You Can Get Anything You Want:
Internet Pharmacies Overstep Boundaries

By Melanie R. Margolis

You can buy almost anything online now. With startling ease, even prescription drugs can be obtained over the Internet thanks to the booming development of e-commerce. Internet pharmacies have been subject to increasing scrutiny, though, particularly ones that diagnose patients and/or prescribe drugs for these patients as part of their online services. See Viagra Prescriptions on the Internet: Is this Telemedicine? Some online pharmacies stand to make tremendous profits at the risk of patient safety.

While the Internet is largely unregulated, the practice of pharmacy within a state's borders is regulated by the state. Generally, all states have a board of pharmacy that requires pharmacists to be licensed or registered to practice pharmacy. According to the National Association of Boards of Pharmacy (NABP), requirements vary among the states, but generally, pharmacists must: have a degree from an accredited college of pharmacy; complete a residency or internship program; pass a licensing examination; and meet continuing education requirements for practicing pharmacists in most states. In addition, the Food and Drug Administration regulates safety and effectiveness of drugs, and the Drug Enforcement Administration regulates controlled substances.

Because the practice of pharmacy is so heavily regulated--in stark contrast to the Internet--it not surprising that states are beginning to take a strong stance against some out-of-state online pharmacies reaching within their borders. At issue is the ease with which patients are able to obtain prescription drugs without a face-to-face meeting with a physician. (In addition to illegally prescribed drugs, the availability of unapproved or illegal drugs is problematic and dangerous). Examples of states taking action are cropping up around the nation:

On September 15, 1999, in response to online pharmacy fraud, the NABP announced the first 3 Internet pharmacy site certifications under the Verified Internet Pharmacy Practice Sites (VIPPS) certification program. To be VIPPS-certified, a pharmacy must comply with the licensing and inspection requirements of their state and each state to which they dispense pharmaceuticals. In addition, pharmacies displaying the VIPPS seal on their sites have demonstrated to NABP compliance with VIPPS criteria, including patient rights to privacy, authentication and security of prescription orders, adherence to a recognized quality assurance policy, and provision of meaningful consultation between patients and pharmacists. To date, only 3 online pharmacies have been certified: drugstore.com; Merck-Medco Rx Services; and PlanetRx.com. The VIPPS database can be accessed at http://www.nabp.net/vipps/intro.asp.

The federal government plans to add its muscle to the regulation of Internet pharmacies. On December 28, 1999, President Bill Clinton proposed a new initiative to protect consumers from illegal pharmaceutical sales over the Internet. The initiative would: establish new federal requirements for all Internet pharmacies to ensure that they comply with state and federal laws; create new civil penalties for the illegal sale of pharmaceuticals; give federal agencies new authority to swiftly gather the information needed to prosecute offenders; expand federal enforcement efforts; and launch a new public education campaign about the potential dangers of buying prescription drugs online.

Legitimate Internet pharmacies, already in compliance with applicable state laws, do not oppose the federal proposal outright. They do not feel, however, that an additional layer of regulation by the federal government is necessarily justified. Many believe that the states' licensure requirements coupled with the FDA's existing regulation of drugs and the voluntary certification process is adequate.

By enforcing pharmacy licensure and registration laws, the states and the federal government are a step closer to achieving some degree of control over U.S. Internet pharmacies and to protecting public health.

01/10/00