Study exposes scale of rogue online pharmacy sector

A new study has estimated that illegal online pharmacies (IOPs) filled 416 million prescriptions to patients over a six-year between 2017 and 2022 – roughly 1.6% of all prescriptions – and the number of medicines they dispense each year has been on the rise.

The alarming finding comes from a study carried out by IQVIA, which relied on web scraping and deep learning algorithms to identify IOPs – which operate without the necessary licenses and registration with the National Association of Boards of Pharmacy (NABP) – and analyse their activities.

Use of IOPs as a source of medicines raises the risk that a patient is exposed to a counterfeit, substandard, diverted or stolen drug, which could lack efficacy or place them at risk of harm. However, according to the Alliance for Safe Online Pharmacies (ASOP), 95 per cent of the public are unaware of the certification schemes that help them identify legitimate operations.

The research identified more than 15,000 illegal online pharmacies operating in the US, and another 3,500 that were inactive, and were selling more than two thirds (70 per cent) of all the prescription medicines legally dispensed in the US.

It estimates that 12.6 per cent of total adverse events experienced by patients could have been avoided if all drugs purchased from IOPs had instead been purchased from legal pharmacies during the period.

The number of prescriptions dispensed annually through IOPs increased from 64 million in 2019 to 85 million in 2022 – a compounded annual growth rate of 10 per cent – which coincided with the restricted access to healthcare caused by the COVID-19 pandemic.

Illegal market valued at $34bn

The economic value of drugs purchased from IOPs totalled $34bn last year, based on invoice level prices and the prices they would have commanded if acquired through legal channels.

IQVIA notes that double the $17bn estimated value in 2017, and takes the aggregate value for the past six years to $167bn.

The most common drug classes dispensed by IOPs were headed by drugs used as part of cancer treatment – including hormone therapies – accounting for just over 10 per cent of the total by volume.

Also prominent were sex hormones (5.5 per cent) as well as dermatology products, cardiovascular drugs including those for erectile dysfunction, contraceptives and therapies for attention-deficit hyperactivity disorder (ADHD).

The report notes that main drivers for buying prescription drugs from IOPs were lower prices, use of the drug for an unapproved (off-label) purpose, and embarrassment at obtaining them through regular channels.

The World Health Organization (WHO) has previously estimated that 50 per cent of the drugs for sale on the Internet are fake, while an NABP survey a few years ago found that 96 per cent of online pharmacies serving US consumers were “potentially unsafe.”

The methodology used to generate the results was developed by IE University in Spain, and commercialised by Translucent Datalabs.

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