The St. Petersburg Times reports that Dr. Juan Ibanez, who wrote thousands of prescriptions for hydrocodone (generic Vicodin) based solely on an online questionnaire, has been sentenced to four years in prison.

The article says:

Customers only had to fill out a brief online questionnaire, select a dosage and occasionally submit medical records. At no time did they see a doctor.

Dr. Ibanez’s actions were, of course, prior to the passage of the Ryan Haight Online Pharmacy Consumer Protection Act, which clarified that writing prescriptions solely on the basis of an online questionnaire, without ever physically examining a patient in person, is not lawful. This suggests that the new law, which went into effect in late 2008, served to clarify and strengthen existing law, not outlaw something previously permissible, although some commentators disagree with our analysis.

What is striking is the amount of money that was involved in Dr. Ibanez’s operation:

Ibanez…was involved in a “criminal organization” that grossed more than $85 million from 2003 to 2007 by distributing the pills, according to the plea agreement.

The article indicated that Ibanez was responsible for distributing over 50 million pills of hydrocodone across the US between 2003 and 2007.

LegitScript standards require that online pharmacies not fill “invalid” prescriptions, which includes prescriptions written solely on the basis of an online questionnaire. This applies to both controlled substances and non-controlled substances, such as Lipitor or tramadol.

The ninth LegitScript Standard has to do with how up front an Internet pharmacy is about its business practices. As you might have guessed, LegitScript requires that our approved pharmacy websites are highly transparent about how they conduct business.

LegitScript Standard 9: Website transparency. The pharmacy must not engage in practices or extend offers on its website that may deceive or defraud patients as to any material detail regarding the pharmacy, pharmacy staff, prescription drugs, or financial transactions.

What does it mean? When a pharmacy website is “transparent”, it means that it is open about where and how it conducts business. Legitimate pharmacy websites list their addresses and contact information right out in the open. Many rogue Internet pharmacies fail to post any of this information, and when they do, it is often inaccurate. When you order a prescription online, you want to be sure you know where the drugs are coming from, and that you can get in touch with the pharmacy if need be. Internet users have every right to be wary of a pharmacy website that does not provide such information. After all, why would a legitimate business have cause to hide their location and contact information?

But Standard 9 doesn’t just target the transparency of contact information. It also encompasses the hidden “surprises” rogue Internet pharmacies often slip past consumers. A good example are the recurring fees rogue Internet pharmacies often charge. Many customers have complained of completing a one-time order with an Internet pharmacy, only to find their credit card being charged every month for unwanted refills or fees. And how can you put a halt to the charges when the pharmacy doesn’t give you a means to contact it in the first place? Good question.

Another shady practice employed by many rogue Internet pharmacies is the touting of “cheap generics!” Sounds pretty good, and pretty legitimate, since many of us frequently opt for generic drugs as a cost-cutting technique. Generic drugs are a great way of saving money, as long as the drugs are FDA-approved and safe. The only problem is, not all drugs have a legally available generic alternative. If a drug is still under patent protection (20 years post-patent date), generic versions of the drug are illegal in the US. And with good reason: illegal generics are unregulated, and may in fact contain diluted or counterfeit ingredients. Offering non-approved generics is just another rogue Internet pharmacy trick to make consumers think they are getting quality for a bargain. In reality, the drugs are not approved, are unregulated, and are sometimes more expensive than the genuine version: just because they’re advertised as cheaper doesn’t mean they really are.

How can I be sure I’m not getting duped? The short answer is, use the LegitScript pharmacy validator to see if a given pharmacy website has made it to our approved list. Only safe, legitimate Internet pharmacies will be listed there. Otherwise, look for telltale signs such as a lack of contact information or too-good-to-be-true offers prominently displayed on a pharmacy website. Legitimate pharmacy websites are not interested in pushing drugs. Rather, they exist to provide a safe and convenient alternative for consumers who prefer to order their prescriptions online.

LegitScript is 100% owned by its employees. Our start-up funding was provided 100% by our staff. Additionally, we don’t accept money from the pharmacies we monitor, specifically to avoid any appearance of conflict of interest. We also haven’t accepted any investment or financial control or interest from or by any pharmacy, pharmaceutical manfacturer, pharmaceutical wholesaler, or any similar organization.

LegitScript offers advanced market research on the Internet pharmacy market and monitoring of websites of interest. Although much of what we do is offered for free, as a public service (rogue website termination, legitimate Internet pharmacy verification for the public, and so on), LegitScript’s advanced fee-based search, monitoring and analytical program can help businesses reduce liability and risk by identifying which pharmacy websites are acting legitimately, and thus are safe to do business with. Our fee-based research also identifies developing trends and industry data. Please contact us to discuss quotes for specific projects.

LegitScript’s mission is to identify which pharmacy websites act safely and lawfully, and which do not. One way that we do this is by breaking down the Internet pharmacy world into manageable components (e.g., affiliate network), and thus “map out” the Internet pharmacy world. This helps bring transparency and light to a corner of the Internet that thrives on darkness and obfuscation.

LegitScript is glad to be noted by the National Association of Boards of Pharmacy as the only Internet pharmacy certification authority, other than VIPPS, that adheres to standards recognized by that organization, and are glad that other authorities, like the Federation of State Medical Boards and the American Pain Foundation, have noted our organization as well. None of these organizations provide financial support for LegitScript.

We just added websites within the RxAff network to our “rogue Internet pharmacies” list. These websites are “fake” Internet pharmacies: not licensed in any US state, they pretend to operate safely and legitimately, but actually, they are breaking every law in the book. In fact:

1. The drugs, including controlled substances, are sold without a prescription.

2. The drugs arrive from overseas, which is unsafe and illegal.

3. The “drugs” may not be drugs at all, but rather counterfeit substances.

4. There is no licensed pharmacy involved. (Some of the websites within the network claim that a licensed pharmacy in Manhattan, New York supplies the drugs. This is false.)

5. There is no licensed pharmacist involved.

We got quite a chuckle out of one the RxAff websites’ FAQs:

Q. Where Are You Located?

A. We are located in Manhattan, NY. We cannot give our exact physical address for security reasons. Researches have shown that people with addictiveness may act in extreme ways to get their medication. To prevent this, we do not keep any medications within our facilities and ship all products directly to the person that ordered them.

In other words, this website, which is selling addictive controlled substances without a prescription, says that they won’t give out their address in Manhattan because they are worried that the addicts they sell to will…what? Break and enter? (Hint: the real reason they won’t give out their address is that they aren’t actually located in Manhattan, or even in the United States.)

In short, RxAff is a criminal organization that lies to its customers and lies to the public. Given that, it wouldn’t be any surprise if the drugs were counterfeit.

Here’s a partial list of the websites within the RxAff network. Avoid them like the proverbial plague.

allpillz.com

allrxpharma.com

allsitesdns.com

best-rx-drugs.com

bestbrandpharmacy.com

bestmedpharm.com

brandpills.com

buy-medicals.com

buy-pillz.com

Buypill.net

Controlledpills.net

Deluxepharm.com

Directmedzmarket.com

Discountrxmall.com

Discountrxshop.net

Discountusmeds.net

Dutyfreepharmacy.com

Epharmacyexpress.com

erxmart.com

evaluepharm.com

gulfsouthrx.com

hot-pharmacy-store.com

luxepharmacity.com

med-shopper.com

mexicopharmacymeds.com

myonlinepharm.com

myrxvalue.com

online-rxpills.com

pharmacyworth.com

phentermine-drug-store.com

pilleasy.com

pillex.com

prime-rx.com

pro-medics.com

rx-bestsellers.com

rx4pills.com

rxbestmeds.net

rxexpress247.com

rxhealthpharm.com

Rxonlinepharm.com

rxpharmc.com

rxpills-shop.com

Rxpillstore.com

rxpilltoday.com

rxreal.com

rxwebpharm.com

Rxwebtrust.com

Rxworth.com

Sales-callcenter.com

simplerxstore.com

store4meds.com

store4pills.com

superpharmacy.org

theonlinepharm.com

unitedtabs.com

usepharm.com

wellknowndrugs.com

world-of-pills.com

yourwebpharm.com

LegitScript Standard #8 is a good example of how we hold pharmacy websites to the same standards as brick-and-mortar pharmacies. This standard has to do with pharmacy website transparency regarding their location and contact information.

Standard 8: Patient services. The pharmacy must provide on the website an accurate US street address of the dispensing pharmacy or corporate headquarters. The pharmacy must provide on the website an accurate, readily accessible and responsive phone number or secure mechanism via the website, allowing patients to contact or consult with a pharmacist regarding complaints or concerns or in the event of a possible adverse event involving their medication.

Why is this important? LegitScript believes that any legitimate pharmacy website should have no problem listing its address and contact information. Just as you would expect any legitimate business to prominently list its location and contact information on their website, the same goes for pharmacy websites. Consumers have a right to know where their order is coming from, as well as how they can get in touch with the pharmacy in case of any questions or problems.

By providing a valid street address along with a phone number and/or email address, a pharmacy website gives consumers confidence that they are ordering from a real pharmacy, located in the US that they can get in touch with in case anything goes wrong. While pharmacy websites are meant to make it easier to fill prescriptions, legitimate pharmacy websites also maintain the same level of professionalism that would be expected of a local pharmacy. In fact, many pharmacy websites are simply the online presence for local pharmacies, giving their customers the option to order prescriptions online with the same customer services provided by walking into the local pharmacy.

Is there ever a reason a pharmacy website would not post its contact information? Yes: they have something to hide. Many rogue Internet pharmacies provide either fake contact information or no contact information at all. As we’ve mentioned before, these operations are interested solely in your money, not your health. If there is a problem with your order (and with rogue Internet pharmacies, there’s a good chance there will be) you have no way of getting in touch with them after the fact.

When it comes to prescription medication, there is always a chance that you could have a reaction to, or simply a question about, a drug. That’s where the ability to have a pharmacist consultation becomes important. Legitimate pharmacies offer pharmacist consultations at no charge so that patients can be sure to get their questions answered about any medication they’ve been prescribed. Of course, it’s impossible to have a pharmacist consultation if the pharmacy doesn’t even list its contact information!

Pharmacist consultations are a valuable tool and are not to be confused with the doctor consultations offered by rogue Internet pharmacies which, by contrast, are typically for a fee and serve to provide a false veneer of legitimacy. LegitScript makes sure that all of our approved pharmacy websites have valid contact information in case you should need to get in touch with the pharmacy staff about an order.

Great news on the Internet pharmacy front for pets! The National Association of Boards of Pharmacy has announced a new program for accrediting pet Internet pharmacies, Vet-VIPPS.

Although not as commonly discussed, some online pet pharmacies also cut corners, dispensing prescription drugs to a pet owner even though the veterinarian didn’t physically examine the animal.

The NABP’s announcement says:

Vet-VIPPS was developed to assist the states in their efforts to maintain control over the Internet-based distribution of prescription drugs and devices for non-food producing animals as well as hold Internet veterinary drug distributors accountable for meeting patient/client safety practice standards. The Vet-VIPPS criteria, which is based on the Association’s original VIPPS® criteria, will also incorporate new criteria specific to veterinary pharmacies.

The NABP’s website lists the criteria for becoming a Vet-VIPPS Internet pharmacy. The press release also says:

In order to receive Vet-VIPPS accreditation, Internet veterinary pharmacy practice sites that dispense prescription veterinary drugs for use in companion and non-food producing animals such as dogs, cats, and horses must be licensed in good standing with their respective state boards of pharmacy, and also adhere to Vet-VIPPS criteria and program requirements. Pharmacies that dispense medications for food-producing animals are not eligible to receive accreditation.

The NABP’s VIPPS (Verified Internet Pharmacy Practice Sites) program is the gold standard of Internet pharmacy verification, and any VIPPS-accredited Internet pharmacy is granted recognition as a LegitScript-verified pharmacy website.

LegitScript has recognized four Internet pharmacies exclusively focused on pets: petscriptions.com, vetrxdirect.com, allivet.com and drsfostersmith.com. As with all other pharmacy websites we approve, we (well, LegitScript’s Director of Public Relations, a six-month old puppy named Parker) urge these and other veterinary Internet pharmacies to become accredited through the NABP’s program.

LegitScript’s 7th standard relates to something most of us are concerned about when it comes to the Internet: Privacy.

Standard 7: Privacy. If the pharmacy website transmits information that would be considered Protected Health Information (PHI) under the HIPAA Privacy Rule (45 CRF 164), the information must be transmitted in accordance with HIPAA requirements, including the use of Secure-Socket Layer or equivalent technology for the transmission of PHI, and the pharmacy must display its privacy policy that accords with the requirements of the HIPAA Privacy Rule.

What does it mean? If you’ve been to the doctor in the recent past, you’ve probably heard of HIPAA. Short for Health Information Portability and Accountability Act of 1996, HIPAA came into being as a means of protecting patient health information. As it applies to the Internet, HIPAA requires that any website engaging in the transmission of Protected Health Information (PHI) must use secure technology when doing so. PHI refers to “individually identifiable health information”, or information that could identify a patient in relation to a health condition. For instance, if an Internet pharmacy requires that you enter your name and address, along with the medication name when submitting a prescription request, that information is deemed PHI. In such cases, the website is required to protect that information through the use of technology such as Secure-Socket Layer (SSL). You can usually tell if a website does this by checking if the “http” that begins the URL changes to “https” when transmitting PHI. This requirement is a patient privacy and safety mechanism that prevents your personal information from getting into the hands of anyone outside those directly related to your health care.

Is PHI always submitted when ordering an online prescription? No. Many legitimate pharmacy websites do not require patients to enter personally identifying health information. Some sites are formatted in such a way that a patient only needs to enter a prescription number, not the actual medication name, as well as a patient ID number to order a refill. These sites are not required to post a privacy policy or use SSL technology, but many still do as an added precaution.

Why is privacy protection important for health information? We’re sure most people would agree that they don’t want their medical history posted on the Internet for all to see. Health information is private, and HIPAA helps make sure it stays that way in the face of health-related technology. It comes as no surprise that rogue Internet pharmacies do not abide by HIPAA regulations and while they may purport to protect payment information, there are no such guarantees on PHI. Ironically, many people who buy drugs from rogue Internet pharmacies do so out of a desire for privacy (just look at the sheer number of illicit sites for erectile dysfunction drugs). However, if you’re not buying your prescription from a legitimate site, you cannot rest assured your privacy has been protected.

LegitScript is a strong proponent of both patient privacy and HIPAA. You can be sure that all of LegitScript’s approved sites comply with our privacy standard.

The sixth LegitScript standard is pretty straightforward. It requires that LegitScript only approves pharmacy websites that act lawfully.

Standard 6: Legal compliance. The pharmacy must comply with all provisions of federal and state law, including but not limited to the Federal Food, Drug, and Cosmetic Act and the Federal Controlled Substances Act (including the provisions of the Ryan Haight Online Pharmacy Consumer Protection Act, upon the effective date). The pharmacy must not dispense or offer to dispense medications that have not been approved by the US Food and Drug Administration (FDA).

Why is this important? It may seem self-explanatory, but LegitScript believes it is necessary to only approve pharmacy websites that act within the confines of U.S. law if they offer to sell prescription drugs to U.S. consumers. The laws mentioned above were developed in response to the dangers posed by a lack of regulation over prescription drugs. As we mentioned in the last blog, there is a reason these drugs must be obtained by prescription only, and ordering and dispensing them without following the relevant regulations can result in dangerous situations such as receiving counterfeit drugs that pose serious health risks. Many rogue Internet pharmacies use the argument that they aren’t breaking any laws in “their” country (India, Russia, Turkey, etc) and therefore should be considered a safe Internet pharmacy. Unfortunately for them, if you ship products to U.S. consumers, you must follow U.S. law, and U.S. law does not permit importation of drugs from another country except in rare instances where the drugs adhere to U.S. regulations.

Do we have the right to impose U.S. law on businesses based in other countries? This is a question commonly asked by rogue Internet pharmacies and their patrons: How can the U.S. demand that other countries follow U.S. laws when their businesses are not located in the U.S.? On the surface, the question appears to make sense. And, if a company is located outside of the U.S. and does not do business with U.S. customers, then no, we do not have the right to hold the business to U.S. legal standards. However, this is not the case with the majority of rogue Internet pharmacies. Such entities may be based outside the U.S. and source their drugs from any number of countries, but their target consumer base, by and large, are U.S. citizens. These Internet pharmacies frequently advertise shipping to the U.S. and use “United States” as their default shipping destination. So, although the business and drugs may be based outside of U.S. borders, the fact that these pharmacies are shipping their product into the U.S. makes them subject to U.S. laws.

LegitScript is committed to approving only those Internet pharmacies that follow U.S. laws as they exist and evolve. We do this with the public’s interest in mind- after all, if an Internet pharmacy is willing to disregard our laws, what else will they disregard?