Good reasons for filling prescriptions online

There are good reasons for filling prescriptions online -- but also some good reasons for being cautious.

• Online Discount Pharmacies: Why Bother?
• General Factors When Comparing Online Pharmacies o Comparing Drug Discounts o Beyond Discounts: Comparing Quality, Service and Reliability
• Types of Online Discount Pharmacies o Comparing U.S. Medicine-Only Pharmacies o Comparing U.S. Online Pharmacies Offering Online Prescriptions o Comparing Discount Foreign Pharmacies
• Comparing Discount Canadian Pharmacies
• Comparing Discount Mexican Pharmacies
• Comparing Other International Pharmacies and Generic-Only Pharmacies

Online pharmacies: Why bother?

As explained in the separate page on the Background to the Online Discount Drug Controversy, due to the absence of pricing regulation in the U.S., American consumers pay far higher prices for their prescription medications than Italians, French, Swedes, Germans, Swiss, British, and many others. Increasingly, U.S. consumers are looking to online discount pharmacies in the United States or even to pharmacies overseas to escape the aggressive pricing practices of large pharmaceutical companies. I strongly believe in individual choice and freedom and the notion of voting with one's pocketbook -- but there are also some reasons for caution.

Note that the United States Food and Drug Administration (FDA) has recently produced a list of medications (PDF) which it specifically recommends against buying on the internet.

General factors when comparing online discount pharmacies

As with any online service, there's a fair bit of work to be done to make sure you are getting the best deal from an online pharmacy.

Comparing drug discounts

When shopping for medications online at discount pharmacies, it is obviously worth doing some comparison shopping: who offers the best prices on the specific medications you are interested in, and who offers the best overall cost for your order? Free overnight delivery may be great, but only if the pharmacy offers a sufficient level of discount on the drug itself; likewise, the absolutely cheapest prices on drugs are not very helpful if you have to pay substantially more for delivery.

But even more important than discounts and free overnight delivery is the level of quality, service and reliability which the merchant offers.

Beyond discounts: Comparing quality, service and reliability

The quality of online discount pharmacies varies greatly, much like other online discount businesses: and free delivery and cheap drug prices are worthless if you never see your money again.

It's worth checking some or all of the following before being persuaded by the financial attractiveness of a particular online pharmacy:

• Do they provide a real physical address or at least a toll-free telephone number for customer service? (Or do they only provide an email address?)
• Do they provide evidence either that they are a licensed pharmacy themselves, or that they fulfil orders via a licensed pharmacy? (Or are orders put together by unlicensed personnel who may or may not know anything about the drugs they are providing?)
• Do they state a privacy policy, so you know that your private details will be kept secure? (Or should you expect spam several times daily once you've provided your personal information?)
• What is their policy on verifying prescriptions; or, alternatively, do they provide actual medical consultations and online prescriptions? (This one is open to debate, as ultimately it is your responsibility to obtain medications only when they have been appropriately prescribed for you; some online services do ship medications without a prescription.)

The bottom line when searching out cheap drugs from an online pharmacy is: buyer beware! It is your health on the line -- as well as your pocketbook. I believe it is possible to meet the needs of both health and pocketbook, and some time invested in comparing and evaluating the available options will be well spent.

Comparing types of online discount pharmacies

Essentially three different types of online pharmacies will be of interest to consumers in the United States.

Comparing U.S. Medicine-Only pharmacies

The most well known online pharmacies in the United States supply only medications and require a prior prescription from your own doctor. You must organize and pay for the consultation with your doctor, and you must fax or mail a copy of your prescription to the service concerned.

• Pros:
• Low prices for the medication itself
• Longer operating history
• Large medication selection

• Cons:
• Higher prices when the medical consultation is factored in
• Inconvenience of scheduling face-to-face medical appointment
• Slower turnaround time when a prescription must be forwarded

While I previously recommended one or more of these large online pharmacies, recent feedback from a variety of sources has consistently indicated that brick-and-mortar discount chains, such as Costco, now offer prices which are just as competitive, with the added benefit of face-to-face contact and without the extra delays involved with shipping medications.

Comparing U.S. online pharmacies offering online prescriptions

Possibly the most innovative category of United States online pharmacies (or, more precisely, pharmaceutical ordering services) includes those which provide actual medical oversight of the process, normally incorporating an online medical consultation with a doctor resulting in a so-called 'online prescription'. Pharmacies of this type can offer greater savings when compared to the total price of a medication and a separate face-to-face medical consultation, although they normally carry a much narrower range of medications because doctors will only prescribe certain medicines without seeing a patient face-to-face. They are also very controversial due to the fact that prescribing without a prior physical examination contravenes recommendations published by the American Medical Association; the legal standing of such pharmaceutical ordering services grows more puzzling and uncertain almost by the day.

• Pros:
• Low combined price for the medication together with the consultation
• Convenient and private ordering online
• Rapid response time

• Cons:
• Higher overall price compared to medication only
• Shorter operating history
• Narrow medication selection

For customers who value the overall package of a medical consultation together with the medicine itself, these types of pharmacies provide a worthwhile service. I believe the best option is:

MedBasket.com - This site provides what I believe are some of the best savings available (including inexpensive overnight delivery) via Health Solutions Network, one of the most respected suppliers in the business. Other favourites include FrugalMed.com (with the largest selection by far), plus Intregra RX and DrugsPark.com.

Comparing discount foreign pharmacies

As explained in the separate page on the FDA's Personal Importation Policy, importing prescription drugs into the United States for personal use may be tolerated at the discretion of individual officials, but it remains technically illegal. If you live within the United States, this stands as probably the best reason for choosing an online pharmacy which is also in the United States. However, I recognize that many people do choose to purchase prescription medications from a Canadian pharmacy, a Mexican pharmacy, or an online pharmacy in another country -- see below for separate sections on foreign pharmacies, including Canadian pharmacy recommendations and Mexican pharmacy recommendations.

• Pros:
• Low prices for branded medications
• Shorter operating history
• Large medication selection

• Cons:
• Prices may be higher than the U.S. for generic medications
• Uncertain legal status in case of order disputes
• Uncertain legal status of FDA Personal Importation Policy
• Slower turnaround time when a prescription must be forwarded
• Longer shipping times and higher shipping charges

Note that some foreign online pharmacies do still require a prescription, while others (notably Mexican pharmacies such as XL Pharmacy) do not. When ordering from a pharmacy which neither requires a prescription nor provides medical consultations, the onus is entirely on the customer to make safe, accurate, and appropriate purchasing decisions.

Comparing discount Canadian pharmacies

Even in the case of U.S.-based online discount pharmacies, making legal claims across state lines may be difficult -- although this is essentially no different from other types of interstate commerce. But in the case of international discount pharmacies, taking successful action in the event of a disputed order may be virtually impossible. It is unclear what -- if any -- legal recourse consumers may have should a problem arise when dealing with an online pharmacy based in another country. In addition, orders from online pharmacies based outside the United States may attract higher shipping charges and take longer to arrive. (Many U.S.-based pharmacies offer overnight delivery.) Having said all that, however, prices are very frequently lower for branded drugs almost anywhere but the United States, and the Canadian government's prescription drug price controls ensure that Canadian drugs are amongst the cheapest available. Some organizations for retired people living near the border with Canada are even sponsoring bus trips across the Canadian border for people to purchase medications at much lower Canadian prices, and the states of Wisconsin and Minnesota have launched dedicated Canadian pharmacy web sites to help their residents buy Canadian drugs. Increased competition within the U.S. discount drug market for generics, however, does mean that the price advantage for Canadian or other foreign pharmacies has been somewhat eroded for these less expensive drugs. For customers looking to take advantage of Canadian government prescription drug price controls, my top recommendation is:

Comparing discount Mexican pharmacies

In contrast to the comparatively well-developed Canadian discount drug market -- an area which has been positively flooded with carbon copy 'me too' sites attempting to cash in on the U.S. rush to buy discount drugs abroad -- the Mexican market is comparatively under-developed. Like Canada, Mexico has long attracted regular forays from U.S. citizens living along the border who journey a few miles to make big savings on prescription drugs. But the online trade in discount Mexican drugs is only just getting started in earnest; I would expect the Mexican market to be awash very soon with the same kind of low quality profit engines that have sprung up all over Canada. (I would also expect further proliferation of the widespread scams offering to sell you special 'members only' access to lists of Mexican pharmacies.) Having said that, I am aware of at least a few reputable online discount pharmaceutical ordering services working with suppliers in Mexico. They offer what may be the lowest prices available anywhere, and my top suggestion is:

XL Pharmacy - To my knowledge, this is the largest and most comprehensive of the Mexican pharmacies operating online. In addition, MedBasketMexico, with a library of Mexican pharmacy ordering information covering nearly 500 drugs, includes links to purchase discount drugs from a selection of high quality services.

Note that drug laws in Mexico permit many drugs to be dispensed without a prior prescription; this enables Mexican pharmacies to ship (legally, in accordance with Mexican law) many medications which US pharmacies would not be able to ship without a prescription.

Other international and generic-only pharmacies

include Budget Medicines, which appears to offer a reliable and cost-effective service and which does not require a prior prescription, and Rx Mex, which requires a prior prescription for some but not all medications. Although I had previously mentioned one Swiss pharmacy, along with a caution that I was unaware of its history and background, that service has since disappeared and reappeared a couple of times; I cannot recommend it until it functions more reliably.

Source: RefillPill.com Editors' Choice