The Med Diva

An insider's guide to Medicare Part D and more

Archive for the category “Online pharmacies”

What do online pharmacies and mystery meat have in common?

Mystery meat and online pharmacies: you never know what you're gettingReport shows almost all online pharmacies are fake, don’t follow U.S. laws.

As drug prices continue to rise, many Medicare beneficiaries are turning to the Internet to find cheaper drugs at online pharmacies. It may be tempting to use an online pharmacy, especially one of the many “Canadian online pharmacies,” but drugs purchased from these sites often come with some big risks.

Rogue websites are all over the Internet selling drugs that may be counterfeit, contaminated, or otherwise unsafe. In addition, about 16 percent of Internet drug outlets do not have secure sites, which means your personal and financial information could be at risk if you place an online order. In a nutshell, when you buy from an online pharmacy, it’s just like choosing the mystery meat in the cafeteria: You never know what you’re getting.

According to the a 2012 Internet Drug Outlet Identification Program Progress Report from the National Association of the Boards of Pharmacy (NABP), 97 percent of the more than 10,000 websites they reviewed are operating out of compliance with U.S. pharmacy laws.  Many of these so-called pharmacies are unlicensed, operating illegally, or operating from foreign countries where drugs shipped to the U.S. are unregulated. If you buy from one of these online pharmacies, you run a high risk of receiving drugs that may be:
• Contaminated
• Sub-potent
• Super-potent
• Expired
• Counterfeit
• Improperly stored and shipped (and thus, may not be as effective)

O Canada! That website might not be what it seems
Lots of seniors I talk to tell me they get their drugs from a Canadian online pharmacy because of the cheaper prices. The problem is, although it may call itself a “Canadian pharmacy,” it may actually get its drugs from countries in Asia, South America, or Eastern Europe, where quality standards are less stringent and counterfeit drugs more widespread.

Beware of an online pharmacy that shows these signs of being fake
Fake online pharmacies can manipulate their websites to appear legitimate, so if you still insist on getting your drugs this way, make sure you avoid any online pharmacy that:

• Lets you buy drugs without a prescription from your doctor
• Offers cheap prices that seem too good to be true
• Sends spam or unsolicited email offering cheap drugs
• Is located outside of the United States
• Is not licensed in the United States

Look for these signs of a safe online pharmacy:
• Always requires a doctor’s prescription.
• Provides a physical address and telephone number in the United States.
• Offers a pharmacist to answer your questions.
• Has a license with your state board of pharmacy.  Check here find out.

 Verified Internet Pharmacy Practice Sites

To minimize your risk when using an online pharmacy, be sure to look for the VIPPS seal.

An easy way to find accredited online pharmacies
To help you make an informed choice, NABP reviews thousands of websites to determine if they maintain safe pharmacy practices.  NABP recommends using sites accredited through the VIPPS (Verified Internet Pharmacy Practice Sites) program. Look for the VIPPS seal, which is a symbol of a pharmacy’s commitment to its patients’ health and safety. Currently, only 50 sites, or about 3% of the online pharmacies NABP has reviewed, have received accreditation.

You can also check out this list of Internet drug outlets that appear to be out of compliance with state and federal laws or NABP patient safety and pharmacy practice standards.


Medicare’s moving parts, Part 1: Three strikes you’re out

I often tell people that Medicare is a cluster a moving parts: the parts being A, B, C, D, and so on; the “movement” generated by annual regulatory changes courtesy of the Centers for Medicare & Medicaid Services (CMS). Although these regulations provide job security for many people, they also greatly add to the confusion for Medicare providers, pharmacists, plan sponsors, and of course, beneficiaries.
For example, in October, CMS issued Federal Register Volume 76, Number 196, which addresses proposed changes to the Medicare Advantage and Medicare Prescription Drug Benefit programs for 2013. This 161-page, 77,017-word document, with all its sections and sub-sections, is absolutely mind-boggling. Feel free to take a peak here, but don’t say I didn’t warn you!

In my next few blogs, I’m going to try to break it all down and explain some of the points that may be of interest to you and other Medicare beneficiaries.

I want to start, however, by confessing that I’m getting a lot of help from the Medicare Rights Center, a national, nonprofit consumer service organization that works to ensure access to affordable, high-quality health care for Medicare beneficiaries. Click here to check out their excellent e-mail newsletters.

Today I’m going to briefly discuss sections (§) 422.504, 422.510, 423.505, and 423.509, which are grouped together and titled, “Plan Performance Ratings as a Measure of Administrative and Management Arrangements and as a Basis for Termination or Non-Renewal of a Medicare Contract.”  Under this guidance, Medicare Advantage (Part C) and Medicare prescription drug (Part D) plans that receive a summary star rating of less than three stars for three years in a row would be subject to termination.

The proposed ruling states, “A summary rating of less than 3 stars can be achieved only when a sponsor demonstrates poor performance across a range of measures. Therefore, we believe that sponsors that consistently achieve poor plan ratings have demonstrated a substantial failure to comply with the terms of their Medicare contracts.” CMS further states that it believes three years is enough time for a sponsor to develop and put in place corrective action.

In response to this proposed regulation, the Medicare Rights Center states that while it agrees plans with low star ratings should be terminated, three years is too long to allow poor performers to stay in business serving Medicare beneficiaries. “Keeping a low quality plan in the market for three years seems inappropriate and dangerous for beneficiaries,” the center notes in its comments to CMS.

The center also believes that if plans have a one- or two-star rating in any one year, CMS should strengthen incentives for plans to improve quality immediately and better protect beneficiaries. And it recommends CMS consider the use of sanctions or other enforcement mechanisms if a plan’s rating consistently fluctuates between one to three stars; then once a plan with one or two stars improves to three stars, a probationary period should kick in for that plan to ensure it continues to meet adequate performance goals.

I agree that three consecutive years of poor performance is not acceptable. As the writer for a national prescription drug plan that received 5 stars in 2010 and 4 in 2011 (the highest ratings of any national plans in the country), I know first-hand how difficult it is to achieve and maintain a high star rating. But it makes me feel good to know that everyone I work with is taking those extra steps to ensure our members get the service they need to stay healthy and safe. There’s no reason for any plan to continue serving beneficiaries if it can’t achieve a 3-star rating or better in any one year.

Playing Russian Roulette with online pharmacies: If it walks like a duck, quacks like a duck, it may not be a duck

The other day I heard a coworker’s conversation with his wife on the telephone. I did not like what I had heard.

First let me state that I was not snooping on my coworker. I work in a large office area that has many cubicles and very high ceilings. The acoustics in here are great–if you want an audience. This worker is in his late sixties, and he tends to speak loudly all the time. So it’s impossible not to overhear his conversations (unless I get up and leave my desk).

During this particular conversation with his wife, he was apparently instructing her to use her Medicare Part D benefit to fill an expensive prescription one time at the local pharmacy. After that one time, he advised, she could fill the script through an online pharmacy to save money.

I wanted to jump over my cubicle right there and then and warn him of the dangers of using online pharmacies, many of which are stocking their “shelves” with unsafe, counterfeit drugs. I restrained myself, and decided to blog on the subject  instead.

In March 2011, CBS’ 60 Minutes reported on the proliferation of counterfeit drug makers, who often use ingredients such as highway paint, floor wax, and boric acid to keep prices down. According to the report, many of these drugs are sold by rogue Internet pharmacies, including those that claim to be real Canadian pharmacies but are in fact not legitimate and not based in Canada. The abundance of fake drugs is in fact so great that any consumer who purchases drugs through an online pharmacy is playing Russian roulette.

During a raid on a fake drug manufacturing plant in Lima, Peru, a global security team made up of former FBI, Homeland Security, and narcotics agents, and headed by John Clark of Pfizer, discovered counterfeit Pfizer drugs lying in dirty pans in a filthy apartment. “If the consumer ever realized that products that they’re putting inside their bodies come from this, from dirty water…insects and everything else getting into it…I think they’d be horrified,” Clark said.

The issue of illegitimate online pharmacies is of such great concern in this country that combating these fake drug sellers has even garnered bipartisan support.  This week, Senators Dianne Feinstein (D-Calif.) and Jeff Sessions (R-Ala.) introduced the Online Pharmacy Safety Act of 2011 to stop criminals from exploiting the Internet to illegally sell prescription drugs. The legislation targets fraud associated with illegitimate online drug sellers, particularly those who sell counterfeit drugs, provide drugs without a prescription, or take money without providing anything in return. The bill, which requires the Food and Drug Administration to establish a registry of legitimate online pharmacy websites, is co-sponsored by Senators Charles Schumer (D-N.Y.) and John Cornyn (R-Texas).

Better options to lower your drug costs

There are much better ways to lower your drug costs than by filling your prescriptions through online pharmacies. Using lower-cost generic drugs or legitimate mail-order pharmacies owned and operated by U.S. health plans and pharmacy benefit managers are two of the best ways to save. Discount prescription drug cards and prescription savings programs are also helpful if you are not yet eligible for Medicare, or you can check with your state to see if it offers help paying drug plan premiums and/or other drug costs.

Medicare and Social Security have a program for people with limited income and resources that helps you pay for your prescription drugs. If you qualify, you could pay between $1 and $6 for each drug. To apply, visit or call 1-800-772-1213. TTY users should call 1-800-325-0778.

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