High drug prices are a global public health crisis. This is mostly the case among lower income countries but also for citizens and residents in the U.S, where tens of millions are not filling prescriptions due to cost. The international online marketplace is a much-needed lifeline for consumers who cannot afford prescription medication where they live. People deserve the widest possible access to safe and affordable medication, including online access, and the Internet community can help.
There is plenty of discussion about the safety of ordering medications online. While rogue and illegal online pharmacies are dangerous and need to be stopped, the online marketplace is complex and potentially misunderstood by thought leaders in Internet governance, which can lead to the acceptance of rules that hinder access to affordable medication. The Internet community has a unique opportunity to play a role in pushing back against unjust pharmaceutical-industry interests and Internet censorship: and even protecting human rights.
To understand the importance of online access to medicines, consider these numbers. Thirty-five million Americans did not fill a prescription in 2014 because of cost. According to a survey by the Harvard School of Public Health and Kaiser Health Foundation about 50% of Americans who could not afford medication said they became sicker.
It's neither surprising nor objectionable that Americans have looked to other countries where drug prices are lower to meet their health needs. While technically illegal under most circumstances, Americans are never prosecuted for importing small quantities of medication for their own use. According to the U.S. Centers for Disease Control and Prevention, about four million Americans import medication for personal use due to cost.
Senator Bernie Sanders used to take his constituents across the border on bus trips to import lower cost medications from Canada. Having scrutinized government data, it's clear that most personal imports now originate online and extend beyond Canada.
To keep this channel of affordable medication open and set a framework for expanding it — while simultaneously cracking down on dangerous drug-selling websites — the Internet community needs to be able to distinguish safe international online pharmacies from rogue online pharmacies. The former requires a valid prescription, facilitates the processing of orders sent by mail from lawfully operating and licensed pharmacies, protects the privacy of patients, and makes sure customers have access to consult with a licensed pharmacist. In complete contrast, rogue online pharmacies are known to intentionally sell counterfeit or adulterated medication; real medication but without requiring a prescription and/or not under the supervision of licensed personnel.
It's not easy for many consumers to tell the difference between a safe and dangerous prescription drug selling website. Companies like ours, PharmacyChecker.com, run a program that verifies and monitors international online pharmacies, and provides information that identifies the safest ones and compares their prices. Our Verification Program is run by Kelly Ann Barnes, JD, Rph, formerly the Director of Pharmacy Quality Assurance for the Massachusetts Board of Pharmacy.
Our program and programs operated by the Canadian International Pharmacy Association (CIPA), LegitScript, and the National Association of Boards of Pharmacy (NABP) were the subject of peer-reviewed studies. The findings were clear. Online pharmacies credentialed by the above groups, domestic and international, required valid prescriptions and sold only genuine medications. The U.S. pharmacies just cost a lot more money.
The NABP and LegitScript categorize all international online pharmacies that sell to consumers in the U.S. as rogue, unapproved and/or illegal, including ones approved by PharmacyChecker.com and CIPA. By relying on those classifications, consumers who are unable to afford medications locally are potentially scared away from obtaining medication they need and could afford internationally. Those misguided standards are being pushed on the Internet community.
Funded and supported by the largest global pharmaceutical companies and U.S. pharmacy industry associations, the NABP applied for and now administers the generic top level domain (gTLD) .Pharmacy, with the stated goal of helping global consumers know which online pharmacies are "safe and legitimate." It's a worthy goal but, unfortunately, the safest international online pharmacies that sell to consumers in the U.S. and also worldwide are not eligible to register a .Pharmacy web address.
The Alliance for Safe Online Pharmacies (ASOP), which was founded by pharmaceutical company Eli Lilly, the National Association of Chain Drugstores, and LegitScript, is pushing the .Pharmacy standard to the Internet community, encouraging registrars, registries, payment processors, and other gatekeepers to "do the right thing” — meaning takedown sites that are not eligible for .Pharmacy. Worse, Eli Lilly has called for search engines to delist all non-U.S. online pharmacies so Americans can't find them, which reeks of Internet censorship.
Global access to medicines advocates disagree with NABP's standard. For example, Peter Maybarduk, JD, the Director of Public Citizen's Access to Medicines Project, wrote in opposition to NABP's application:
Consumer access to medicines depends in significant part on price and competition. It would be inappropriate to allow NABP to control such an important gTLD while it maintains exclusionary plans for the domain, which work against the consumer interest in a robust marketplace of quality and affordable pharmaceuticals.
Lee Graczyk, who founded RxRights, which advocates for Americans who import medication for personal use, went to an ICANN meeting in 2014 to deliver a petition with almost 25,000 signatures of consumers who opposed NABP's application for .Pharmacy.
James Love, executive director of Knowledge Ecology International, wrote to the U.S. Trade Representative in support of personal drug importation. About online access he wrote:
The failure of the United States to have a successful regulatory regime for online parallel trade is for the most part due to PhRMA member companies lobbying against anything that would legitimize parallel trade, even among higher-income countries.
Earlier this summer, furthermore, the UN Human Rights Council was clear in its position that access to affordable medication is a human right. A special panel has even been created by the U.N. Secretary General calling on the global community to address the crisis of high drug prices and to take steps to mitigate where international trade law in pharmaceuticals collides with human rights.
As some in this community believe: access to the Internet is also a human right. So as the Internet community seeks to infuse the principles of international human rights law into the discourse and practice of Internet governance it can and should help maintain the widest possible online access to safe and affordable medication.
In our respective countries, we're all subject to traditional political power, which is often captured by commercial interests, such as the pharmaceutical industry in the U.S. In contrast, through the diffuse, fluid and more democratic processes that can characterize Internet governance, we can sometimes transcend that corporate power. Thus, the Internet community should provide service to and in fact encourage the use of the safest international online pharmacies for those struggling to afford medication wherever they live. Registrars, for example, should resist takedown requests of safe international online pharmacies but agree to take down rogue online pharmacies pursuant to a court order. Progressive principles fostered within this community about the online sale of medication can lead to better public policies and health outcomes. In doing so the Internet community will join with medicine access advocates in their quest to make medication affordable for all who need it.
By Gabriel Levitt, President at PharmacyChecker.com. Gabriel is also founder of Prescription Justice Action Group, a non-profit organization dedicated to providing relief and protection for American patients who are struggling to afford medication.
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