Utilization of an Online Cash-Pay Pharmacy for Topical 5-Fluorouracil Prescriptions in Older Patients.

BACKGROUND: High cost of prescription medications presents a challenging issue for older patients with multimorbidities. Topical 5-fluorouracil (5-FU) is an effective treatment for actinic keratoses (AK), a highly prevalent condition among elderly populations, but it is often associated with unpredictable retail prices and high out-of-pocket costs. One online pharmacy offers branded prescription medications at fixed, low prices, but it may be less accessible to older patients for numerous reasons. OBJECTIVE: To determine if the number of patients receiving topical 5-FU from an online pharmacy is proportionate to the national data on expected payment types for patients prescribed topical 5-FU for AK. METHODS: We conducted a cross-sectional study using weighted pooled data from the National Ambulatory Medical Care Survey (NAMCS) on topical 5-FU prescriptions for AK from 2007-2016. Data regarding online pharmacy use were provided by Dermatology.com for the year 2019. RESULTS: Among patients with AK prescribed topical 5-FU, the most prevalent payment source was Medicare (54%) followed by private insurance (40%). On the online pharmacy, the majority of patients had commercial insurance (71%) followed by Medicaid (12%). LIMITATIONS: Data from Dermatology.com are limited. CONCLUSIONS: Lower-cost medications from the online pharmacy site may improve adherence and outcomes in older adults and decrease total cost associated with AK treatment. However, the online pharmacy is underutilized by this population. J Drugs Dermatol. 2020;19(4): doi:10.36849/JDD.2020.4690.

Analysis of common oral and topical dermatologic medication price variation by source.

Online coupon retailers and pharmacies are popular sites that patients can access discounted medications when compared to cash prices. These sources are especially important for those patients without insurance. In our study, we analyzed commonly prescribed topical and oral medications and compared the cash prices to the discounted medications based on a typical month of usage. We found savings in every one of the medications that we analyzed, some with savings up to hundreds of dollars. Savings were present in all the sources analyzed, with the coupon-based programs often having the lowest price. We suggest certain alternative prescribing guidelines when considering patients who may not be able to afford cash prices of medications. Our hopes with this study are to quantify savings for discounted medications as well as to help physicians target more affordable medications for their patients.

Falsified vardenafil tablets available online.

It is often reported that falsified medicines have harmful effects on patients both Japan and abroad. In this study, we purchased vardenafil tablets on the internet and investigated their quality and authenticity using visual observations, authenticity investigations, non-destructive tests (handheld NIR and Raman spectroscopy), and quality analyses (active ingredient content and tablet dissolution rate). We used genuine 20-mg Levitra tablets that were sold in Japan and tablets from Bayer AG (Germany) as controls. In April 2015, we obtained 28 samples from 15 websites on the internet. Our authenticity investigations revealed that 11 (40%) were genuine products and 17 (60%) were falsified products. Handheld NIR and Raman results revealed that the falsified products had different spectra to the genuine products. Principal component analysis of the NIR and Raman spectra showed variation among the falsified products. The 11 genuine products were of good quality, and the 17 falsified products were of poor quality. The falsified products contained sildenafil (the active ingredient of Viagra) or tadalafil (the active ingredient of Cialis) instead of vardenafil. Our results show that falsified Vardenafil tablets are sold on the internet and that it is important to prevent illegal internet sales and increase consumer awareness of the presence of falsified medicines.

The availability and acquisition of modafinil on the internet.

INTRODUCTION AND AIMS: Prescription medications are readily accessible on both the dark and surface web. This study focuses specifically on modafinil. Modafinal is a medication that is used to treat sleepiness due to a range of sleep disorders, but is also used off-label as a cognitive enhancer. This study aimed to evaluate surface websites which sold modafinil to Australia to provide an overview of and to document the characteristics of surface web retailers. DESIGN AND METHODS: An online search to identify online retailers selling modafinil was performed using three search engines. Retailers were included if they sold modafinil to Australia, as verified through the purchasing process. Thirteen retailers were included in the final sample. RESULTS: Most retailers sold more than one product, with products being sold in tablet form the most common (88%). Retailers offered products of multiple strength, with the 200 mg product most common (51%). Most retailers included information on the side effects of the substances (77%), few listed any supporting evidence. Few listed information regarding legal status (24%). Most retailers used a number of features to indicate legitimacy. DISCUSSION AND CONCLUSION: This is the first study to document the characteristics of surface web retailers purporting to sell modafinil to Australia. Future studies may analyse purchased samples to identify potential counterfeit or poor-quality medications.

Baclofen in gamma-hydroxybutyrate withdrawal: patterns of use and online availability.

PURPOSE: Gamma-hydroxybutyrate (GHB) withdrawal is a life-threatening condition that does not always respond to standard treatment with benzodiazepines. Baclofen has potential utility as a pharmacological adjunct and anecdotal reports suggest that it is being used by drug users to self-manage GHB withdrawal symptoms. Here, we investigate current patterns of use and the online availably of baclofen. METHODS: Data triangulation techniques were applied to published scientific literature and publicly accessible Internet resources (grey literature) to assess the use of baclofen in GHB withdrawal. An Internet snapshot survey was performed to identify the availability of baclofen for online purchase and the compliance of retailers with the UK regulations. Data were collected according to pre-defined criteria. RESULTS: A total of 37 cases of baclofen use in GHB withdrawal were identified in the scientific literature, as well as 51 relevant discussion threads across eight Internet forums in the grey literature. Baclofen was available to purchase from 38 online pharmacies, of which only one conformed to the UK regulations. CONCLUSIONS: There is limited published evidence on the use of baclofen in GHB withdrawal, but both scientific and grey literature suggests clinical utility. Online pharmacies are readily offering prescription-only-medication without prescription and due to inadequate regulation, pose a danger to the public.

How to reduce out-of-pocket costs for prescription medications.

The cost of prescription medicines has recently been rising faster than other healthcare costs.  This is also true for traditionally inexpensive generic medications that have long served as a fundamental healthcare safety net in the USA.  These changes increasingly present challenges for individuals to obtain common medications.  Owing to rising insurance co-pays, even patients who have prescription medication insurance coverage are beginning to experience challenges in this area.  This document was created to help patients and their families consider various strategies and programs that exist in 2015 for reducing their out-of-pocket costs for their prescription medications.  We believe that this information can also be helpful to healthcare providers when counseling patients about managing rapidly rising prescription drug costs.  An effort has been made to make this document readable to patients and their families as well as to healthcare providers.

A detailed analysis of online pharmacy characteristics to inform safe usage by patients.

BACKGROUND: Evidence suggests that consumers potentially put themselves at risk when purchasing medicines on-line. Whilst logos provided by regulators may provide some level of reassurance there may be other indicators which could be used by consumers to identify those websites which may be safely used. OBJECTIVES: Identify characteristics of on-line pharmacies which are related to whether websites are regulated or non-regulated and those characteristics which could be used by patients to increase the likelihood of accessing regulated sites. SETTING: Online pharmacies which supply diazepam, fluoxetine and simvastatin. METHODS: Using piloted search terms via Google and Yahoo search engines, identified websites were screened for regulatory status, adherence to regulatory standards, administrative requirements, clinical assessment requirements and additional details deemed to be of relevance to a user. Characteristics of regulated and non-regulated (defined as those with an absence of a correctly linked regulatory logo) websites were compared to identify differences which could be used to improve patient safety. MAIN OUTCOME MEASURE: Regulatory status, adherence to regulatory standards, quality of information provision, barriers to medicines access. RESULTS: 113 websites sold diazepam, fluoxetine and simvastatin; were identified within the first 100 results. Less than quarter were found to be regulated online pharmacies. 80 websites were willing to sell the medication without a prescription. The unregulated internet pharmacy websites (defined as those with an absence of a correctly linked regulatory logo) were found to adhere more closely to the clinical criteria, were less significantly likely to disclose a contact name and address, telephone number of the pharmacy or demand a prescription prior to sale (P < 0.05, Fisher's Exact). CONCLUSIONS: The three prescription-only medicines which are liable to abuse, have potentially serious interactions and require counselling to ensure patient safety are readily available via the internet. When purchasing medicines via this route UK consumers should be made aware of the importance of regulatory logos and additionally should ensure that the seller can be meaningfully contacted by the contact details provided. The provision of clinical information should not be used alone as an indication of the seller's provenance.

Care versus convenience: Examining paracetamol overdose in New Zealand and harm reduction strategies through sale and supply.

AIM: To examine statistics on paracetamol overdose in New Zealand and investigate options to reduce paracetamol overdose rates, through supply reduction strategies. METHOD: Data was gathered from the Ministry of Health's National Minimum Dataset and Wellington Hospital Emergency Department attendances. Twenty articles on supply reduction strategies were sourced through article database searches. A survey on paracetamol availability from online pharmacies within New Zealand was conducted by searching for New Zealand online pharmacies through Google. RESULTS: A five-year audit of data (2007-2012) from the Wellington Hospital Emergency Department revealed that paracetamol was the most common medication used for overdose (23%). National data on aminophenol derivatives accounted for 22.4% of poisonings in New Zealand's public hospitals. An online search found that 25 out of 27 online pharmacies sold packets containing 50 grams of paracetamol. However, the literature supported restricting packets to the minimum threshold for an acute exposure (10 g). CONCLUSION: Paracetamol poisoning is the most common form of drug overdose in many developed countries. Tightening restrictions on the quantity of paracetamol sold per packet, in all outlets in New Zealand, may be an effective strategy to reduce overdose rates. This includes online pharmacies where large quantities of paracetamol per packet are available for sale.

Characteristics of online pharmacy users in a nationally representative sample.

OBJECTIVE: To identify health care-related factors associated with online pharmacy use by considering patients' prescription drug insurance coverage, number of prescriptions, health care expenditures, types of medications purchased, and health status. METHODS: Data were obtained from the Agency for Healthcare Research and Quality's 2002-2010 Medical Expenditure Panel Survey. Online pharmacy users were compared with nonusers across study variables in unadjusted and adjusted comparisons using logistic regression. Survey weights were applied to generate nationally representative estimates. RESULTS: A total of 443 online pharmacy users were identified, representing an average of 1.5 million individuals per year. Online users were found to be older and to have more prescriptions compared with nonusers, as well as to have higher health care expenditures and higher Charlson comorbidity index scores. Online users were also more likely to be privately insured, white, and married, and to be more educated. In logistic regression models, higher prescription expenditures (odds ratio [OR] 1.17 [1.05-1.32]), higher number of prescriptions (OR 5.13 [1.4-19]), medium to high income (OR 1.82 (1.3-2.5)], and use of erectile dysfunction drugs (OR 2.09 [1.06-4.10]) were associated with greater odds of online pharmacy use. Black race (OR 0.47 [0.3-0.72]), Medicaid insurance coverage (OR 0.23 [0.1-0.5]), and use of narcotic medications (OR 0.72 [0.53-0.97]) were associated with decreased odds of online pharmacy use. CONCLUSION: This study showed that age, race, income level, insurance coverage, high health care expenditures, and higher number of prescriptions are predictors for online pharmacy use.

Availability of buprenorphine on the Internet for purchase without a prescription.

BACKGROUND: Use of illicit buprenorphine is increasingly recognized, but it is unknown if the Internet currently represents an accessible source. METHODS: A series of Internet searches were conducted. Twenty searches were performed on two different search engines. The first 100 results of each search were classified into categories based on content. All Internet pharmacies were searched for buprenorphine preparations and if available, sites were examined to determine if a prescription was required for purchase, for the cost of buprenorphine, the geographical origin of the pharmacy, and evidence of validation by an online pharmacy verification service. RESULTS: Of the 2000 links examined, 1422 were unique. Six percent of links were to illicit commercial sites, 2% were to legitimate commercial sites, and 2% were to illicit portal sites, which contained links to many illicit commercial sites. Twenty pharmacies offering buprenorphine for purchase without a prescription were identified. The monthly cost of a typical starting dose of 2 mg buprenorphine daily ranged between $232 and $1163 USD. No pharmacies were listed by online pharmacy verification services. CONCLUSION: Twenty online pharmacies advertising buprenorphine formulations for sale without a prescription were identified. Prices varied widely between illicit pharmacies but were uniformly more expensive than legitimate pharmacies. Illicitly obtained buprenorphine formulations appear to be relatively inaccessible and at high cost on the Internet.