Of the 8,000 pharmacies in Canada, only about 50 are primarily involved in supplying medications south of the border via the Internet

The Canadian National Association of Pharmacy Regulatory Authorities is adapting a set of standards for online pharmacies that was created by its U.S.  counterpart.

Soon, consumers will be able to tell whether a pharmacy Web site is legitimate just by looking for the Verified Internet Pharmacy Practice Sites (VIPPS) seal of approval.

A pharmacy displaying the seal has agreed to adhere to the laws governing controlled substances, as well as to a set of stringent standards set out by NAPRA. 

No cross-border sales

One thing a VIPPS-certified pharmacy won't do is send prescription drugs directly to U.S. citizens — something that is illegal.

Barbara Wells, executive director of NAPRA, says about 50 of Canada's  8,000 pharmacies have made the United States their primary market,  and she doesn’t expect these companies to scramble for certification.

"If you are determined, and money is the motivation, then there’s not much incentive,” she says of online pharmacies who supply U.S. customers.  Many of these are in Manitoba, where the online pharmacy industry had sales of $300 million last year.

"Not everybody wants to ship to the United States," says Wells. "The volumes are high for those pharmacies that do, but there's very few of them."

CanadaRx is one company that focuses on U.S. sales. The VIPPS program would put pharmacies that rely on cross-border sales out of business, says CanadaRx operations manager John Lubelski. Unless the VIPPS program is changed, he says, his company will not display the seal on its site.

Canadian drugs offered on the Internet are as much as 70 per cent cheaper than the same product in the United States, he says.

"The reality is that there are people in the United States who find themselves in the position where they have to make a decision between medications and food," Lubelski says. 

Besides an easy-to-recognize accreditation, the Canadian Pharmacists Association says VIPPS will provide more security for Canadians, by ensuring that legitimate online pharmacies are recognizable and that the supply of Canadian pharmaceuticals is not siphoned off by the huge U.S. market.

"The most pressing concern for us is the potential disruption to the supply chain of pharmaceutical products to Canadians," says Barry Power, director of practice development for the association. "The American market is 10 times the size of that in Canada."

Power says he's heard stories about temporary shortages of drugs within Canada. Though it's not known whether they were caused  directly by Internet pharmacies, he says even a small number of American sales can have serious consequences on supply, causing shortages of vital medications for Canadians.

Canadian shortages

Barbara Wells says she's also concerned about the supply of drugs — and about the number of bodies to dispense them.

"There's a shortage of pharmacists in Canada," she says. And with the volume of sales at online pharmacies shipping south of the border, there simply aren't enough pharmacists to meet the demand. 

Because Canada has a national price-control system for pharmaceutical products, and the Canadian dollar is so weak against the U.S. dollar, it's easy to understand why Americans continue to bargain-shop for medications north of the border.

The Glebe Apothecary in Ottawa operates feelbest.com, which  only accepts prescriptions from Canadian residents or Canadians living abroad

Pharmacies like CanadaRx have found loopholes in the law. Because U.S. doctors' offices are allowed to import drugs, CanadaRx requires the customer's prescribing physician to formally order the supply of medication, which is then dispensed at the office. Other online pharmacies use limited power-of-attorney agreements, giving them the right to buy and ship pharmaceuticals on behalf of a customer.

The loose interpretations of the laws do not sit well with the U.S. Food and Drug Administration. But, Power says, this is not a Canadian pharmaceutical problem.

"This issue is apparently widely ignored by U.S. Customs, which  frequently allows residents to import up to a 90-day supply."

Americans break no laws by carrying a 90-day supply of medication into the U.S. — provided they got their prescriptions from a licensed Canadian physician. Though it's illegal to mail prescription drugs to non-Canadians across the border, Power says, U.S. officials ignore personal-use shipments. They prefer to focus their efforts on illicit drugs and large importers.

Power says it's simply a manpower issue. Lubelski says the FDA and U.S. Customs are lax because no one wants to persecute elderly, cash-strapped Americans in need of medications.

"If there were a political will to do it, it would get done," he says. "The FDA is doing what it has to do to maintain a balance here."

The VIPPS program is already in place in the United States and Wells says she expects to begin certifying Canadian pharmacies this month.

"I'm very optimistic," she says. "There's a lot of interest in it. We've got takers already."

Wells says the forum's agenda is not so much to promote VIPPS as to encourage discussion and address concerns.  Invitees such as Health Canada, Industry Canada, the FDA and provincial regulators want clarification on the laws regulating Internet pharmacies. Some people are still under the impression that shipping pharmaceuticals across the border is legal.

Power is supportive of the VIPPS program and its potential to ensure the quality and quantity of medications for Canadians. But, like Lubelski, he's not sure it will discourage Americans from buying drugs from Canadian online pharmacies.

Related Links FDA: Buying Medicines and Medical Products Online NAPRA's Model Standards for Canadian Online Pharmacies National Association of Boards of Pharmacy