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LegitScript Standard #5: Valid Prescription

The fifth LegitScript standard has to do with what it means to have a valid prescription for a prescription medication. Perhaps no other standard is the subject of so much debate (see, e.g., the Internet Drug Law blog), and no other issue has been so exploited by rogue Internet pharmacies for their own financial gain. We’ve tried to clarify the issue below.

Standard 5: Validity of prescription. The pharmacy shall dispense or offer to dispense prescription drugs only upon receipt of a valid prescription, as defined below, issued by a person authorized to prescribe under state law and, as applicable, federal law. The pharmacy must not distribute or offer to distribute prescriptions or prescription drugs solely on the basis of an online questionnaire or consultation without a pre-existing patient-prescriber relationship that has included a face to face physical examination, except as explicitly permitted under state telemedicine laws or regulations.

So what is a “valid prescription”? We collaborated with the National Association of Boards of Pharmacy to establish the following definition, which the Federation of State Medical Boards has also indicated to us that they support:

A valid prescription is one issued pursuant to a legitimate patient-prescriber relationship, which requires the following to have been established:

1. The patient has a legitimate medical complaint;

2. A face-to-face physical examination adequate to establish the legitimacy of the medical complaint has been performed by the prescribing practitioner, or through a telemedicine practice approved by the appropriate practitioner board; and

3. A logical connection exists between the medical complaint, the medical history, and the physical examination and the drug prescribed.

LegitScript requires, with no exceptions, that Internet pharmacies adhere to this standard.

But I know what drugs I need, I’ve been taking them for years. Why do I need to go through the hassle of getting a prescription when I can just order them online? Two reasons. First, the very definition of a “prescription” drug (as opposed to “over the counter”) is one that requires “medical supervision” because of possible side-effects, interactions with other drugs, and several other very well established reasons. Does that mean that the doctor who examines you needs to see you for every prescription he or she writes? No: it is perfectly okay for a doctor who has physically examined you before, and is familiar with your medical history, to determine that an over-the-phone consultation does the trick for certain drugs. By contrast, a doctor who has never met you and simply reviews an “online questionnaire” isn’t really your doctor: they’ve never met you in person, and simply can’t be familiar enough with you to provide any sort of “medical supervision.” Second, think about it this way: does an Internet pharmacy that doesn’t require a prescription really have your well-being in mind or just their bottom line? How can you be sure the drugs they sell are legitimate if they don’t follow the most basic protocol of requiring a valid prescription to dispense a prescription drug? If they are willing to violate this standard just to make a quick buck, you can bet that they are willing to take short-cuts with your health and safety as well.

Why is having a valid prescription important? There is a reason certain drugs require a prescription. Such drugs can be harmful if taken by people who don’t have a medical need for them or who have medical conditions or allergies that could interact dangerously with the drugs. The basis of having an in-person consultation with a physician is the understanding that the doctor will take into consideration a patient’s medical history and any underlying conditions when deciding the appropriate drug to prescribe. When patients bypass this protocol, self-diagnose and order drugs online without a prescription, they are taking serious risks with their own health.

What about the “online consultation” some Internet pharmacies offer? The online consultation, or medical questionnaire, is a tactic that rogue Internet pharmacies artfully employ to exploit the lack of common understanding of what constitutes a valid prescription. Many rogue Internet pharmacies claim that by answering a few questions about your medical history you may obtain a legitimate prescription prescribed by a “licensed doctor” who will review your questionnaire. In actuality, these questionnaires rarely get more than a one-second glance (if they are read at all), are not cross-checked and are not valid methods of obtaining a prescription. An apt analogy would be someone who knows little about cars filling out an online questionnaire to diagnose their car trouble, ordering a part, and then playing mechanic. It might work in some cases, but is it worth the risk?