Online Pharmacies Research Articles

Fair Balance of Prescription Drug Information on Legitimate and Illegitimate Online Pharmacy Websites.

Patients require important information when prescribed medications. For example, the U.S. Food and Drug Administration (FDA) requires that promotional information includes a fair balance of risks and benefits. This study evaluates how well legitimate online pharmacies (LOPs) and illegitimate online pharmacies (IOPs) comply with the spirit of the FDA's fair balance guidelines by examining the extent and equivalence of risk and benefit information on their websites. This study analyzed the content of 307 online pharmacy websites. Most (90.3%) communicated drug benefits, while 84.7% provided risks. Both risk and benefit information was moderately extensive. Presentation of risks and benefits differed between online pharmacy types. Compared to LOPs, IOPs were more likely to present risk information but also exaggerate benefits. Four in ten online pharmacies presented a fair balance of risks and benefits. However, LOPs (47.4%) were more likely to present a fair balance than IOPs (36.5%). Interestingly, IOPs were more likely to disclose instructions for use and overdose information than LOPs. These findings underscore the need for regulatory guidelines to encourage online pharmacies to present a fair balance of benefit and risk information. Also, pharmacists should develop online approaches to better fulfill their professional responsibility as drug information providers while maintaining their integrity and objectivity.

Factors affecting customers intention towards online pharmacies in Indonesian market

Online pharmacies are a promising business model for promoting online sales of medicines. The purpose of this study is to investigate how technology acceptance model (TAM) variables (perceived ease of use and perceived usefulness), perceived trust, perceived performance risk, and perceived physical risk influence customers' intention to use online pharmacy. A questionnaire survey was used to collect data for the planned study. The results showed that perception of trust is a critical factor influencing costomers intention to use an online pharmacy. The reluctance of customers to buy medicines, categorized as risk, through online pharmacies which was originally thought to be a determining factor, has no impact if customer trust in online pharmacy has been formed. This study has several relevances for advancing online pharmacy promotion including the importances of user-friendly and benefits provided by online pharmacies provider. It is very important how online pharmacies providers can increase customers trust in terms of legality, quality and security of personal data.

Combining zip code-based population data and pharmacy administrative claims data to create measures of social determinants of health.

Social determinants of health (SDoH) are key factors that impact health outcomes. However, there are many barriers to collecting SDoH data (eg, cost of data collection, technological barriers, and lack of standardized measures). Population data may provide an accessible alternative to collecting SDoH data for patients. To explain how population data can be leveraged to create SDoH measures, assess the association of population SDoH measures with diabetic medication adherence, and discuss how understanding a patient's SDoH can inform care plans and patient engagement. A nationally representative commercial sample of patients who were aged 18 years and older and met Pharmacy Quality Alliance inclusion criteria for diabetes mellitus were analyzed (N = 37,789). US Census and North American Industry Classification System data were combined with pharmacy administrative claims data to create SDoH measures. Derived measures represent 2 SDoH domains: (1) economic stability (housing density, housing relocation, jobs per resident, and average salary) and (2) health care access and quality (urban/rural classification, distance traveled to prescriber and pharmacy, use of a primary care provider [PCP], and residents per PCP). The association of population SDoH measures with diabetic medication adherence (proportion of days covered) was assessed via logistic regression, which included covariates (eg, sex, age, comorbidities, and prescription plan attributes). As housing density (houses per resident) increased, so did the likelihood of adherence (odds ratio = 1.54, 95% CI = 1.21-1.97, P = 0.001). Relative to patients who did not move, patients who moved once had 0.87 (95% CI = 0.81-0.93, P < 0.001) the odds of being adherent, and patients who moved 2 or more times had 0.82 (95% CI = 0.71-0.95, P = 0.008) the odds of being adherent. Compared with areas with fewer jobs per resident, patients living within a zip code with 0.16 to 0.26 jobs per resident were 1.12 (95% CI = 1.04-1.20, P = 0.002) times more likely to be adherent. Patients who lived in an urban cluster were 1.11 (95% CI = 1.01-1.22, P = 0.037) times more likely to be adherent than patients living in a rural area. Patients who travel at least 25 miles to their prescriber had 0.82 (95% CI = 0.77-0.86, P < 0.001) the odds of being adherent. Community pharmacy users had 0.65 (95% CI = 0.59-0.71, P < 0.001) the odds of being adherent compared with mail order pharmacy users. Patients who had a PCP were 1.26 (95% CI = 1.18-1.34, P < 0.001) times more likely to be adherent to their medication. Leveraging publicly available population data to create SDoH measures is an accessible option to overcome barriers to SDoH data collection. Derived measures can be used to increase equity in care received by identifying patients who could benefit from assistance with medication adherence.

Vitamin A-containing dietary supplements from German and US online pharmacies: market and risk assessment.

Vitamin A supplements are used by many people, and the number of newly registered dietary supplements is continuously increasing. The preparations fall under food law and are not subject to the strict controls of pharmaceuticals. Risk indications and maximum quantity recommendations, e.g., from the Bundesinstitut für Risikobewertung (BfR) and the U.S. Food and Drug Administration (FDA) are not binding, which means that overdoses and potentially serious health problems can easily occur. The hepatotoxicity and teratogenicity of vitamin A are well documented, and other negative effects of high doses of vitamin A are also being discussed. Nevertheless, preparations with exorbitantly high doses are freely available for sale and unrestricted. In this study, 75 supplements containing vitamin A available in Germany and 26 available in the USA were critically examined on the basis of various parameters such as the recommended daily dose according to the manufacturer, daily therapy costs (DTC), the presence of warnings about overdose, use during pregnancy and breastfeeding, and information on adverse effects/interactions. The aim was to gain insights into their risk potential and to examine the need for closer monitoring and stricter guidelines for these preparations. The results show some considerable country-specific differences. Overall, there are serious deficiencies in compliance with the labeling requirements for both the German and the US preparations, and the dosages are often far too high in view of the applicable expert recommendations. Overall, these deficits can pose a risk for consumers that is difficult to assess in its entirety, especially for vulnerable consumer groups. It should be noted that the US preparations perform better overall than the German preparations. This suggests better regulation of dietary supplements in the US market. Based on the available data and literature research, it is doubtful whether the intake of vitamin A-containing preparations, without a diagnosed vitamin A deficiency, has a positive health benefit. Furthermore, it should be examined whether vitamin A should continue to be offered over-the-counter as a food supplement.

Characteristics analysis of Internet pharmacy consultation services for children in southwest China during the post-epidemic era: A cross-sectional study

AimThis study aims to examine the features of online pediatric pharmacy consultations in Southwest China, an area with limited medical resources during the post-epidemic era and to explore the factors affecting the dialogue volume in online consultations. MethodsA cross-sectional study was conducted in southwest China from April 2022 to March 2023. The study encompassed a cohort of 2,526 children, ranging from 0 to 18 years old. The collected data encompassed patient gender, age, weight, department, drugs involved in consultation services, types of questions consulted, consultation start time, and the dialogue volume in online consultations. Descriptive statistics and an ordered multicategorical logistic regression analysis were performed. SPSS 26.0 software was used for data analysis. ResultsAmong the total Internet pharmacy consultation services offered, the infant group constituted the largest portion (n = 1021). Children with internal medicine concerns have greater online consultation needs (n = 455). The peak usage of Internet pharmacy consultation occurred in the fall at 11:00 a.m. (n = 73). Factors influencing the dialogue volume in online consultations include the non-availability of Chinese medications [P = 0.033, OR = 0.81, 95 % CI (0.67–0.98)], consultation initiation during the spring [P = 0.002, OR = 1.52, 95 % CI(1.17–1.97)] or afternoon [P = 0.012, OR = 1.36, 95 % CI (1.07–1.72)] and weight＜15 kg group [P = 0.038, OR = 2.19, 95 % CI (1.04–4.58)]. ConclusionOur findings provide important information for peers to carry out their work. In the post-epidemic era, emphasis should be placed on addressing concerns related to children's internal medicine and otolaryngology. Optimizing healthcare resource allocation should take into account the time-seasonal variability of children's consultation behaviors. Furthermore, it is recommended to focus on weight＜15 kg children in inquiries, absorb sufficient knowledge about Chinese medicines, and schedule more pharmacists to participate in consultation services during the spring or in every afternoon. These findings help the authorities of online platforms and the National Health Commission to rationalize the allocation of healthcare resources, optimize the quality of service delivery, and develop new policies.

Search Engines and Generative Artificial Intelligence Integration: Public Health Risks and Recommendations to Safeguard Consumers Online.

The online pharmacy market is growing, with legitimate online pharmacies offering advantages such as convenience and accessibility. However, this increased demand has attracted malicious actors into this space, leading to the proliferation of illegal vendors that use deceptive techniques to rank higher in search results and pose serious public health risks by dispensing substandard or falsified medicines. Search engine providers have started integrating generative artificial intelligence (AI) into search engine interfaces, which could revolutionize search by delivering more personalized results through a user-friendly experience. However, improper integration of these new technologies carries potential risks and could further exacerbate the risks posed by illicit online pharmacies by inadvertently directing users to illegal vendors. The role of generative AI integration in reshaping search engine results, particularly related to online pharmacies, has not yet been studied. Our objective was to identify, determine the prevalence of, and characterize illegal online pharmacy recommendations within the AI-generated search results and recommendations. We conducted a comparative assessment of AI-generated recommendations from Google's Search Generative Experience (SGE) and Microsoft Bing's Chat, focusing on popular and well-known medicines representing multiple therapeutic categories including controlled substances. Websites were individually examined to determine legitimacy, and known illegal vendors were identified by cross-referencing with the National Association of Boards of Pharmacy and LegitScript databases. Of the 262 websites recommended in the AI-generated search results, 47.33% (124/262) belonged to active online pharmacies, with 31.29% (82/262) leading to legitimate ones. However, 19.04% (24/126) of Bing Chat's and 13.23% (18/136) of Google SGE's recommendations directed users to illegal vendors, including for controlled substances. The proportion of illegal pharmacies varied by drug and search engine. A significant difference was observed in the distribution of illegal websites between search engines. The prevalence of links leading to illegal online pharmacies selling prescription medications was significantly higher (P=.001) in Bing Chat (21/86, 24%) compared to Google SGE (6/92, 6%). Regarding the suggestions for controlled substances, suggestions generated by Google led to a significantly higher number of rogue sellers (12/44, 27%; P=.02) compared to Bing (3/40, 7%). While the integration of generative AI into search engines offers promising potential, it also poses significant risks. This is the first study to shed light on the vulnerabilities within these platforms while highlighting the potential public health implications associated with their inadvertent promotion of illegal pharmacies. We found a concerning proportion of AI-generated recommendations that led to illegal online pharmacies, which could not only potentially increase their traffic but also further exacerbate existing public health risks. Rigorous oversight and proper safeguards are urgently needed in generative search to mitigate consumer risks, making sure to actively guide users to verified pharmacies and prioritize legitimate sources while excluding illegal vendors from recommendations.

Co-designing the first online pharmacy course with the technology-enhanced learning accreditation standards (TELAS) as a reflective tool

This research describes the experiences of co-designing a technology-enhanced online Pharmacy course and how the Technology Enhanced Learning Accreditation Standards (TELAS) informed the design and development of a fit-for-purpose online course. This study used Gibb’s reflective model and Driscoll’s constructivist learning theory to unpack and align the processes in the development of the course. Finally, we have discussed the broader implications of the TELAS framework to online courses not only as a reflective tool but as an opportunity to inform future pedagogical practices, course improvements, validations and application of TELAS in practice.

(253) Use of Online Pharmacy Tools May Lead to Significantly Reduced National Expenditures on Vaginal Estrogen

Abstract Introduction High medication costs for vaginal estrogen may create a barrier for patients seeking treatment for numerous urinary and vaginal symptoms and lead to poor medication adherence. The Mark Cuban Cost Plus Drug Company (CPD) and GoodRx tools offer patients a method to purchase prescription medications at a discount, which may lead to improved medication adherence and decreased national expenditures on such medications. Objective To compare the pricing of vaginal estrogen as advertised by retail pharmacies, Medicare, and discount listings through CPD and GoodRx. Methods A review of publicly available data from CPD and GoodRx was performed to obtain listed retail and discounted prices for Estrace (topical), Vagifem (tablet), and Premarin (topical). GoodRx prices were obtained using prices from Costco, CVS, Walgreens, and Walmart pharmacies in the most from populous zip code from each of the 3 most populous U.S. states: California, New York, and Texas. Prices were adjusted to account for dosage and prescribed quantity to estimate an average cost per dosage unit ($/adu). The Medicare Part D Drug Spending and Utilization data from 2021 were used to report the average spending per dosage unit and total expenditure for each of the listed medications. These data were compared to create an estimate of average national savings after use of CPD and/or GoodRx. Results Average spending per dosage unit for Estrace, Vagifem, and Premarin was lesser when discount tools were used (0.50 $/adu, 3.75 $/adu, and 4.30 $/adu respectively), compared to Medicare pricing (6.14 $/adu, 20.95 $/adu, and 10.10 $/adu respectively) or retail pricing (3.14 $/adu, 10.19 $/adu, and 5.43 $/adu respectively). When adjusted for total dosage units, use of CPD over Medicare pricing for the three medications would result in a combined annual national saving of $64.2M. Use of either CPD or GoodRx compared to retail pricing would similarly result in a combined annual national saving of $39.2M. Conclusions The utilization of CPD and GoodRx in the prescription of vaginal estrogen led to a substantial national average cost savings when compared to retail and Medicare pricing. CPD and GoodRx may offer a way to decrease the cost burden for patients seeking treatment for urinary and vaginal symptoms and significantly reduce national expenditures on medications. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: The utilization of CPD and GoodRx in the prescription of vaginal estrogen led to a substantial national average cost savings when compared to retail and Medicare pricing. CPD and GoodRx may offer a way to decrease the cost burden for patients seeking treatment for urinary and vaginal symptoms and significantly reduce national expenditures on medications.

Prescriptions of homeopathic remedies at the expense of the German statutory health insurance from 1985 to 2021: scientific, legal and pharmacoeconomic analysis

The prescription of homeopathic remedies at the expense of the statutory health insurance (SHI) system in Germany has been criticized for years due to a lack of evidence. Now, on the planned abolition of the reimbursement of homeopathic medicines in Germany, the debate on this topic has been reignited. The aim of this paper is to show the costs and their development over time incurred by homeopathic remedies in the healthcare system from 1985 to 2021. For this purpose, 15 selected homeopathic medicines were chosen from the drug prescription report (Arzneiverordnungsreport) and analyzed with regard to their development of DDD (Defined Daily Dose) using data from the Wissenschaftliches Institut der Ortskrankenkassen (WidO, Scientific Institute of the General Local Health Insurance Funds) and compared with their respective rational pharmacological alternatives. The price comparison was based on the DDD costs and the pharmacy retail price of the smallest packaging in each case. The clinical study situation for the preparations was also analyzed. For this purpose, the clinical studies provided by the manufacturer and those on PubMed were divided into evidence levels and analyzed. In addition, the presentation of homeopathic remedies on company websites, in online pharmacies, in specialist information and package leaflets was analyzed with regard to side effects, interactions, indication, and information on the alleged effect/proof of efficacy. In many media, information on homeopathic medicines remained incomplete, and non-compliance with the Therapeutic Product Advertising Act (Heilmittelwerbegesetz) was noted. Naming of the products if often very suggestive, too. Manufacturers’ claims of efficacy go far beyond what can be considered proven in terms of evidence-based medicine and the quality of most clinical studies is poor. Homeopathic remedies are on average significantly more expensive than their rational pharmacological alternatives. Furthermore, DDD costs have continued to rise over the years analyzed. In aggregate, from a pharmacoeconomic, legal, and scientific perspective, abolition of reimbursement of homeopathic medicines in Germany at the expense of the SHI system is well justified.

Evaluation of Potential Urologic Prescription Drug Savings With Mark Cuban Cost Plus Drug Company.

Mark Cuban Cost Plus Drug Company (MCCPDC) launched in 2022 with a goal to decrease prescription drug costs. Thus far, research has focused on possible savings if Medicare purchased its annual volume of drugs at MCCPDC prices. The aim of this study is to analyze if MCCPDC can offer savings directly to urologic patients compared with other mail-order pharmacies, local pharmacies, and with patients using health insurance. Twelve drugs used to treat urological diseases available on MCCPDC were analyzed. Pricing data of 30-tab and 90-tab prescriptions from MCCPDC, other mail-order pharmacies, and local in-person pharmacies near our zip code 40508 (Lexington, Kentucky) were compiled. To compare if MCCPDC could offer savings to patients using health insurance to fill their prescriptions, out-of-pocket drug costs for patients from the 2020 and 2021 Medical Expenditure Panel Survey and the 2021 Medicare Part D spending data were extracted. Greater savings at MCCPDC were found at 90-tab prescriptions, but overall variability in prices existed. When comparing without health insurance, 9 of 12 drugs at MCCPDC were cheaper at 90 tabs with solifenacin and tadalafil saving $20 and $12 per prescription. When considering patients using insurance, abiraterone, sildenafil, and tadalafil offered savings on out-of-pocket costs at 30- and 90-tab prescriptions. MCCPDC may offer cheaper prices for patients filling urologic medications, especially at 90-tab prescriptions. This study is the first to show patients could save money using MCCPDC and has implications for physician counseling when prescribing common urologic drugs.

The characteristics and operations of "online pharmacies" investigated in relation to medicines popularised during the coronavirus pandemic: a cross-sectional study.

Aim: To explore the characteristics and operations of online pharmacies in relation to medications that gained widespread popularity and increased demand during the COVID-19 pandemic. Furthermore, to assess and compare practices between legitimate and "rogue" online pharmacies. Methods: Fifteen COVID-19-pandemic-related medications were investigated through a UK-based online search. We systematically assessed the credibility of 116 retrieved online pharmacies using the factors: operational location, range of medicines sold, prescription requirements for Prescription Only Medicines (POMs), information exchange, payment/delivery, user-friendliness, legitimacy. Descriptive analysis was conducted, and legitimacy status (legitimate vs. illegitimate/rogue) was tested against relevant safety indicators using a chi-square test. Results: Out of 116 "online pharmacies," 55 (47%) were confirmed as "rogue," 47 (41%) were verified as legitimate by the General Pharmaceutical Council (GPhC), and 14 (12%) were verified by other bodies but not by the GPhC. A total of 93 declared their "apparent" physical location of operation on the webpage of which 63 (67.7%, n = 93) declared a location that did not match their actual location according to the online pharmacy's server (through their IP address). All 15 medicines analysed were readily available for purchase. A high percentage of online pharmacies offered POMs to the public (93.1%, n = 116). Only 23 out of the 116 online pharmacies assessed required a prescription for providing POMs, with only four of these verified as legitimate by the GPhC register, while most of the legitimate pharmacies (44 out of 47) offered online consultations as an alternative option instead of a prescription. Controlled medicines were offered by 28 online pharmacies 27 of which were deemed as rogue. Rogue online pharmacies were significantly more likely to guarantee refunds for medication, not require prescriptions for POMs, and not require an online consultation to obtain POMs. Discussion: Findings reveal easy access to rogue online pharmacies, posing patient safety risks. We also found legitimate online pharmacies often offer online consultations without requiring prescriptions for POMs, raising concerns about inadequate safety checks. This emphasises the need for improved regulations for both types of online pharmacies, especially during public health crises.

A New Blockchain-Based Medical Model for Smart Hospital Integrity Management of the Drug Supply Chain

Counterfeit medications are currently one of the biggest issues in pharmacology. According to a research from the Health Research Funding organization, between 10–30% of pharmaceuticals in underdeveloped nations are counterfeit. The primary problem is not in counterfeiting per such, but rather in the fact that these pharmaceuticals have distinct adverse consequences on human health when compared to regular drugs. The WHO estimates that over 30% of all medications sold in Latin America, Asia, and Africa are fake. This is the main issue facing the entire world, and things become worse in underdeveloped nations where one in ten medications are either counterfeit or do not adhere to drug standards. It is becoming increasingly challenging to standardize drug safety due to the growth of online pharmacies. It is challenging to identify fakes. The safety of the pharmaceutical supply chain is becoming a serious public health concern, a process that affects all of us. In this work, we present a new approach to medication supply chain management that handles safe drug supply chain data using Hyperledger Fabric, a blockchain-based platform. By implementing drug record transactions on a blockchain, a drug supply chain and smart healthcare ecosystem may be constructed. The suggested method addresses this issue. To allow for time-limited access to patient health information and electronic prescription records, a smart contract has been introduced.

What influences consumers' online medication purchase intentions and behavior? A scoping review.

Objective: Consumers increasingly buy pharmaceuticals online. No scoping review has been carried out to summarize and synthesize the studies that have identified drivers of consumers' purchase intention and behavior from online pharmacies. Thus, we conducted a scoping review to explore the extent to which prior research has studied consumer purchase intentions and behavior related to online pharmacies, the drivers previously identified to explain consumers' online pharmacy purchase intentions and behavior, and how these antecedents differ between OTC and prescription medications. Then, we identified gaps in the published literature to form a comprehensive theory-based agenda for future research. Methods: We searched PubMed, Web of Science, and Scopus to retrieve relevant studies published in English in peer-reviewed journals. The search strategy identified forty-eight eligible studies. Results: We identified twelve types of factors influencing purchase intentions and behaviors from online pharmacies: demographics, convenience, availability, price, evaluations of the purchase environment, information sources, internet usage, prior experience, perceived risk, health insurance, privacy, and product. Our analysis also revealed differences between OTC and prescription medications in drivers of purchase intentions and behaviors. Conclusion: While demographic factors tended to be the most often measured influences on intentions and behavior, their role was generally inconsistent, with many contradictory results. However, other factors (e.g., convenience, availability, lower prices, and favorable evaluations toward the purchase environment) more consistently enhanced online medication purchase intentions and behavior. An extensive agenda for future research is advanced.

(163) The High Price of Anonymity: Comparison of Cost of Direct-to-Consumer Mail Order Pharmacies Compared with Cost Plus Drug Company

Abstract Introduction Direct-to-consumer (DTC) mail order pharmacies often entice patients with erectile dysfunction (ED) by highlighting the ability to obtain medication online and avoid an “awkward” doctor’s visit. The markup and cost of obtaining medications for ED through subscription services from DTC pharmacies that include a “telemedicine” visit remains unknown. Objective To compare the cost of generic ED medications available from DTC mail order pharmacies to Mark Cuban Cost Plus Drug Company. Methods We obtained the cost of medications from three direct-to-consumer online mail order pharmacies (hims, BlueChew, and Roman) as well as comparable medications which are available with a prescription from Mark Cuban Cost Plus Drug Pharmacy. Cost per pill, monthly costs, and annual costs were compared in a variety of subscription options from DTC pharmacies compared with Cost Plus Drug Company. Results Introductory packages of sildenafil started at $25/month at BlueChew (30mg, 6 pills/month, $4.17/pill), $26/month at hims (25mg, 4 pills/month, $6.50/pill), and $16/month at Roman (25mg, 4 pills/month, $6.25/pill). Alternatively, 30 pills at Cost Plus Drug Company costs $9.40 (20mg, 30 pills/month, $0.32/pill). Introductory packages of tadalafil started at $25/month at BlueChew (6mg, 4 pills/month, $6.25/pill), $30/month at hims (10mg, 4 pills/month, $7.50/pill)), and $39/month at Roman (5mg, 4 pills/month, $9.75/pill). Alternatively, 30 pills at Cost Plus Drug Company was $10.70 (10mg, 30 pills/month, $0.36/pill). The cheapest per pill price of sildenafil is $2.79 at BlueChew (30mg), $4.00 at hims (25mg), and $2.80 at Roman (25mg). To obtain the lowest price, patients are required to commit to 34 pills/month at $90 from BlueChew, a 12-month subscription for 16 pills/month totaling $768 from hims, and a 12-month subscription of 10 pills/month totaling $336 from Roman. The cheapest cost/pill at Cost Plus Drug Company was $0.15/pill (20mg) to obtain 90 pills for $13.40. These values are even more stark when ordering the highest strength and highest quantity of tadalafil for 1 year from each of DTC pharmacy: BlueChew $1,445 (9mg, 28/month, $4.30/pill), hims $1,284 (10mg, 16/month, $6.69/pill), and Roman $5,136 (20mg, 10/month, $42.80/pill)). 360 tabs of Tadalafil 20mg from Cost Plus Drug Company cost $75.20, $0.21/pill). This analysis is limited as the cost of a doctor’s visit to obtain a prescription is not included in the price of medications at Cost Plus Drug Company but is included in the direct-to-consumer services. Conclusions Direct-to-consumer online pharmacies that include a telehealth appointment and provide access to generic medications to treat ED have considerable markup. This markup likely exceeds the out-of-pocket cost for a primary care office visit needed to obtain a prescription to treat ED. Prescribers should inform patients of cost-effective methods to obtain commonly used medications to treat ED. Disclosure No.

(164) Potential Savings with Use of Cost Plus Pharmacy for Medical Treatment of Erectile Dysfunction

Abstract Introduction With its stated goal “to end ridiculous drug prices,” the Mark Cuban Cost Plus Drug Company (MCCPDC) launched in January 2022 with over 100 generic prescription drugs available to be mailed directly to patients without the involvement of health insurance. To promote drug cost transparency, all drugs are priced at the cost to manufacture the drug with a 15% administrative markup, a $3 pharmacist fee, and a $5 shipping fee. Prior research has focused on the theoretical savings MCCPDC could offer if Medicare purchased drugs at MCCPDC prices with studies reporting a potential $3.3 billion in savings for Medicare. Prescription drug spending is continuing to rise in the United States and providers are increasingly considering patient’s out-of-pocket costs. MCCPDC touts a transparent, consistent pricing model, but it is unclear if this pricing model will actually translate to cost savings for patients. Objective We sought to analyze if Mark Cuban Cost Plus Drug Company (MCCPDC) can offer savings directly to patients compared with other mail-order pharmacies, local pharmacies (based on zip code of our urology clinic) and with patients using health insurance to fill prescriptions for their sildenafil, vardenafil and tadalafil. Methods Out of the approximately 100 generic drugs available on MCCPDC website, we analyzed the 3 drugs that are prescribed to treat erectile dysfunction. We analyzed drug prices of 30 and 90-day prescriptions at the same dose of each medication. Using Good Rx prescription drug search engine, we compared the drug prices of the cheapest mail order and local in person pharmacies near our zip code. We also included prices for the recently started telemedicine company Roman. To compare if MCCPDC could offer savings to patients using health insurance to fill their prescriptions, we extracted the out-of-pocket drug costs for patients from the 2020 Medical Expenditure Panel Survey (MEPS; a national survey that compiles data from both the pharmacy and the survey respondent to determine the exact cost of each prescription filled during that year) and the 2020 Medicare Part D spending data. Medicare Part D spending data was used to estimate the out-of-pocket cost for each medication, which is approximately a 25% copayment for Medicare prescriptions. Results MCCPDC offered the lowest direct-to-consumer price on sildenafil and tadalafil 90-day prescriptions (Table 1). MCCPDC saved patients approximately $10 per sildenafil and tadalafil prescription compared with the next cheapest option. We found additional, although smaller, savings at 30-day prescriptions for sildenafil and tadalafil. MCCPDC was not the cheapest option for vardenafil. Compared with Roman, MCCPDC offered cheaper prescriptions for sildenafil and tadalafil by over $300 and $900, respectively. Conclusions MCCPDC can offer significant cost savings to patients, especially considering the high number of sildenafil and tadalafil prescriptions each year. The transparency and consistency in pricing with MCCPDC can be utilized by providers when counseling patients on medical therapy options for erectile dysfunction. Disclosure No.

(317) Significant Cost Savings for Erectile Dysfunction Medications are Available Using Discount Online Pharmacies Compared to Medicare

Abstract Introduction The Mark Cuban Cost Plus Drug Company (CPD) is an online retailer launched in January 2022 that sells generic prescription medications directly to consumers at cost of ingredients and manufacturing plus a fixed 15% margin in addition to a small pharmacy dispensing fee and shipping fee. GoodRx is an online tool which offers coupons redeemable at pharmacies for discounts on prescription medications. The combination of these two tools offers physicians a way to provide prescription medications to patients at lower costs, which may lead to improved medication adherence and lower medication expenditures nationally. Objective To compare the cost of various erectile dysfunction medications when purchased through retail pharmacies, reimbursed through Medicare, or obtained utilizing CPD and GoodRx. Methods A review of publicly available data from CPD and GoodRx was performed to obtain average retail and discounted prices for generic sildenafil, tadalafil, and vardenafil. GoodRx prices were obtained using prices from Costco, CVS, Walgreens, and Walmart pharmacies in the most from populous zip code from each of the 3 most populous U.S. states: California, New York, and Texas. Prices were adjusted to account for dosage and prescribed quantity to estimate an average cost per dosage unit ($/adu). The Medicare Part D Drug Spending and Utilization data from 2021 were used to report the average spending per dosage unit and total expenditure for each of the listed medications. These data were compared to create an estimate of average national savings after use of CPD or GoodRx. Results Average spending per dosage unit for sildenafil, tadalafil, and vardenafil was less when GoodRx or CPD were used (0.28 $/adu, 0.31 $/adu, and 6.17 $/adu respectively), compared to Medicare pricing (2.14 $/adu, 8.08 $/adu, and 27.84 $/adu respectively) or retail pricing (0.52 $/adu, 2.82 $/adu, and 8.35 $/adu respectively). When adjusted for total dosage units, use of CPD over Medicare pricing for the three medications would result in a combined annual national saving of $149M. Use of either CPD or GoodRx compared to retail pricing would similarly result in a combined annual nation saving of $40M. Conclusions The utilization of CPD and GoodRx in the prescription of common erectile dysfunction medications may lead to significant reductions in pricing compared to retail and Medicare estimates. Knowledge of these prescription tools may lead to significant reductions in national expenditures on medications and decreased cost burden for patients seeking treatment. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

(003) Use of Online Pharmacy Tools May Lead to Significantly Reduced National Expenditures on Vaginal Estrogen

Abstract Introduction High medication costs for vaginal estrogen may create a barrier for patients seeking treatment for numerous urinary and vaginal symptoms and lead to poor medication adherence. The Mark Cuban Cost Plus Drug Company (CPD) and GoodRx tools offer patients a method to purchase prescription medications at a discount, which may lead to improved medication adherence and decreased national expenditures on such medications. Objective To compare the pricing of vaginal estrogen as advertised by retail pharmacies, Medicare, and discount listings through CPD and GoodRx. Methods A review of publicly available data from CPD and GoodRx was performed to obtain listed retail and discounted prices for Estrace (topical), Vagifem (tablet), and Premarin (topical). GoodRx prices were obtained using prices from Costco, CVS, Walgreens, and Walmart pharmacies in the most from populous zip code from each of the 3 most populous U.S. states: California, New York, and Texas. Prices were adjusted to account for dosage and prescribed quantity to estimate an average cost per dosage unit ($/adu). The Medicare Part D Drug Spending and Utilization data from 2021 were used to report the average spending per dosage unit and total expenditure for each of the listed medications. These data were compared to create an estimate of average national savings after use of CPD and/or GoodRx. Results Average spending per dosage unit for Estrace, Vagifem, and Premarin was lesser when discount tools were used (0.50 $/adu, 3.75 $/adu, and 4.30 $/adu respectively), compared to Medicare pricing (6.14 $/adu, 20.95 $/adu, and 10.10 $/adu respectively) or retail pricing (3.14 $/adu, 10.19 $/adu, and 5.43 $/adu respectively). When adjusted for total dosage units, use of CPD over Medicare pricing for the three medications would result in a combined annual national saving of $64.2M. Use of either CPD or GoodRx compared to retail pricing would similarly result in a combined annual national saving of $39.2M. Conclusions The utilization of CPD and GoodRx in the prescription of vaginal estrogen led to a substantial national average cost savings when compared to retail and Medicare pricing. CPD and GoodRx may offer a way to decrease the cost burden for patients seeking treatment for urinary and vaginal symptoms and significantly reduce national expenditures on medications. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

Analyzing third-party data leaks on online pharmacy websites

PurposeWith digitalization, using essential digital services such as online services has become increasingly common. These services process sensitive health related data, such as customers’ prescription medicine orders, which makes ensuring stringent data privacy crucial. The current study examines third parties such as analytics services on Finnish pharmacy websites and investigates the nature and contents of data leaks on these websites.MethodsWe perform an extensive network traffic analysis to reveal data leaks among 163 Finnish online pharmacies. We also study a set of privacy policies of these online pharmacies, and provide a legal analysis regarding the interpretation of the concept of data concerning health in the context of online pharmacies.ResultsOur findings reveal serious data leaks among Finnish online pharmacies. We found 145 pharmacies had third-party services on their websites and only 18 did not. Out of all 163 online pharmacies, 57 (35.0 %) leaked a specific prescription medicine name connected with identifying personal data on the customer. We argue that the information concerning purchases on the prescription medicines should be interpreted as data concerning health to ensure efficient protection of customers’ right to data protection and privacy.ConclusionsWe hope that these concerning results will serve as a wake-up call for the developers and maintainers of online pharmacies and other web services processing sensitive data. Any third-party services incorporated into websites processing sensitive personal data should be closely inspected in terms of data leaks, or preferably not used at all.

A Scoping Review of Online Pharmacies and ePrescriptions: What are the Opinions of Pharmacists and Patients?

A Scoping Review of Online Pharmacies and ePrescriptions: What are the Opinions of Pharmacists and Patients?

Analysis of the Marketing and Claims of Online Pharmacies: A Focus on Administrative, Regulatory and Content Criteria

Analysis of the Marketing and Claims of Online Pharmacies: A Focus on Administrative, Regulatory and Content Criteria