Online Pharmacies: The U.S. and China

Did you know that Americans frequently go to Mexico and Canada or use online pharmacies to buy prescription medications at a fraction of the U.S. price? They risk buying contaminated or counterfeit products, but “desperate times call for desperate measures.” Yes, this practice is technically illegal (Wolfson, 2019). However, the cost savings can be significant. For example, Canadian drug prices can be 28-35% of U.S. prescription drug prices (Neuman & Cubanski, 2020).

Buying prescription medications online is not unique to U.S. citizens. In this article, we will examine the pharmaceutical buying practices of consumers in China and the United States, a follow-up to an article on purchasing supplements online.

The Pharmaceutical Industry in the United States

While manufacturing jobs in many industries have decreased in the United States, the number of biopharmaceutical jobs has increased by over 20%. Employment in the biopharmaceutical industry in the U.S. grew 26% between 1998 and 2019 (Atkinson, 2019).

However, U.S. manufacturers depend on China for thousands of ingredients and raw materials to make medications. Only a small percentage of finished pharmaceutical drugs come from China, but 80% of active pharmaceutical ingredients used to make drugs come from China and India. In addition to a dependence on China for active pharmaceutical ingredients, there have been growing concerns about the safety and security of Chinese-made pharmaceuticals (Huang, 2019).

A Study by the FDA on Drug Quality

The FDA polices a global pharmaceutical supply chain that supplies at least 80% of the drug ingredients and 40% of the finished goods in the U.S. When the FDA released its site inspection scores based on compliance, drug recalls, and inherent risk, this is what it found. Problems included problem drug factories, drug price-fixing, and cancer risk (Alltucker, 2019).

The Pharmaceutical Industry in China

While China lags behind the U.S. in biopharmaceutical competitiveness, it is working hard to catch up. Chinese biotechnology firms have started new research and development facilities in the U.S. in many biotech hubs in order to gain access to new technologies and bring them back to China. A surplus of small and mid-sized pharmaceutical companies and low per-capita income makes it challenging for Chinese firms to pay the upfront costs needed for drug innovation (Atkinson, 2019).

The Chinese depend on the U.S. pharmaceutical companies for finished drugs primarily to treat non-communicable diseases such as cancer, cardiovascular disease, and diabetes, which have reached crisis levels in China. In 2016, China’s FDA introduced the Generic Consistency Evaluation (GCE), which requires testing for generics to prove that they are equivalent to brand names in terms of safety and efficacy. This practice identified over half of the nation’s 2,900 small and often low-quality domestic drug makers and led to the exit or reorganization of 20 companies in the industry (Huang, 2019).

Purchasing Prescriptions Online in the U.S.

Tips from the U.S. FDA

The U.S. Food and Drug Administration offers several tips and warnings for U.S. consumers looking to purchase prescription medications online. First, make sure that the site requires a prescription, and that there is a pharmacist available to answer questions about drugs and their side effects.

Purchase only from licensed pharmacies in the United States. BeSafeRx: Know your online pharmacy has information about finding safe online pharmacies. The site cautions that fake online pharmacies can manipulate their websites so they look legitimate. They recommend checking the pharmacy’s license by using their website tool.

Protect your personal information and ensure that the online pharmacy has safeguards in place to protect both your medical and financial information.

An estimated 36 million Americans have bought drugs online without a valid prescription. — (Blackstone, Fuhr & Pociask, 2014)

Risks of Buying from Fake Online Pharmacies

According to the FDA, buying from a fake online pharmacy can be dangerous and even deadly. Here are a few of the risks they cite:

• You could receive counterfeit or substandard drugs. Beware of pharmacies that offer deep discounts or low prices that seem too good to be true.
• A slight difference in the medication formulation can make a big difference in its effects. Medications approved for use in the U.S. have been reviewed for safety and effectiveness by the FDA. Medications produced and approved for use in other countries might have slight variations in their chemical composition that could cause side effects.
• There is a risk that the security of your personal medical and financial information may be compromised.

Even though you might think that nearly all online pharmacies are safe and legal, the FDA says that only about 3% of online pharmacies reviewed by the National Association of Boards of Pharmacy comply with U.S. pharmacy laws and practice standards.

In 2008 a counterfeit version of the drug thinner heparin that came from China was suspected to be the cause of as many as 81 deaths. — (Blackstone, Fuhr & Pociask, 2014)

Is it Legal to Personally Import Prescription Drugs?

The FDA says that it is illegal for individuals to import prescription drugs for personal use under the authority of the United States Federal Food, Drug, and Cosmetic Act (The Act). The reason is that these drugs have not been tested by the FDA and approved for sale in the U.S. The FDA says that it rarely objects to personal imports of drugs in the following circumstances:

• If you have a serious condition for which there is no effective treatment in the U.S.
• If the drug is not sold or promoted to U.S. residents.
• If the drug is not considered to have an unreasonable risk of side effects.
• If the individual can verify that the drug is for personal use.
• If typically, no more than a three-month supply of the drug is imported.

The FDA says these circumstances should not be construed as a license for individuals to import unapproved and therefore illegal drugs into the U.S. for personal use. The FDA may determine that such medications can be refused entry or seized. The circumstances listed by the FDA do not create any legally enforceable rights for the public. They are not intended to allow the importation of foreign versions of drugs that are approved in the U.S.

Purchasing Prescriptions from an Online Pharmacy in China

As of December 1, 2019, a new Chinese law makes third-party online platform medication sales legal as long as they are registered in China and approved by the NMPA. It decriminalizes the practice of importing prescription drugs for personal use as long as the quantities are small (Levitt, 2019).

LegitScript and ASOP Global found that about half of all Chinese online pharmacies are illicit, which is below the global average. Globally, about 96% of internet pharmacy websites are operating illegally.

Chinese patients use online forums and social networks to discuss how to get cheaper, generic medications. Many websites appear to be informational only but have stores that sell medications. These stores depend on third-party platforms such as WeChat to complete the transactions. Many of these stores are based in India.

Any illicit pharmacy selling medications can have the incorrect amount of active ingredients, the wrong ingredients, or no active ingredient at all (LegitScript & ASOP Global, 2019).

Pfizer Global Security used the search term “buy Viagra” to evaluate the companies and drugs that were being sold as Viagra. They found 22 sites. Nearly 80% of the sites they surveyed were selling counterfeits. They chemically evaluated these medications and found:

• Blue printer ink
• Amphetamines
• Metronidazole, an antibiotic
• The wrong quantity of active ingredients
• Binding agents such as drywall
• Toxic ingredients such as boric acid, floor wax, brick dust, rat poison, and road paint
• The wrong medications

Pfizer recommends that you ensure your website requires a valid prescription, ensure you see a U.S. address and phone number, and look for Verified Internet Pharmacy Practice Sites.

Summary: Purchasing from an Online Pharmacy

Is it worth the risk of buying online? An international crackdown in 2014 found that many online pharmacies are not what they seem to be. Packages purportedly from Australia, Canada, New Zealand, and the UK actually contained drugs from other countries, including India, China, and Laos (Bluth, 2016). It is risky to buy medications online unless you have a prescription and you verify that the pharmacy is licensed in the United States.

DISCLAIMER

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice. 

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References

1. Atkinson, R. (2019). China’s Biopharmaceutical Strategy: Challenge or Complement to U.S. Industry Competitiveness?. Information Technology And Innovation Foundation. Retrieved from https://itif.org/publications/2019/08/12/chinas-biopharmaceutical-strategy-challenge-or-complement-us-industry
2. BeSafeRx: Know Your Online Pharmacy. (2019). Retrieved from https://www.fda.gov/drugs/quick-tips-buying-medicines-over-internet/besaferx-know-your-online-pharmacy
3. Is it legal for me to personally import drugs?. (2018). Retrieved from https://www.fda.gov/about-fda/fda-basics/it-legal-me-personally-import-drugs
4. Frequently Asked Questions About Drugs. (2019). Retrieved from https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/frequently-asked-questions-about-drugs
5. Wolfson, B. (2019).Shopping Abroad For Cheaper Medication? Here’s What You Need To Know. Retrieved from https://californiahealthline.org/news/shopping-abroad-for-cheaper-medication-heres-what-you-need-to-know/
6. Neuman, T & Cubanski, J. (2020).10 FAQs on Prescription Drug Importation.Retrieved from https://www.kff.org/medicare/issue-brief/10-faqs-on-prescription-drug-importation/
7. Gabriel L. (2020). China Opens the Door to Personal Medicine Imports and Third-Party Online Platform Sales. Retrieved from https://pharmacycheckerblog.com/china-opens-the-door-to-personal-medicine-imports-and-third-party-online-platform-sales
8. Bluth, R. (2020). Looking for bargains, many Americans buy medications abroad. Retrieved from https://www.npr.org/sections/health-shots/2016/12/17/505690791/looking-for-bargains-many-americans-buy-medicines-abroad
9. Huang, Y. (2019). U.S. Dependence on Pharmaceutical Products From China. Retrieved from https://www.cfr.org/blog/us-dependence-pharmaceutical-products-china
10. Alltucker, K. (2019). FDA defends oversight amid questions of safety of generic drugs made in India and China. Retrieved from https://www.usatoday.com/story/news/nation/2019/05/17/generic-drug-safety-questioned-amid-valsartan-recalls/3707843002/
11. Blackstone, E. A., Fuhr, J. P., Jr, & Pociask, S. (2014). The health and economic effects of counterfeit drugs. American health & drug benefits, 7(4), 216–224. https://pubmed.ncbi.nlm.nih.gov/25126373/#:~:text=Trafficking%20in%20counterfeits%20can%20be,research%20and%20development%20and%20innovation.
12. LegitScript & ASOP Global. (2019). Retrieved from http://www.safemedicines.org/wp-content/uploads/2019/10/The-Chinese-Internet-Pharmacy-Market-2019.pdf

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