States draw the line on on-line Internet dispensing, bring suit
States draw the line on on-line Internet dispensing, bring suit against out-of-state doctors, pharmacies
At least three states are cracking down on what they say are illegal uses of the Internet to prescribe and sell prescription drugs. The states are targeting pharmacists and physicians using the Internet to practice where they are unlicensed, but regulators seem wary of Internet medicine, period.
"It’s wrong and dangerous to dispense prescription drugs on the basis of a prescription issued by a doctor who has never spoken with the patient, and who issues the prescription for a potentially lethal drug solely on the basis of an e-mail," Missouri Attorney General Jay Nixon said in a prepared statement. He has obtained temporary restraining orders to prevent several Texas pharmacies and pharmacists from doing business with Missourians. (See specifics on Missouri and Kansas at the end of this article.)
Michigan Attorney General Jennifer Granholm has created a high-tech unit whose charge includes investigating Internet dispensing, but has not yet brought any formal action in the area, says the office’s director of communications Christopher DeWitt.
Kansas is pursuing its cases on two fronts. All six of the state’s active cases involve allegations that out-of-state pharmacies or physicians have used the Internet to cross state lines and practice illegally in Kansas. The other tack relies on claims of deceptive advertising — the promise that every prescription order is reviewed by a physician, for example — or of substandard levels of care.
In one instance, for example, a 16-year-old boy was able to secure Viagra on-line even after he correctly supplied his age. "We’re alleging that it’s unconscionable within the meaning of our consumer protection statute for any entity, whether it’s a pharmacy or a clearinghouse or the prescribing physician, to put prescription drugs in the hands of a consumer who has never had an in-person examination or consultation with the examining physician," says Kansas assistant Attorney General Derek Schmidt.
Confimed LLC is one of the five companies under a temporary restraining order from doing business in Kansas. Its Web site is active, but requires customers to attest that they are not from Kansas "or any other jurisdiction that limits access to medication over the Internet."
In response to "public concern" regarding the safety of pharmacy practices on the Internet, the National Association of Boards of Pharmacy in Park Ridge, IL, is promoting a policy of self-policing. The association has developed a 17-point certification program for on-line pharmacies, the Verified Internet Pharmacy Practice Sites (VIPPS). The certification is voluntary, and the official position of the association is that existing laws and regulation applied to "bricks and mortar" pharmacies should be used for the on-line variety. VIPPS addresses areas "where existing laws do not specifically mention the distinctions of on-line pharmacies," according to the NABP’s description of the program.
The association estimates the number of on-line pharmacies at 400. In mid-September, the group certified its first three VIPPS pharmacies: RxAmerica LLC (www.drugstore. com), Merck-Medco Services of Nevada, Inc.(www.merck-medco. com), and planetRx (www.planet Rx.com).
Telemedicine advocates are watching the regulation of on-line pharmacies "very closely," but so far feel that their activities look nothing like the on-line prescribing that’s the target of state regulators.
"Right now, it seems like apples and oranges," says Glenn Wachter, head of advocacy and government affairs for the Association of Telemedicine Service Providers in Portland, OR. "Telemedicine technology is a lot more sophisticated that going on-line and filling out a form.
• Missouri
— Temporary restraining order against S&H Drug Mart and pharmacist William Stallknecht from selling and shipping prescriptions
— Agreement with James Reed Williams, MD, of Texas to stop treating Missouri residents or using on-line consultations to write prescriptions for Missouri residents
— Temporary restraining order against Houston’s Procare Clinic for Men, owner Kenneth N. Miles, Piney Point Pharmacy, and Danny Ray Johnson, MD, from accepting or processing orders from Missourians, or in Mr. Johnson’s case, from treating or prescribing drugs for Missourians.
• Kansas
— Suit against DVM Enterprises Inc.; Home Prescription Services Inc.; Confimed LLC; Focus Medical Group Inc.; Senior Care Pharmacy Inc., formerly LTC Pharmacy Inc.; and Viapro Inc.
— Also named are two individuals doing business as Male Clinic, one individual doing business as Community Drug of Pittsburgh, and one individual doing business as Stivercorp and On-line Physicians.
— The state also is pursing out-of-state doctors who prescribed the medications.
Contact Mr. Schmidt at (785) 296-2215, Mr. Wachter at (503) 222-2406, and the National Association of Boards of Pharmacy at (847) 698-6227.
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