Frequently Asked Questions

1. Why do I need to be concerned about buying medicine online?
Many Internet drug outlets are unlicensed, operating illegally, or operating from foreign countries where medicines shipped to the United States are not approved by the US Food and Drug Administration (FDA) and unregulated. Thus, there is no way of knowing whether the medicine you receive is contaminated, sub-potent, super-potent, expired, or counterfeit, or whether it has been stored and shipped under proper conditions to maintain its effectiveness. Once a drug is outside the strictly regulated US distribution channel, there is no guarantee of its authenticity, effectiveness, or safety.

2. How does NABP determine which Internet pharmacies to recommend?
In the interest of protecting patient safety, NABP recommends only those Internet pharmacies that are accredited through the Verified Internet Pharmacy Practice Sites^CM (VIPPS^CM) program. NABP has verified that these pharmacies are appropriately licensed, professionally operating, and have successfully completed the well-recognized and rigorous VIPPS criteria evaluation and on-site inspection.

3. So, any site that is not VIPPS-accredited automatically goes on the Not Recommended list?
No. Only those outlets that appear to break state and federal laws or otherwise fail to meet criteria for legitimate pharmacy practice standards as outlined in the Program criteria.

4. What does NABP do with the information it obtains on illegitimate Internet drug outlets?
First and foremost, NABP lists on its Web site Internet drug outlets that appear to be operating in opposition to Federal and state laws and regulations and outside of established patient safety practices for Internet pharmacies. Secondly, NABP reports information it obtains on sites that appear to be breaking laws and quality standards to state and federal regulatory bodies, which may have the authority to pursue disciplinary and/or legal actions against these site operators.

5. What’s wrong with buying medicine from foreign sources?
The problem with buying medicine from foreign sources is that you never know what you’re getting.  For instance, a Web site calling itself a “Canadian pharmacy” may actually obtain its medications from countries in Asia, South America, or Eastern Europe, where quality standards are more lax and counterfeit medications more widespread. While counterfeit medications can surface anywhere, they are significantly more common in developing foreign countries.
Because the identity, purity, and safety of drugs purchased from foreign sources cannot be guaranteed, it is illegal (with very few exceptions) to ship prescription drugs that are not approved by FDA into the United States, regardless of whether the drug is legal to sell in another country.

6.  What is the difference between an FDA-approved generic drug and an unapproved unbranded drug containing the same active ingredient?
Pharmacists use the term "generic" to mean unbranded drug products containing a certain active ingredient. FDA-approved generic drugs, on the other hand, have undergone a rigorous approval process in which they are determined to work in the same way and to be as effective and safe as its brand name-counterpart, and the manufacturing, packaging, and testing sites have met the same quality standards as those of the branded drug.
FDA-approved generics are safe and effective for patients to use, but when patients purchase unapproved "generics" from unknown sites, there is no guarantee as to what they’re getting, where it came from, who made it, or in what conditions. Patients can find a list of FDA-approved generics in the FDA’s Orange Book.
Another risk that patients run by ordering a foreign drug not approved for sale in the US is being uninformed if that drug is recalled. When a US FDA-approved drug is recalled, patients are notified through the US media. If the drug is not approved for sale in the US, this system is not in place. If the US patient is taking a foreign drug that has been recalled and is unaware, they could be in danger and not know it.

7. What should I do if I believe an Internet drug outlet is operating suspiciously?
Please report suspiciously operating Internet drug outlets to NABP by using the “Report-a-Site” feature in the VIPPS and Internet Pharmacies sections of our Web site. You may do so anonymously. We also encourage you to report such sites to your local state board of pharmacy, especially if you or a loved one has been harmed. NABP forwards information regarding suspiciously operating sites to the appropriate regulatory authorities.

8. What if a Web site I’m looking for is not on either list?
If an Internet drug outlet does not appear on either the list of recommended sites or the list of not recommended sites, it is for one of two reasons:

• Either the outlet appears to be operating within the law and within NABP standards but, because it is not VIPPS-accredited, which means NABP has not conducted a thorough investigation and on-site inspection of the pharmacy, we cannot verify its practices; or
• We have not reviewed it yet. 

If you would like information on an Internet drug outlet that does not appear on either list, feel free to e-mail us at custserv@nabp.net, and we will look into it for you.

9. Why can’t I access one of the sites on the Not Recommended list?
Simply put, rogue Internet drug outlets are shifty. They can be posted online, taken down, renamed, and re-posted in a matter of minutes. NABP tries to provide the most up-to-date information possible. Web site operators that want to avoid detection, however, can be difficult to pin down. If you have a question about a Web site, feel free to e-mail us at custserv@nabp.net, and we will look into it for you.

10. What is a “rogue” Internet drug outlet?
There are a variety of reasons that Web sites selling prescription drugs may fail to meet NABP standards. In some cases, the failure to meet those standards is of such a serious nature that the Web site may be referred to as a “rogue” Internet drug outlet.
A “rogue” Internet drug outlet is a Web site selling, offering to sell, or facilitating the sale of prescription drugs that intentionally or knowingly:

• Violates, appears to violate, or encourages or facilitates violation of any federal or state law or regulation; and
• Does not adhere to accepted standards of pharmacy and/or medicine practice, including standards of safety. For example, an Internet drug outlet would be considered rogue if it engages in the following practices:
• dispenses or offers to dispense prescription drugs without receipt of a valid prescription (ie, one issued pursuant to a legitimate patient-prescriber relationship that has included a face-to-face physical examination of the patient by the prescribing practitioner) issued by a person authorized to prescribe under state law and, as applicable, federal law;
• distributes or offers to distribute prescriptions or prescription drugs solely on the basis of an online questionnaire or consultation without a pre-existing patient-prescriber relationship that has included a face-to-face physical examination, except as explicitly permitted under state laws or regulations; or
• Engages in fraudulent or deceptive practices in any jurisdiction where the Web site or the entity that controls the Web site dispenses or offers to dispense prescription drugs.

11. Why is the incidence of counterfeiting on the rise?
A number of factors have contributed to the rise in criminal counterfeiting activity. Among them are:

• The growing involvement in the drug supply chain of under-regulated wholesalers and re-packagers
• The proliferation of rogue Internet drug outlets
• The increased importation of medicines from other countries.

12. How do I know if I've purchased a counterfeit product?
Patients may not know that the medicines they've purchased are counterfeits. That's why it's important to purchase prescription products from a pharmacy and pharmacist with whom you're familiar. In some cases, patients have noticed a different taste, consistency, or appearance of products that are later identified as being counterfeit, or they may have a different reaction to the counterfeit drug.

13. How can I avoid buying counterfeit products?
The best way to avoid counterfeit drugs is to purchase prescription medicines at your local pharmacy from a reputable pharmacist whom you know. Before you fill your prescription online, always see your doctor and get a valid prescription first. A legitimate Internet pharmacy will always require you to send a written prescription from the practitioner who examined you or contact the doctor directly to obtain a valid prescription for you.
NABP also recommends that you use an online pharmacy accredited by NABP when you buy prescription medicines online. The NABP Verified Internet Pharmacy Practice Sites^CM (VIPPS^CM) program only accredits pharmacies that are appropriately licensed and have successfully completed the well-recognized and rigorous VIPPS criteria evaluation and on-site inspection. Also:

• Don't buy medicine from online pharmacies that aren't licensed in your country or that offer to write a prescription or sell medicine without a prescription.
• Where available, ask for the product in the manufacturer's original package.
• Avoid drugs in foreign packaging because unregulated imports have been a way for counterfeits to enter the US market.
• Closely scrutinize the appearance of your medicine and its packaging. Talk to your pharmacist if you notice anything unusual, or if you have a different reaction to your medicine.
• Report suspected counterfeiting to the FDA MedWatch Program (or 800-FDA-1088) and to the manufacturer.

Remember that if the price of a medicine seems too good to be true, it probably is.

14. How serious a problem is the counterfeiting of prescription medicines?
While US consumers purchasing prescription medicines from licensed domestic pharmacies can rest assured that the vast majority of medicines they receive are safe and effective, counterfeiting is increasingly becoming a more serious problem. While it remains more prevalent in developing countries, the problem has grown with international market expansion, globalization, and increased Internet use to all countries and regions.
Current estimates indicate counterfeit medicines range from 1% of sales in developed countries to over 10% in developing countries:

• Many countries in Africa, parts of Asia, and Latin America have areas where more than 30% of medicines can be counterfeit;
• In many of the countries of the former Soviet Union more than 20% of medicines are thought to be counterfeit;
• Medicines purchased over the Internet from sites that conceal their physical address are counterfeit in over 50% of cases.

The state boards of pharmacy and other government and professional organizations are actively working to reduce the threat of counterfeiting.

15. What are the causes of counterfeiting?
Technology to produce everything from labels to active pharmaceutical ingredients is now widely available. Globalization has made distribution channels easy targets for introducing counterfeit products.  The Internet provides counterfeiters with ready access to consumers and markets. Regulations governing the drug distribution system do not provide a strong enough deterrent, in terms of enforcement and penalties, to discourage counterfeiters. Organized crime has become increasingly involved in counterfeiting as it becomes more profitable.

16. What are the consequences of counterfeiting?
Counterfeiting has significant consequences. Most importantly, patients don't get the safe and effective products they pay for and, instead, may be put at significant risk.

17. What can be done to improve the counterfeiting situation?

• Strengthen accountability within the drug distribution system through tougher enforcement and penalties.
• Evaluate and improve, where necessary, the practices of all those who distribute or dispense prescription medicines.
• Employ new technology that has been proven to be effective against counterfeiting.
• Determine whether increased regulation is needed at both the state and federal levels.
• Evaluate whether FDA will need additional resources to deter counterfeiting. FDA collaborative efforts with industry have been a very positive first step.

18. What can I do to help?
Ask questions and express your concerns about drug counterfeiting, poorly repackaged products, confusing or foreign labeled packs, or any other issues regarding your medication that make you feel uncomfortable. Do not leave the pharmacy if you are unhappy, concerned, or confused about any aspect of your medicines, the way the medicine is packaged, or the condition of the medicine or packaging.

Join a patient organization that represents your disease and seek advice from other members on your medicine, how it should be packaged, its appearance, the effects of switching to generic or different formulations, and your rights to refuse any medicine in which you are not confident or about which you are confused.

• Internet Pharmacies
  • Recommended
  • Not Recommended
  • LegitScript
  • Pharmahelper
• Why "Not Recommended"?
• Buyer Beware: Protect Yourself from Illicit Sellers
• Avoid Counterfeit Drug Scams
  • Counterfeit Drug Identification Checklist
  • How to Report Suspected Counterfeits
  • FDA Information on Counterfeits
• In the News
• Report a Site
• FAQ
• Criteria