Buying Prescription Drugs over the Internet

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.

The summary below is from the full report titled "Internet Availability of Prescription Pharmaceuticals to the Public." It is in the 7 December 1999 issue of Annals of Internal Medicine (volume 131, pages 830-833). The authors are B.S. Bloom and R.C. Iannacone.

What is the problem and what is known about it so far?

The Internet may increase the public's access to health care information and services, including the purchase of prescription drugs. The exact nature of Internet-based prescription drug services is not well known, however.

Why did the researchers do this particular study?

Researchers at the University of Pennsylvania Medical School wanted to find out which prescription drugs people could buy over the Internet, as well as the requirements for buying them, the associated purchase costs, and the type of company that sells drugs in this way.

What was studied?

Forty-six Web sites.

How was the study done?

In February-March 1999, the researchers extensively searched the Internet to identify sites that provided consultations with a doctor and sold drugs available in the United States only by prescription. To be included in this study, the site had to sell the product directly to patients.

What did the researchers find?

Of the 46 sites found that sold prescription drugs directly to the public, 37 required a prescription or a consultation with the site's online doctor (or both). Consultations consisted of the doctor's review of purchasers' answers to online questionnaires. The 9 sites that required no prescription were all based outside the United States. None of the sites would identify the consulting physicians or their qualifications. One site sold a medication that was not approved for use in the United States. The most commonly available drugs were sildenafil (Viagra, used to treat male impotency) and finasteride (Propecia, used to treat male baldness). Even without shipping costs (which varied from $8 to $25), the drugs were more expensive online than in Philadelphia pharmacies. Online consultation fees were generally about $70; in comparison, the average cost of a visit to a primary care doctor in the Philadelphia area was $60.

What were the limitations of the study?

This study evaluated Internet sites over a 2-month period in 1999. Internet sites come and go rapidly, so the findings might be completely different if someone repeated the study at a later time. In addition, the researchers looked in detail at the procedures for getting only the two most commonly available drugs.

What are the implications of the study?

It is easy to buy some prescription drugs over the Internet, even without a prescription. Doctors who provide online prescriptions are not accountable for their decisions, since they are not identified on any site. The medical information requested by doctors online may be incomplete, and purchasers could easily misrepresent information; patients could therefore receive drugs that might be useless or risky for them to take. Drugs and consultations may cost more over the Internet than in local pharmacies. The Internet may increase public access to prescription drugs, but at higher costs and with uncertain accountability and quality control.