Since about the year 2000 , hundreds of pharmacies have begun operating over the internet. Many such pharmacies are, in some ways, similar to community pharmacies; the primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient than traveling to a community drugstore.

While many internet pharmacies sell prescription drugs only with a prescription, some do not require a pre-written prescription. In some countries, this is because prescriptions are not required. Some customers order drugs from such pharmacies to avoid the inconvenience of visiting a doctor or to obtain medications which their doctors were unwilling to prescribe. Many of these websites employ their own in house physicians to review the medication request and write a prescription accordingly. Some websites offer medications without a prescription or a doctor review. This practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and the suitability of a medication for a specific individual. Pharmacies offering medication without a prescription and doctor review or supervision are sometimes fraudulent.

In the United States, there has been a push to legalize importation of medications from Canada and several European countries, in order to reduce consumer costs. Although importation of prescription medication usually violates Food and Drug Administration (FDA) regulations and federal laws, enforcement is generally targeted at international drug suppliers, rather than consumers. Often Americans purchase lower-cost foreign drugs by driving to Canadian or Mexican pharmacies, buying their medications when traveling abroad on vacation, or, buying from foreign pharmacies that ship their orders via mail.

International consumers

International consumers often purchase drugs online from online pharmacies in their own countries, or those located in other nations such as India, Spain, Pakistan and the Philippines. Some of these pharmacies require prescriptions, while others do not. Of those which do not require prescriptions, some do ask the customer to fill in a health questionnaire with their order. Drugs available online are often produced by well-known manufacturers such as Pfizer, Wyeth, Roche, and generic Indian drugmakers Cipla and Ranbaxy and Teva Pharmaceutical Industries of Israel. It is a fairly common practice for North American and European visitors to countries like Thailand, India and South Africa to purchase and bring home affordable medications for themselves, family members and/or friends. Savings can be significant, often exceeding 80 percent compared to the same medications available in their home countries. Travellers may avoid possible difficulties inherent to physically going through customs with their medication purchases by mailing the drugs to their home so they receive them upon their return. Among well-respected online pharmacies serving international patients are InternationalDrugMart.com and IsraMeds.com.

U.S. consumers

To save money, millions of uninsured and underinsured U.S. consumers purchase drugs from online pharmacies in Canada, India, the UK and other countries and receive their purchases by mail. Especially for uninsured Americans taking prescription drugs for chronic health conditions, a major attraction of online pharmacies abroad is that nearly every country, except the U.S., controls its drug prices.

Few of these orders are investigated because U.S. authorities are much more worried about controlling illegal pharmacies in the U.S., not consumers themselves. In fact, the Washington Post reported that ".. millions of Americans have turned to Mexico and other countries in search of bargain drugs...U.S. Customs estimates 10 million U.S. citizens bring in medications at land borders each year. An additional 2 million packages of pharmaceuticals arrive annually by international mail from Thailand, India, South Africa and other points. Still more packages come from online pharmacies in Canada."

Until about 2005, American consumers looking abroad most commonly turned to Canadian pharmacies for affordable medications. Today, many consumers head to online pharmacies in India, South Africa and other countries where drug prices are often lower than in Canada.

A report published in the journal Clinical Therapeutics concludes that U.S. consumers are facing a growing risk of getting counterfeit drugs because of rising Internet sales of medical drugs, projected to reach upwards of $75 billion by 2010.

Overseas online pharmacies and U.S. law

Legality and risks of purchasing drugs online depend on the specific kind and amount of drug being purchased.

• While rarely enforced, it is usually illegal to purchase controlled substances from an overseas pharmacy. Generally speaking, a person purchasing a controlled substance from such a pharmacy may be violating two federal laws which can carry stiff penalties. The act of importation of the drug from overseas violates 21 USC, Section 952 (up to 5 years in prison and $250,000 fine for importation of non-narcotic Schedule III, IV, or V drugs; possibly more for narcotics and Schedule I and II drugs). The act of simple possession of a controlled substance without a valid prescription violates 21 USC, Section 844 (up to 1 year in prison and $1,000 fine). Note that FDA does not recognize online prescriptions; in order for the prescription to be valid, there has to be a face-to-face relationship between the patient and the health care professional prescribing the drug. What exactly constitutes a "face-to-face" relationship is considered by many online pharmacies to be a subjective definition which would allow them to operate as an adjunct to the patient's own physician if the patient submits medical records documenting a condition for which the requested medication is deemed appropriate for treatment. Sections 956 and 1301 provide exemptions for travellers who bring small quantities of controlled substances in or out of the country in person, but these exemptions do not cover delivery via a mail carrier.
• Importation of any prescription drug (not necessarily a controlled substance) violates 21 USC, Section 301(aa), unless the following conditions are met (as listed in Section 804):
1. The drug is imported from Canada, from a seller registered with the Secretary (i.e. with FDA);
2. The drug is imported from a licensed pharmacy for personal use by an individual, not for resale, in quantities that do not exceed a 90-day supply;
3. The drug is accompanied by a copy of a valid prescription;
4. The drug is a prescription drug approved by the Secretary;
5. The drug is in the form of a final finished dosage that was manufactured in an establishment registered under section 510; and
6. The drug is imported under such other conditions as the Secretary determines to be necessary to ensure public safety.
• The law further specifies that enforcement should be focused on cases in which the importation by an individual poses a significant threat to public health, and discretion should be exercised to permit individuals to make such importations in circumstances in which the prescription drug or device imported does not appear to present an unreasonable risk to the individual.
• According to Department of Homeland Security Appropriations Act, Section 535, Customs and Border Patrol are not allowed to prevent people from importing FDA-approved prescription drugs. Although originally the law was worded to cover all prescription drugs, countries of origin, and methods of delivery, its final edition specifies that it only applies to importation from Canada, and to "...individuals transporting on their person a personal-use quantity of the prescription drug, not to exceed a 90-day supply". Controlled substances are also explicitly excluded. Therefore, it does not disallow Customs to screen and intercept drugs sent by mail.
• It is also technically illegal to import "non-approved" drugs (21 USC sections 331(d) and 355(a)); however, FDA policies suggest that, under certain circumstances, the patients may be allowed to keep these drugs.
• Individual U.S. states may implement their own laws regulating importation, possession, and trafficking in prescription drugs and/or controlled substances.
• For several years, the states of Nevada, Minnesota, Illinois and Wisconsin have run official state programs to help their residents order lower-cost drugs from abroad to save money.
• Most online pharmacies worldwide will send consumers a free replacement order if their order is not received for any reason, including customs seizure (some do require the customer to submit a copy of the seizure letter they received from customs, in order to prevent fraudulent claims of non-receipt). Normally, consumers should wait about 30 days after placing their order before considering this option. When considering an order, a prospective customer should read the rules regarding reships on the pharmacy's website.

Enforcement

Enforcement of the laws listed in the previous section can be difficult (and in some cases purposely lax), as evidenced by the many profitable online pharmacies worldwide. Among other reasons, strict drug law enforcement is politically unpopular because many customers of online pharmacies are seniors and the uninsured who cannot afford to buy their prescription drugs in the United States.

• Any package containing prescription drugs may, in principle, be seized by customs. The package may be held and eventually returned to the sender if the addressee does not respond and provide proof that they are allowed to receive these drugs (e.g., a valid prescription). (Sample package detention notification letter) In practice, the number of packages containing prescription drugs sent to United States on a daily basis far exceeds Customs' capabilities to inspect them. In the past, packages often passed through customs even if they were not sent from Canada or otherwise didn't meet the requirements of section 804 of 21 USC. Until recently, about 5 percent of prescription drug packages sent from Canada were being seized.
• At the present time, U.S. customs does not seize packages from Canada.
• DEA and FDA generally do not target consumers unless drugs are imported in large quantities (suggesting intent to distribute) or represent a perceived danger to public health (opiates, amphetamines).
• Rarely, drug importation laws are enforced on the local level. For example, in June 2005 in Baton Rouge, Louisiana, a number of customers of online pharmacies were arrested by local law enforcement officers and charged with possession of a controlled substance without prescription.

References

External links

• Buying Prescription Medicine From Internet Foreign Pharmacies — US Customs and Border Protection
• http://www.woodtv.com/Global/story.asp?s=5508535 Seniors using Online Pharmacies while in the medicare gap