Online Prescription Drug Services: Safety, Quality, and Buying Cheap Medications Online

Online Pharmacies: Why Bother?

As explained in the separate page on the Background to the Online Discount Drug Controversy, due to the absence of pricing regulation in the U.S., American consumers pay far higher prices for their prescription medications than Italians, French, Swedes, Germans, Swiss, British, and many others. Increasingly, U.S. consumers are looking to online discount pharmacies in the United States or even to pharmacies overseas to escape the aggressive pricing practices of large pharmaceutical companies. I strongly believe in individual choice and freedom and the notion of voting with one's pocketbook -- but there are also some reasons for caution.

Note that the United States Food and Drug Administration (FDA) has recently produced a list of medications (PDF) which it specifically recommends against buying on the internet.

General Factors When Comparing Online Prescription Drug Services

As with any online service, there's a fair bit of work to be done to make sure you are getting the best deal from an online pharmacy.

Comparing Drug Discounts

When shopping for medications online at discount pharmacies, it is obviously worth doing some comparison shopping: who offers the best prices on the specific medications you are interested in, and who offers the best overall cost for your order? Free overnight delivery may be great, but only if the pharmacy offers a sufficient level of discount on the drug itself; likewise, the absolutely cheapest prices on drugs are not very helpful if you have to pay substantially more for delivery.

But even more important than discounts and free overnight delivery is the level of quality, service and reliability which the merchant offers.

Beyond Discounts: Comparing Safety and Quality, Service and Reliability

The quality of online discount pharmacies varies greatly, much like other online discount businesses: and free delivery and cheap drug prices are worthless if you never see your money again, or if the product being shipped is of low quality or even fake.

It's worth checking some or all of the following before being persuaded by the financial attractiveness of a particular online prescription drug service:

• Do they provide a real physical address or at least a toll-free telephone number for customer service? (Or do they only provide an email address?)
• Do they provide evidence either that they are a licensed pharmacy themselves, or that they fulfil orders via a licensed pharmacy? (Or are orders put together by unlicensed personnel who may or may not know anything about the drugs they are providing?)
• Do they state a privacy policy, so you know that your private details will be kept secure? (Or should you expect spam several times daily once you've provided your personal information?)
• What is their policy on verifying prescriptions; or, alternatively, do they provide actual medical consultations and online prescriptions? (This one is open to debate, as ultimately it is your responsibility to obtain medications only when they have been appropriately prescribed for you; some online services do ship medications without a prescription.)

The bottom line when searching out cheap prescription drugs from an online pharmacy is: buyer beware! It is your health on the line -- as well as your pocketbook. I believe it is possible to meet the needs of both health and pocketbook, and some time invested in comparing and evaluating the available options will be well spent.

Comparing Types of Online Prescription Drug Services

Essentially three different types of online prescription drug services will be of interest to consumers in the United States and other Western countries. The discussion below specifically separates out the US-only suppliers simply because while US consumers may also buy abroad, few if any US suppliers ship outside the US; therefore, the US suppliers will be of less interest to those living outside the US. (Please skip ahead to the section on discount European pharmacies if you'd like to bypass the US-centric sections.)

Comparing U.S. Medicine-Only Pharmacies

The most well known online pharmacies in the United States supply only medications and require a prior prescription from your own doctor. You must organize and pay for the consultation with your doctor, and you must fax or mail a copy of your prescription to the online service concerned.

Comparing U.S. Online Pharmacies Offering Online Prescriptions

Possibly the most innovative category of United States online pharmacies (or, more precisely, pharmaceutical ordering services) includes those which provide actual medical oversight of the process, normally incorporating an online medical consultation with a doctor resulting in a so-called 'online prescription'. Pharmacies of this type can offer greater savings when compared to the total price of a medication and a separate face-to-face medical consultation, although they normally carry a much narrower range of medications because doctors will only prescribe certain medicines without seeing a patient face-to-face. They are also very controversial due to the fact that prescribing online without a prior physical examination contravenes recommendations published by the American Medical Association; the legal standing of such pharmaceutical ordering services grows more puzzling and uncertain almost by the day.

• MedBasket.com - Inexpensive overnight delivery via Health Solutions Network, one of the most respected suppliers in the business.

Other options include FrugalMed.com (with a huge product range), DrugsPark.com, and QEDmeds.com, which uses the same fulfilment service as MedBasket but carries a wider product range.

Comparing Foreign or Offshore Online Prescription Drug Services

As explained in the separate page on the FDA's Personal Importation Policy, importing prescription drugs into the United States for personal use may be tolerated at the discretion of individual officials, but it remains technically illegal. If you live within the United States, this stands as probably the best reason for choosing an online pharmacy which is also in the United States. However, it is undeniable that many people do choose to purchase prescription medications from a Canadian pharmacy, a Mexican pharmacy, or an online pharmacy in another country -- see below for separate sections on foreign pharmacies.

Comparing Discount Online Pharmacies in Europe

Foreign and offshore online pharmacies are not exclusively populated by suppliers of low-cost generic drugs of sometimes questionable quality or authenticity. In at least some cases, online pharmacy services -- particularly in Europe -- go to great lengths to reassure customers that their medications are only genuine branded products sourced directly from the manufacturer or approved distributors.

• Topills - Providing customer support telephone numbers for both the United Kingdom and the US, Topills provides both generic and branded versions of several popular medications, with free worldwide shipping (including directly from Europe for European customers).

Comparing Discount Canadian Pharmacies

Despite the caveats described above with regard to foreign and offshore pharmacies, prices are very frequently lower for branded drugs almost anywhere but the United States, and the Canadian government's prescription drug price controls ensure that Canadian drugs are amongst the cheapest available. Some organizations for retired people living near the border with Canada are even sponsoring bus trips across the Canadian border for people to purchase medications at much lower Canadian prices, and the states of Wisconsin and Minnesota have launched dedicated Canadian pharmacy web sites to help their residents buy Canadian drugs.

Increased competition within the U.S. discount drug market for generics, however, does mean that the price advantage for Canadian or other foreign pharmacies has been somewhat eroded for these less expensive drugs.

Comparing Discount Mexican Pharmacies

In contrast to the comparatively well-developed Canadian discount drug market -- an area which has been positively flooded with carbon copy 'me too' sites attempting to cash in on the U.S. rush to buy discount drugs abroad -- the Mexican market is comparatively under-developed. Like Canada, Mexico has long attracted regular forays from U.S. citizens living along the border who journey a few miles to make big savings on prescription drugs. But the online trade in discount Mexican drugs is only just getting started in earnest; I would expect the Mexican market to be awash very soon with the same kind of low quality profit engines that have sprung up all over Canada. (I would also expect further proliferation of the widespread scams offering to sell you special 'members only' access to lists of Mexican pharmacies.)

Having said that, I am aware of at least a few reputable online discount pharmaceutical ordering services working with suppliers in Mexico. They offer what may be the lowest prices available anywhere. Among the most positive reports are those about:

• XL Pharmacy - Registered in the Caribbean but apparently filling orders using pharmaceutical suppliers in both Mexico and India, I believe this is one of the largest and most comprehensive of the online pharmacies.

Note that drug laws in Mexico permit many drugs to be dispensed without a prior prescription; this enables Mexican pharmacies to ship (legally, in accordance with Mexican law) many medications which US pharmacies would not be able to ship without a prescription.

Other International Pharmacies and Generic-Only Online Prescription Drug Services

One other international generic-only pharmacy is BM Pharmacy (formerly known as Budget Medicines), which appears to offer a reliable and cost-effective service and which does not require a prior prescription.

Although I had previously mentioned one Swiss pharmacy, along with a caution that I was unaware of its history and background, that service has since disappeared and reappeared a couple of times; I cannot recommend it until it functions more reliably.