of Great Britain

Tier 1 International Pharmacies

All PharmacyChecker-accredited online pharmacies (tier 1 and non-tier 1) are verified for compliance with the PharmacyChecker Verification Program Accreditation Standards. To ensure continued compliance, PharmacyChecker verifies online pharmacy credentials and practices on a regular basis. PharmacyChecker knows that some patients and their clinicians would prefer to order medication from a pharmacy located in a country known to have the most advanced systems of pharmaceutical and pharmacy regulations. To meet this need, online pharmacies that only process orders dispensed from such countries are marked with the Tier 1 icon: ^{Tier 1}

Under section 802 of the Food, Drug & Cosmetic Act, the U.S. Food and Drug Administration (FDA) has identified the following countries eligible for export of unapproved drugs: Australia, Canada, Israel, Japan, New Zealand, Switzerland, South Africa, and member countries of the European Union or the European Economic Area (EEA). These countries are known to have high regulatory standards equivalent to those in the United States and are sometimes referred to as Tier 1.

Currently, PharmacyChecker-accredited online pharmacies with the ^{Tier 1} icon only fill prescription orders through their own pharmacy or dispensing pharmacy partners located in Australia, Canada, Israel, New Zealand, United Kingdom, or the United States.

FDA Tier 1 Country Criteria:

• Regulatory requirements for a review of drugs for safety and effectiveness by a government entity in that country.
• Regulatory requirements for adverse event reporting and removing harmful or ineffective drugs from the market.
• Regulatory requirements that drug labeling and promotion are compliant with the drug approval.
• Marketing approval authorization of drugs that only qualified experts have determined to be safe and effective on behalf of the government in that country.
• The country has a marketing authorization system that has equivalence to the other tier 1 countries.

How Much Can You Save With an Online Pharmacy?

Savings on Popular Medications Using International Online Pharmacies:

Prices for a 3-month supply of top-selling brand name medications

Sources: Local pharmacy prices based on prices at chain drugstores in New York City; International online pharmacy prices based on lowest prices listed on PharmacyChecker.com. All prices obtained on March 2018.

*Medications dispensed by licensed pharmacies, accredited by PharmacyChecker, in one of the following countries Australia, Canada, India, Mauritius, New Zealand, Turkey, Singapore, or United Kingdom.

Rogue Online Pharmacies

A rogue online pharmacy is a website that intentionally sells unsuspecting patients falsely labeled, adulterated, or counterfeit medication. These websites posing as legitimate pharmacies could even advertise genuine, regulated medication but without proper safeguards in place to protect patient health.

It is incredibly important that you be careful when searching for medication online. Purchasing drugs from suspicious websites can be very dangerous to your health and your finances. If you take medication sold from a rogue website, it could make you sick or kill you. The least of your worries is that these websites could intentionally misuse sensitive financial information.

Most rogue online pharmacies are known for not requiring a prescription. The worst offenders intentionally sell counterfeit (in other words, “fake”) or substandard medications.

Here's a straightforward list of rogue online pharmacy behavior. Rogue online pharmacies:

     X   Don't require a prescription
     X   Don't publish verifiable and useful contact information
     X   Don't fill orders through licensed pharmacies
     X   Don't sell real medications, or have a licensed pharmacist dispensing the prescription order
     X   Don't protect your personal and financial information

Fake Remote Online Medical Consultations

Some rogue pharmacy sites advertise online medical consultations towards the issuance of a prescription that is allegedly written by a real doctor. Be extremely wary of such offers, though don’t confuse these sites with the safe remote consultation websites that are legitimate (see: Types of Online Pharmacies). For rogue pharmacies, the word "consultation" is just window dressing to give the appearance of legitimacy and safety.

Fake PharmacyChecker Seals

One way we often identify rogues is catching those that display a fake version of our PharmacyChecker Seal. Displaying an unauthorized seal is fraud. We continually find and reach out to rogue websites to remove fake PharmacyChecker seals. If you see a PharmacyChecker Seal, click on it to make sure it directs you to a pharmacy profile that is hosted on a website that has a web address starting with https://www.pharmacychecker.com or www.pharmacychecker.com. If you are not directed to a pharmacy profile hosted on www.pharmacycheckcer.com, then it's a fake seal and you are dealing with a website posing as a legitimate source for prescription medication.

Here’s an example of a legitimate PharmacyChecker Seal and sample profile:

Spam Emails from “Canadian Online Pharmacies”

That spam email in your junk folder that markets a very cheap medication is almost certainly a rogue online pharmacy. Don't click on any links in there! Mark the email as spam and/or delete is permanently.

Rogue Websites Posing as “Canadian Pharmacies”

Many rogue online pharmacies pretend they are "Canadian pharmacies" when they have no connection to Canada whatsoever.
See our blog post: So You Want To Buy Cheap Medicine from an Actual Canadian Pharmacy

Suspicious Web Addresses

Some rogue pharmacy websites often have a web address that is nothing like the so-called pharmacy name published on its home page. For example, you might see the web address www.cheapestmedsever45.com in the address bar that you see at the top of your browser, but they call themselves "Canada Neighborhood Pharmacy." This is a sure sign it’s a rogue operation. Steer clear.

Below are examples of 1) common rogue pharmacy names; 2) actual rogue sites; and 3) rogue websites that have been taken down or simply stopped doing business under a certain name. We strongly recommend that you do NOT use these websites.

Common names and phrases rogue websites use to fool patients

•    Authentic Steroids
•    Canadian Family Pharmacy
•    Canadian Neighbor Pharmacy
•    Canadian Online Pharmacy
•    Canadian Pharmacy
•    Men's Health Pharmacy
•    Online Pharmacy
•    Pharmacy Express
•    Pharmaoffshore.com
•    Toronto Drug Store

Rogue websites that have been active as of August 6, 2018:

•    Bestmedzonline.biz
•    Canadapharmacy24rx.com
•    Canadapharmacytrust.net
•    Canadarxstore.net
•    Canadian-pharmacies-store.com
•    Cenforce.cc
•    Cheapedtabs.com
•    Cheap-pills.com
•    Cheap-rx.com
•    Greatestpharmacy.com
•    Hop.kz/9jfz
•    Miecare.com
•    Mycanadastore.com
•    My-canadianpharmacy.com
•    Mycanadianpharmacyrx.com
•    Myhealthmeds.net
•    Mypillsbox.com
•    Onlineforyou.net
•    Online-pills.com
•    Ourtramadol.com
•    Overtabs.com
•    Pharmaglobalrx.com
•    Pharmaoffshore.com
•    Prescriptionsolutions.biz
•    Puretabsquality.ru
•    Rxcanadapharmacy.com
•    S14sbxbsz.genericrxservice.ru
•    Smartfastmd.com
•    Starlightpharmacy.com
•    Supremegenerics.com
•    Thinksteroids.com
•    Phrmreviews.com
•    Rxstars.net

Many rogue online pharmacies are fly-by-night websites that shutdown and then pop back up as a different website.

Rogue websites that have been inactive as of August 8, 2018:

•    24hsmeds.com
•    Amerisur.net
•    Bestedonline.com
•    Bestliferx.com
•    Buyphentermine4u.com
•    Canadianfamilypharmacy.net
•    Canadian-drugshop.com
•    Canadianpharmacyltd.com
•    Canadianneighborpharmacy.com
•    Cheap-pharmacy.us
•    Cheap-pharm-store.com
•    C-v-s-pharmacy.com
•    Codpharmacy.net
•    Dynamicmeds.com
•    Jumprx.com
•    Globalrxpharmacy.com
•    Mypharmacydata.com
•    Nextdaysoma.com
•    OvernightMedsDirect.net
•    Pharmarxdirect.com
•    Phenterminerankings.com
•    Reliable-tablets.com
•    Rxpharma24hs.com
•    Rxsmartfind.net
•    Shoprxtoday.com
•    Theusdrugsdirect.com
•    Totaltrustmeds.com
•    Tramadolbargain.com
•    Usonlinepharm.com
•    Verylowpricemeds.com
•    Vpro-fash-ship.info
•    Without-prescription.net
•    Xlpharmacy.com

How to avoid rogue online Pharmacies

PharmacyChecker's main mission is to identify safe online pharmacies. Rogue websites can spring up over night and are constantly changing shape and location on the Internet. We hope you can use the information we provide to better understand how they work and the characteristics they share so that you and your family can avoid them on your search for affordable medication.

The number one way to avoid falling into the trap of buying from a rogue website is to stick with the online pharmacies accredited and monitored through the PharmacyChecker Verification Program or other acceptable credentialing programs*.
A study published by the National Bureau of Economic Research found that shopping for medication on websites credentialed through PharmacyChecker always yielded genuine medication, while this was not the case with non-credentialed pharmacies.
See a sample list of pharmacies accredited and monitored through PharmacyChecker:

* Other acceptable credentialing programs include the Verified Internet Pharmacy Practice Sites (VIPPS) program, run by the National Association of Boards of Pharmacy (NABP), LegitScript's online pharmacy verification program, and the Canadian International Pharmacy Association (CIPA). In the case of the NABP and LegitScript programs – safe international online pharmacies are wrongly viewed as "rogue" or "unapproved" – we believe due to commercial interests of U.S. pharmacies, pharmaceutical industry funding, and potentially pressure from the FDA, but the programs otherwise appear to validate online pharmacies that are safe to buy from. CIPA's online pharmacy standards are similar to those of the PharmacyChecker Verification Program. Many of their members are also approved in our program. We cannot vouch for those that are not. You can also search for medication on websites of your neighborhood pharmacies.

Safe Online Pharmacies — Verification Program

To ensure consumers shop at safe, licensed pharmacies on the Internet, we operate the PharmacyChecker Verification Program. Only pharmacies meeting high standards of practice are eligible for accreditation in our program and may apply to the program under the following accreditation types:

• Accredited Pharmacy (retail, wholesale, and veterinary), and
• Accredited Online pharmacy (websites that market and sell prescription drugs dispensed by pharmacies)

Accredited pharmacies are licensed, brick-and-mortar pharmacies that fill prescription orders. Accredited pharmacies include walk-in pharmacies; mail-order only pharmacies; pharmacies that fill orders internationally and others only within their own countries. Some PharmacyChecker-accredited pharmacies operate their own websites, while others fill orders for other online pharmacies.

Accredited online pharmacies are defined as websites that market and sell prescription medications. An accredited online pharmacy may or may not own a brick-and-mortar pharmacy but must refer orders to one or more pharmacies that are also approved pharmacy members in the PharmacyChecker Verification Program. Many accredited pharmacies provide consumers with the option to have a prescription filled by their own pharmacy as well as licensed pharmacies in different countries so that patients can take advantage of lower international prices.

Pharmacy and online pharmacy applicants must meet critical safety qualifications to be eligible for and accredited in the PharmacyChecker Verification Program and publish the PharmacyChecker.com Seal on their websites. PharmacyChecker.com verifies the following qualifications to determine accreditation eligibility:

• Prescription orders dispensed by licensed pharmacies accredited by PharmacyChecker
• Requires valid prescription
• Meets website security requirements
• Publishes customer privacy policy on website
• Publishes contact information on website for customer service
• Pharmacist consultation offered to consumers
• Quantities marketed on website restricted to a maximum of 3 months' supply at a time
• Disclosure of pharmacy location to consumer prior to purchase

In addition, 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 experts in pharmacy safety to inspect pharmacies in certain countries to be sure that accredited pharmacies adhere to high standards of practice.

Additional information is available on our PharmacyChecker Verification Program page.

The PharmacyChecker.com Seal

Accredited online pharmacies vetted through the PharmacyChecker Verification Program are permitted to display the PharmacyChecker.com Seal on their website. Look for this seal before ordering medication online, especially if the company is not generally well known or from a different country. To verify the validity of the seal displayed, just click it. When clicked, a valid seal will direct online shoppers to a profile of the online pharmacy that is hosted on PharmacyChecker.com. Rogue online pharmacies publish fake PharmacyChecker.com seals so it's important to confirm the validity of a seal.

Click on the seal below to see how they work.

Types of Online Pharmacies

Traditional

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, except legitimate online pharmacies will not sell controlled drugs internationally.

Remote Consultation

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, ones that follow 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 Verification Program does not approve remote consultation sites. Additionally, federal law prohibits remote consultations as a basis for prescribing controlled substances.

No-Prescription Required! Avoid all of these pharmacies

Some rogue websites will sell you prescription medication without requiring any prescription at all, which can be extremely dangerous. 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, read the section about rogue online pharmacies.

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:

• "Full" range of medication, including prescription and over-the-counter products, as well as testing supplies and other health and beauty products just as you would find in a large pharmacy.
• "Over 500 drugs" includes almost all prescription medication sold at your neighborhood pharmacy.
• "Between 250-499 drugs" covering those medications representing the majority of prescription sales.
• "Popular" medications, the 10 to 50 top-selling prescription drugs.
• "Lifestyle" medications, such as those used for sexual enhancement, hair growth, contraception, weight loss, herpes, and smoking cessation.
• "Specialized" medications for a single purpose, such as for pain, or specific medical conditions.

U.S. Pharmaceutical and Pharmacy Regulations

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, inspections of drug manufacturing establishments, 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 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 July 31st, 2015, there are 40 VIPPS-certified online pharmacies, approximately 25% of which are members-only pharmacy benefit programs. The NABP's VIPPS program is closed to all Canadian and other non-US pharmacies that sell medications internationally to persons in the U.S.

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:

• Lower prices on generics — in fact, generic prices at some U.S. online pharmacies are often half the Canadian price due to greater competition in the U.S. market
• Acceptance of prescription drug insurance to purchase drugs
• Lower shipping charges
• Easier recourse to legal action if you are wronged by the online pharmacy
• Generally strong pharmaceutical and pharmacy safety regulations, although many other countries have similarly strong regulations.

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 counterparts.

International Online Pharmacies: Personal Drug Imports Are Generally Permitted But Not Technically Legal

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 from foreign pharmacies, mostly using online 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, under most circumstances, it is technically illegal. According to the FDA, no one has ever been prosecuted for personal drug importation (importing small quantities of medication for personal use).

The FDA provides personal drug importation guidelines for its personnel.

While the law allows the FDA and the U.S. Customs and Border Patrol to detain and refuse international prescription orders arriving through the mail, less than one percent are actually stopped. In these cases, under U.S. law, you will be informed by the FDA that your drug order has been detained or refused and that you are allowed to challenge their decision to take away your medication to try and have it released. To learn how to provide testimony to the FDA if they take your medication, you can go to Prescription Justice Action Group. The U.S FDA regulates the safety and efficacy of medications sold in U.S. pharmacies. Medications dispensed from outside the U.S. are regulated for safety and efficacy by pharmaceutical/pharmacy regulatory authorities in other countries.

Watch Marcia Crosse, PhD, director for the Health Care Team at the U.S. Government Accountability Office (GAO) explain FDA's personal drug importation policies:

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.

Buying Controlled Medication Online Has Serious Risks

In the U.S., most prescription drug products with a high potential for addiction and abuse are regulated by the U.S. Drug Enforcement Administration, as well as by the FDA. Prescription drugs regulated by the DEA are called controlled substances. Popular controlled substances include Adderall, hydrocodone, Oxycontin, Valium, and Xanax. Whereas regular prescription drugs such as Lipitor, Nexium, and Viagra are only regulated by the FDA but not by the DEA. U.S. pharmacies that sell controlled substances must have a special license 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 Verification Program is closed to all international online 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 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.