Almost three years ago, we blogged about a federal investigation of CanadaDrugs.com, which for many years has safely sold prescription medication at prices far lower than typically available in the U.S, and which is a verified online pharmacy in the PharmacyChecker.com Verification Program. The investigation focused on CanadaDrugs.com’s wholesale drug importation and distribution to doctors and clinics — an area CanadaDrugs.com has long since exited. It did not focus on CanadaDrugs.com’s retail sales to consumers for personal use, which is the focus of the PharmacyChecker.com Verification Program and the information we provide to consumers on our website about online pharmacies.
Recently, an indictment was unsealed in federal district court in Montana that charged CanadaDrugs.com, Ltd. (the entity which owns CanadaDrugs.com) and others with illegal wholesale drug importation, which allegedly occurred between three to six years ago. The allegations include wholesale distribution of a counterfeit version of the cancer drug Avastin to medical clinics in the U.S.
The indictment of CanadaDrugs, Ltd, comes as no surprise, as the investigation was well publicized. It will also come as no surprise, however, when the U.S. pharmaceutical industry tries to use the charges, which focus exclusively on wholesale drug importation, in an effort to discredit safe personal drug importation. As we have written here and opined in the New York Times, the U.S. pharmaceutical industry and pharmacy chains feel threatened because Americans can and do safely purchase their medications online at substantially lower cost from pharmacies in other countries. Thus, the industry, the “non-profit” groups it funds, and the government agencies which it lobbies and seeks to influence, will see this indictment as yet one more opportunity to scare people from personal drug importation. This slight of hand is wrong, since the investigation and indictment have nothing to do with personal drug importation. In fact, even the Wall Street Journal, which was instrumental in publicizing the investigation, clarified the difference between wholesale businesses and CanadaDrugs.com: “There is no indication that fake medicines were sold through the company’s consumer-focused website, CanadaDrugs.com.”
Last week, Bing announced a new effort to use its search engine to warn consumers about threats from “fake” online pharmacies. The big problem is that at least some of the online pharmacies they list are not fake, but represent very real, licensed pharmacies, ones that require valid prescriptions and have been safely helping Americans afford medication for years. We know this because these pharmacies have been carefully evaluated, inspected, and monitored by us at PharmacyChecker.com, and meet high standards of pharmacy practice. See our standards: http://www.pharmacychecker.com/verification_program_guide_and_standards_1_3.pdf.
The online pharmacies targeted by Bing, which are approved in our program, are all located outside the U.S. Curtailing online access to lower cost and safe foreign medication using scare tactics is a strategy employed by the pharmaceutical industry. Indeed, Bing’s action seems to have a lot to do with stopping safe personal drug importation and will recklessly alarm Americans so they don’t buy more affordable medication from other countries.
Here is the warning which appears when a consumer’s Bing search results include links to one of these online pharmacies and they try to click on the link to that online pharmacy:
To choose the pharmacies it targets, Bing is relying on a list of online pharmacies which have received warning letters from the FDA. But, in at least several cases, these warning letters, which you can find on the FDA’s website, do not indicate a pharmacy to be fake, nor do they pertain to sales of counterfeit or adulterated medications, nor to any problems with the pharmacy meeting good standards of practice. Instead they relate to 1) sales of lawfully manufactured generic versions of drugs that are still on patent in the U.S., and 2) medications that are approved in Canada but not in the U.S. We will examine each of these letters fully over the next week, but our initial review indicates that these issues have been addressed by the online pharmacies in our Verification Program that received the letters.
The genesis of Bing’s action, which is most likely coordinated with the FDA, comes from the scare tactics about foreign medications conceived by pharmaceutical companies and their lobbying largesse. Why else would Bing decide to target only online pharmacies when many other pharmacies, pharmaceutical companies, medical device manufactures, and dietary supplement distributors have also received FDA warning letters for various infractions, yet Bing does not target them with its pop-up warning?
Bing’s actions would be great if the websites it is targeting were all fake or rogue online pharmacies, but they are not. When consumers see Bing’s warning, they will likely do one of three things:
- Keep searching for another online pharmacy that charges a price they can afford. They may find one of the tens of thousands of rogue pharmacy websites that don’t require a prescription (but are not included on FDA’s new list) and buy from that one. Then they are far more likely to end up with a counterfeit drug.
- Go to their local big chain pharmacy and pay hundreds if not thousands of dollars more for their prescribed medication. The Warning has a link to “safe online health purchases” but those take you to U.S. online pharmacies only, which are often the websites of the big chain pharmacies!
- Not take their prescription medication at all. Thirty-five million Americans each year already forgo prescribed medication due to cost.
These are horrible outcomes. Yes, warning Americans about rogue online pharmacies is good public policy. But leading Americans away from safe personal drug importation will just lead to fewer people getting medications they need, more Americans choosing between food and medicine, and larger profits for the big drug companies.
For those interested in a full policy analysis of FDA’s current campaign, please see our report called: “Online Pharmacies, Personal Drug Importation and Public Health.”
Appearing on Fox and Friends this past Saturday morning, Tod Cooperman, MD, founder of PharmacyChecker.com, discussed our favorite topic – affording prescribed medication. The hosts wanted to know what is behind a recent class action lawsuit against CVS Health Corp in which the chain pharmacy is accused of overcharging consumers on generic drugs and how Americans can prevent getting bilked on price by pharmacies.
CVS, like many chain pharmacies, has a prescription discount program, and the discounted prices can often be less than the co-pay required with some pharmacy benefit plans. However, CVS has apparently not been informing customers of the lower, discounted price. What has been happening is that hundreds of thousands of CVS customers have paid more money using their health insurance because the co-payments are higher than the discount program price.
Dr. Cooperman basically informed the public that this is probably a pretty common practice among U.S. chain pharmacies with similar programs. He said: “It’s really kind of ridiculous because you have people with insurance who…are being charged more than if you simply walked in and asked for the cash price or discounted price.” So what do you do? When you go to your local pharmacy, ask the pharmacist or pharmacy technician for the absolute lowest price you can pay. Call different pharmacies in your neighborhood, because generic drugs can sometimes cost five times more at one pharmacy than they do at another.
When medication is not affordable at your local pharmacy, international online pharmacies are an option for savings. Dr. Cooperman stated: “about five million Americans actually are now going outside the U.S. because they can’t afford their prescriptions.” Pharmacies in other countries sell safe and effective medications at much lower prices but rogue websites abound — so stick to verified international online pharmacies and compare their prices on www.pharmacychecker.com. Dr. Cooperman noted the technical illegality of personally importing meds but that the FDA doesn’t “go after consumers for doing it.”
Anna Kooiman, one of the hosts, mentioned that people lose their lives because they can’t afford medication. She added, “Listen, it might be illegal but some people do what they have to do to save their own lives.”
Yesterday, in the New York Times, Andrew Pollack reported on the swelling chorus of groups, politicians, and consumers who are sickened by the price of cancer drugs and medication costs generally. They are calling for pharmaceutical companies to justify the outrageous costs of medication.
As part of this swell of frustration and anger about drug prices, over 100 oncologists are calling for the U.S. government to take concrete steps to bring down the prices on expensive cancer medications, many which cost over $100,000/year. One of those steps is allowing importation of cancer drugs across borders for personal use. (What a novel idea!). Despite the federal restrictions on the practice, five million Americans already import prescription drugs across borders for personal use because the costs of medicine are too high domestically. The imports help people afford medications that they would otherwise go without. While people are not prosecuted for doing so as long as the imports are for personal use, expressly legalizing safe prescription importation from licensed pharmacies in other countries is a great idea for all medications, not just cancer medications, and would probably cause medication prices to fall at U.S. pharmacies.
Personal drug importation is just one step among several that doctors are calling on to improve access to affordable cancer medication. Others include allowing Medicare to negotiate drug prices like the Veteran’s Administration does; banning deals (“pay-to-delay”) between brand and generic drug companies, in which the former pays off the latter to postpone introducing a lower cost generic drug; and reigning in patent terms so that lower cost generics can come to market faster.
In reading the New York Times article, the tone of criticism reported on was veering toward visceral disgust that so many seem to have with the pharmaceutical industry. But the Wall Street Journal was on this issue, too. In “Doctors Object to High Cancer Drug Prices,” Jeanne Whalen writes: “The doctors focus attention on the financial burden to patients, saying the out-of-pocket costs are bankrupting many just as they’re fighting a deadly illness.”
To conclude, recall that last month we brought you a real story of an American family facing financial ruin due to the cost of a cancer medication. Lisa wrote:
“We are going broke, will probably lose our home and my husband will probably never be able to retire (even though his body is breaking down from 40+ years of a very physical job as a pipe fitter. I (the wife), am permanently disabled. We will die homeless before this drug ever comes within an affordable price.
“Why doesn’t anyone bring this to the press? Why does Congress and Obamacare turn a blind eye? How many hundreds have to die before this drug and options are researched.”
The media coverage mentioned in this post shows that people are bringing this to the press. It’s exactly the press coverage that Lisa and her family deserve, not to mention the tens of millions of Americans who don’t fill prescriptions each year because of cost! Now will the government do something or are they too under the yoke of the pharmaceutical industry lobbying juggernaut?
A story last Friday on ABC News’s 20/20 featured the topic of counterfeit drugs, their dangers and where they’re being sold. The story was helpful in educating the public about the threat of counterfeit drugs but it really seemed to play along with a misleading narrative, one propagated by the drug companies, that foreign medications are the same as counterfeit drugs. I’ve debunked this nonsense before: affordable and safe medications sold from foreign pharmacies are not the same as counterfeit drugs.
Also, as part of its feature on counterfeits, ABC’s website has a section called “How to Order Prescription Drugs Safely Online” that looks to the Alliance for Safe Online Pharmacies (ASOP) for useful consumer information. ASOP is financed and operated by big corporate pharmaceutical interests that oppose personal drug importation from safe online pharmacies. If you have great health insurance that covers all of your medications, or lots of money to cover exceedingly high out of pocket prescription drug costs, then the recommendations of ASOP might work for you because they recommend big U.S. chain pharmacies, such as Walgreens and CVS, which charge the world’s highest prices for medication. Many other Americans actually NEED safe international online pharmacies, which ASOP would call unapproved or even “rogue.”
It its story, ABC investigative journalists tracked down people selling prescription medications on the street, from push carts, even in clothing stores – usually in relatively poor neighborhoods. Eventually those people were arrested, all for the viewing audience to see. According to the federal agents involved, some of the medications seized were counterfeit and people did not have to provide a prescription to buy prescription drugs. The story was very troubling. Indeed, it was a powerful indictment of our society, one in which drug prices are so outrageously high that people, such as undocumented immigrants without health insurance, look to street peddlers to find affordable medication.
ABC also covered what are known as “Storefront” pharmacies, which are located throughout the country, often in strip malls, where people go to buy medications from pharmacies in other countries by mail order. These storefronts usually have titles that include the words “Canada,” or “Canadian,” and “Drugs,” “meds,” “medicine,” “Rx,” etc., which indicate that a person can acquire medicine from Canada. ABC wanted to highlight that the medications ordered at these places often do not come from Canadian pharmacies but from other countries. ABC’s implication is that people are being misled. On the other hand, when watching the show, it appeared that storefront personnel did communicate that the orders would not come from Canada so I’m not clear on what’s going on here. We wrote a piece about online pharmacies related to this issue: “So You Want to Buy Cheap Medicine from an Actual Canadian Pharmacy. Here’s the Deal.”
We do not verify storefronts but we believe that some of them are essentially people and companies that help Americans place prescription drug orders from foreign pharmacies that require a valid prescription. In fact, through ABC’s mystery shopping (meaning purchasing prescription drugs from storefronts) they were required to submit valid prescriptions and did so. A few weeks later the journalists received four medications, two of them brand, Viagra and Zocor, coming from Singapore and the UK, and two generics, tadalafil (the brand version known as Cialis) and finasteride (the brand version known as Propecia), both Indian drug products.
The story made it seem as if the two generics were either substandard or counterfeit, as it was noted they contained “impurities” or “unknown ingredients”. What ABC News did not communicate is that the so-called “impurities” or “unknown ingredients” might be acceptable inactive ingredients, excipients, etc., just different from those in the brand versions sold in the U.S. This is normal: generic drugs in the U.S. often have different inactive ingredients from their brand name counterparts. When the Indian generics were chemically tested, ABC showed the results as “fail” but didn’t tell you that generics sold in U.S. pharmacies would likely have failed as well if given that same test because they are not the exact same as the brand in terms of inactive ingredients.
Also, when ABC reported that most of the medicines did not meet FDA standards, it didn’t explain that simply having a label designed for a different country automatically means it does not meet FDA standards, regardless of the medication’s actual safety. In short, foreign sourced medications are often safe and effective products, approved for sale in the countries from which they are dispensed – but not counterfeit or substandard.
It’s important to note that the generics received by the journalists came from India, and, as we’ve written about before, India does have more problems with low quality and counterfeit drugs than in the U.S. or other rich countries. At the same time, India is the largest source of generic medications, exporting across the globe to wealthy, middle income and poor countries. In fact, 40% of generics sold in U.S. pharmacies are from India. It’s well known that the top Indian drug companies excel at making high quality, safe and effective prescription medications, but even among them problems exist, too.
On a closing note about ABC’s coverage of counterfeit drugs, I encourage our readers to look at the consumer comments section on ABC’s website. People don’t believe the big drug company propaganda, or even our trusted regulatory authorities like the FDA. That bothers me because the FDA is right that there are rogue pharmacy operators out there, often online, but they’re wrong not to acknowledge the relative safety and public health benefits of safe international online pharmacies. Hopefully ABC will really investigate…
Is it legal to order medications online? Yes. If you live in the U.S., you can legally order medications online for mail order, such as from Walgreens or CVS. Is it legal to order medications from an online pharmacy located in a foreign country – to personally import it? Technically, no; but people who import small quantities of prescription medication for their own use, according to the FDA, are not prosecuted for doing so. There are a lot of nuances and quirky details when it comes to laws and regulations that apply to online pharmacies. Some laws are there to protect your health and safety; others seem more bent on protecting the profits of big drug companies – and there’s a lot in between. It’s complicated.
So this week, in our continuing quest to get the truth out and for our elected leaders in Congress to take bold action to protect online access to safe and affordable medication, we’re publishing the next section of our report called Online Pharmacies, Personal Drug Importation, and Public Health…