ONLINE Rx ( The Atlanta Journal-Constitution )
Overseas sources can slash the cost of drugs, but experts prescribe healthy doses of caution Healthy Living: Your Tuesday guide to medicine and health care

Even proponents of online overseas pharmacies tell horror stories of elderly patients receiving ineffective drugs for arthritis or women becoming pregnant after ordering birth control pills that turned out to be fake.
Overseas Internet pharmacies offer prescription drugs at dirt-cheap prices, but medication from questionable sources can be ineffective or downright harmful. It could also be illegal.

Patients ''could find the cheapest drug made by some bathtub operation located in a country without the same regulations as here or Europe, and they'll get an inferior product," said Andrew Canada, a pharmacist for Global RX, an international online pharmacy based in North Carolina.

But advocates for affordable drugs say that reputable international pharmacies can safely save consumers a bundle, even when shipping charges are included.

Access to medication from other countries gained notice in July when the U.S. House passed a bill to legalize the reimportation of U.S.-manufactured drugs. The Senate is expected to consider a corresponding bill in September.

Patients, doctors, foreign pharmacists and legislators are trying to sort out what's legal and what's not. As a result, many people who think they are importing drugs approved by the U.S. Food and Drug Administration are actually breaking the law.

Up to 2 million packages containing prescription drugs enter the United States through the mail every year, many of them as Internet purchases, according to the FDA. The FDA and the Customs Service intercept packages that appear to contain unapproved medications and send letters to the intended recipients. But many packages aren't checked.

"The purpose of the legislation (that passed the House) is to get the FDA to stop sending letters to people and frightening them," said U.S. Rep. Bernard Sanders, an independent from Vermont and a supporter of the House bill.

Unless that bill becomes law, it is illegal to import drugs that were originally manufactured in the United States. But it is legal to import foreign-made generic drugs that are approved by the FDA. The FDA inspects approximately 1,200 applications for foreign foods, drugs and devices every year. Approved drugs are listed in the FDA's Orange Book, available online at www.fda.gov/cder/orange/default.htm.

The most frequently imported drugs are those used to treat asthma, depression, heart disease and diabetes, according to Pharmacists Planning Service, a nonprofit organization advocating lower drug prices.

The FDA warns that those who buy drugs from foreign online sources risk getting fake, unapproved, outdated or substandard products, with little or no quality control.

In contrast, U.S. pharmaceutical companies must adhere to rigorous FDA standards, which can raise the costs of drugs. Manufacturers must conduct clinical trials to show new drugs' safety. They also must demonstrate quality control and describe how, where and under what conditions the drugs will be manufactured.

Consumer advocates advise Internet drug buyers to stick to sites in countries with the same pharmaceutical standards as the United States, such as Canada and European Union nations.

The cheapest drugs may not be the best deals if they come from unsafe sources, Global RX pharmacist Canada noted. Some online pharmacies may sell counterfeit drugs as if they were made in the United States.

"If you buy from the United Kingdom or Switzerland or Italy, it will probably be a good drug and you'll save 50 percent," Canada said.

"You'll save 75 or 80 percent from a questionable operation," he said.

Darren Jorgenson, a pharmacist responsible for U.S. business with Canadameds.com, a Canadian online pharmacy, said there is virtually no difference between the drugs his company sells and those made in the United States. ''It's not like you walk into Canada and suddenly there are backroom pharmacies," Jorgenson said. Reputable online pharmacies ensure that the drugs prescribed are proper for the patient, pharmacist Canada said.

To screen for interactions and incompatibility, online sites should ask patients for information such as their weight, allergies, health history and any other drugs the patient may be taking.

"It's absolutely critical," Canada said. "Otherwise, they're just pushing pills."

Drug abuse is an additional concern. Some sites require customers to mail or fax prescriptions written by a physician, but others don't require doctors' approval. A number of sites advertise that they'll sell drugs without a prescription. The FDA advises consumers to determine a pharmacy's legitimacy by whether it requires and verifies prescriptions.

No matter how professional their sites may look, all online pharmacies require careful examination.

For instance, 4 Corners Pharmacy posts drugs' generic and commercial names, manufacturers' inserts and photographs of packaging. But unlike many online pharmacies, 4 Corners does not require prescriptions or health forms, nor does the site tell where the pharmacy is located. When questioned, representatives will say only that the company is in a country in the South Pacific.

But despite the risks, many Americans are buying drugs at significantly reduced prices from online overseas pharmacies.

More are likely to do so if the Senate legislation passes.

"To someone who can afford it, it may be too much trouble to use a foreign country," Jorgenson said. "But I get calls from people who aren't taking their medication because they can't afford it."

Illustration of buying unknown prescription drugs over the internet. / BRIAN WILLIAMSON / Staff

PRICE SHOPPING
Here's how various retailers, including Internet sites that require prescriptions, fared on the costs of some common prescription medications. The legal status of importing drugs from these sites is a gray area that would be resolved by the bill awaiting approval in the Senate. Prices are per usual daily dosage.

Pharmacy................ Country....Zyrtec /Celebrex /Glucophage
Eckerd Drugs (store).... U.S....... $2.46....$5.27.... $1.92
Cyberpharmacy.cc........ U.S.........1.68.... 4.62......1.42
Canadameds.com.......... Canada......0.59.... 1.90......0.32
thecanadiandrugstore.com Canada......1.17.... 3.05......0.84
pharmacie-pradier.com....Switzerland 0.55.... 0.41......1.31
pharmaworld.com..........Switzerland 0.54.... 1.56......0.40

BUYING ONLINE: DO'S AND DON'TS With common sense and simple precautions, buyers can identify reputable foreign pharmacies offering drugs to U.S. consumers. Here are some tips from the Food and Drug Administration on buying medications online. The FDA discourages importing drugs from other countries.

• Don't buy from sites that offer to sell a prescription drug without a prescription. The pharmacist should verify each prescription before dispensing the medication.
• Don't do business with sites that have no access to a registered pharmacist to answer questions.
• Beware of sites that advertise a "new cure" for a serious disorder or a quick cure-all for a wide range of ailments. Steer clear of sites that include undocumented case histories claiming amazing results.
• Talk to your health care professional before using any medication for the first time.
• When looking for a pharmacy site, apply the same standards you would use for any place of business.
• Choose sites with easy-to-find, easy-to-understand privacy and security policies. Don't provide any personally identifiable information (Social Security number, credit card number or health history) unless you are confident the site will protect them.
• Avoid sites that do not identify whom you're dealing with and do not provide a U.S. address and telephone number to contact if there is a problem.