Online Pharmacies that Sell Counterfeit Drugs Grew During the Pandemic

People perceive online pharmacy and social media platforms as safe and believe they can get legitimate medicines from these sites, according to a recent survey published in Health Policy. But investigators warn this false confidence can lead to harm if the products they receive are counterfeit or substandard. Amazon’s recently launched pharmacy platform may give consumers a false sense of security around other online platforms for buying medications, investigators said.

“Most participants generally view social media platforms as safe. While the most common reason for purchasing medicines online was accessing legitimate medicine, this makes sense considering participants’ perceived safety and confidence in these online platforms. However, social media sites can lead consumers to dangerous rogue pharmacy sites through simple keyword searches,” investigators wrote.

Of the roughly 35,000 online pharmacies worldwide, 95% operate illegally, in violation of state and/or federal law and relevant pharmacy practice standards, including selling medicines without requiring a prescription and operating without a pharmacy license, according to the Alliance for Safe Online Pharmacies (ASOP).

Research by ASOP and others have found that during the COVID-19 pandemic, the demand for virtual healthcare helped to spur an explosion of new online pharmacies, many of which offered unauthorized and fake COVID-19 treatments.

Libby Baney

“The current situation is made worse because more people are using the Internet for healthcare because of the pandemic,” Libby Baney, partner at Faegre Drinker and senior advisor to ASOP Global, said in an interview. “There has been an increased number of legitimate licenses and compliant telemedicine operations that will connect patients with a doctor. The challenging piece is patients often don't know how to distinguish between legitimate online healthcare and online toll mills that are illegal online pharmacies. The blurring of these lines creates criminal opportunity.”

This was confirmed in a survey ASOP conducted in May 2021. While half of Americans would consider purchasing medication online, most misunderstand or underestimate the risk of illegal online pharmacies. In that survey ASOP Global Foundation commissioned Abacus Data to conduct a national poll of 1,500 American consumers.

This survey builds on an earlier one done by the foundation in June 2020. In that survey, ASOP found that, although awareness about some of the risks associated with purchasing prescription medication online is improving, that awareness isn't enough to overcome powerful purchasing drivers such as convenience and cost.

Of those consumers who have ordered prescription online, 49% did so for the first time in the past year; 64% of those individuals who purchased prescription medication online for the first time say they will continue to do so after the pandemic ends. The primary drivers are convenience/accessibility (47%) and cost (49%).

The narrowing of formularies and increased cost-sharing have led some patients to seek alternatives outside the drug benefit, Michael S. Adelberg, principal at Faegre Drinker Consulting, said in an interview.

“Some prescribers may want their patient prescribed to a drug that is not on formulary, is on formulary after a large annual deductible, or has high coinsurance, but let's say it's as high as 50%,” he said. “The cost of that drug, while it is covered, might put pressure on the consumer to go outside of their insurance. Insurance plans do not want that to happen, but they can't prevent a plan member who chooses to go outside of their coverage from doing so."

Researchers from both ASOP and the Health Policy surveys said policy decisions that are aimed at addressing fake medicines found on online pharmacies must also condition cost and access issues.

Anticipated legislation would require that, upon notification from a trusted notifier, a registrar or registry must lock the offending domain name within 24 hours and suspend it within seven days.

But while this is a great first step to addressing counterfeit drugs purchased on the Internet, more needs to be done, Baney said. “Social media and online marketplaces require a different policy solution. Some private sector solutions already have come into play. I argue for policy solutions, because you don't have accountability without liability and transparency. And you don't get liability and transparency from private sector voluntary actions,” she said.

The alliances position, she said, is that there is a need for legislation on social media platforms to provide liability and transparency and to stop cyber crime, including limitations to the Communications Decency Act, which provides a liability shield for some platforms.

“There is a bill called Shop SAFE Act, which would provide for policing of online marketplaces and help prevent sales of counterfeit goods through online marketplaces,” Baney said.