Originally published in the December 2010 NABP Newsletter
Pharmacists across the nation continue to receive too-good-to-be-true offers from rogue Internet drug outlets attempting to entice them to fill questionable prescriptions in return for large monetary reimbursements. While most pharmacists reject such offers, and some forward information about suspicious offers to their boards, others opt to fill such prescriptions, at times entering into agreements with these illegally operating online drug outlets. Depending upon the authority of the state board of pharmacy, and the circumstances of the case, board actions to stop these activities have taken various forms.
Boards Discipline Licensees for Role in Schemes
Several state boards of pharmacy have taken action by disciplining board licensees, both pharmacists and pharmacies, discovered to have filled invalid prescriptions on behalf of rogue Internet drug outlets. As early as 2002, the California State Board of Pharmacy issued citations against a pharmacy and pharmacists that allegedly dispensed prescriptions on behalf of Internet drug outlets in violation of state law. Specifically, a Los Angeles pharmacy and two pharmacists were issued a citation which claimed that they filled more than 3,500 prescriptions that were written without a “good faith prior medical examination” as required by California law. In recent years, the California State Board of Pharmacy has been aggressively pursuing California-licensed pharmacies, as well as pharmacies licensed in other states, that are dispensing prescription drugs to Californians without a valid prescription on behalf of rogue Internet drug outlets. And, as Virginia “Giny” Herold, MS, executive officer, California State Board of Pharmacy explains, California law requires that the prescribing physician be licensed in California and that an appropriate medical exam be conducted prior to writing a prescription for a California patient. Since 2009, the California Board has assessed $600 million in fines against pharmacies and pharmacists who, in association with Internet drug outlet operations, have dispensed medications based on invalid prescriptions that did not meet the requirements stipulated by California law.
Herold notes that offers to dispense for such illegal Internet operations are generally conspicuously illegal. For example, when multiple patients are receiving prescriptions for the same Schedule III drugs from a single prescriber, or when overnight envelopes from another state arrive containing a stack of “prescriptions” for patients in California and elsewhere, licensees should suspect that the situation may well be in violation of pharmacy law. While pharmacists recognize the signs, unfortunately some opt to take the risk of participating in these illegal Internet outlet operations.
The California Board has become aware of such cases in various ways including receiving complaints, receiving information from other state boards of pharmacy, or by being informed of unusually high quantities of certain medications purchased from wholesalers by a single buyer.
The Minnesota Board of Pharmacy has also disciplined licensees for involvement with Internet drug outlets that offered to arrange for the sale of legend drugs. In mid-2008, pharmacists at two Minnesota pharmacies accepted “prescriptions” sent electronically, and written by a physician and a physician assistant based on reviews of online questionnaires. The pharmacists then shipped legend drugs to customers located across the country, and one pharmacy shipped controlled substances. As noted in the Minnesota Board of Pharmacy Newsletter, the Minnesota Board “has the authority to pursue action against pharmacists and pharmacies involved in the processing of prescriptions that they know originate from illegitimate Web sites.” In this case, the Board placed most of the pharmacists involved on probation and issued fines. One of the pharmacists voluntarily surrendered his license, and one of the pharmacies had its license placed on probation and received a civil penalty.
Boards of pharmacy in two states have taken a different route to shut down pharmacies involved in such arrangements.
The Iowa Board of Pharmacy took emergency disciplinary action against the Union Family Pharmacy in Dubuque, IA, and two pharmacists. The case initiated federal investigations and a six-year criminal prosecution. Federal authorities found evidence that the pharmacy had dispensed more than one million prescription pain, diet, and psychiatric medications over a six-month period for two Florida-based Internet companies. The invalid prescriptions were filled although no medical examinations were conducted and the physicians involved had no contact with the patients. Ultimately, 26 people, including 19 doctors, were convicted in a United States District Court.
In a similar action, the Kansas State Board of Pharmacy issued an emergency order on March 12, 2008, which closed Hogan’s Pharmacy and declared it an imminent danger to the public. The Kansas Board’s order alleged that Hogan’s did not obtain valid prescriptions before dispensing prescription drugs to Internet customers and that 95% of Hogan’s business was Internet based.
The Ohio State Board of Pharmacy has also taken action against involvement in Internet drug outlet operations by revoking the licenses of pharmacies and pharmacists. For example, in April 2007, the Board revoked the licenses of Dublin-based Caringwell Pharmacy Inc and its owner for allegedly dispensing more than 667,000 drug tablets – mostly hydrocodone – without valid prescriptions from November 29, 2006 through March 29, 2007. Nearly all the prescriptions were generated from Web sites by out-of-state physicians.
State Boards Use Newsletters to Caution Pharmacists
Rogue Internet drug outlets have offered similar arrangements to pharmacies and pharmacists across the country. Throughout 2007, state boards of pharmacy in Kentucky, Oklahoma, Alabama, North Carolina, and Delaware, used their newsletters to remind licensees of the illegality of Internet drug outlets that offer prescriptions that are not based on face-to-face medical examinations by a prescribing physician, and to warn licensees about solicitations requesting that pharmacies act as “fulfillment centers” for these invalid prescriptions.
In 2009, boards of pharmacy in Nevada, Alabama, and Vermont updated their registrants with information about the Ryan Haight Online Pharmacy Consumer Protection Act. The North Carolina Board of Pharmacy also reminded pharmacists that prescriptions filled through Internet pharmacies for patients in North Carolina are governed by the stricter laws in their state. For example, Internet pharmacies dispensing to residents in North Carolina must have VIPPS® (Verified Internet Pharmacy Practice SitesCM) accreditation.
State Data Influences Federal Action
The details of cases in Ohio, including two that were investigated in the Ohio State Board of Pharmacy’s capacity as a law enforcement agency, were presented by William T. Winsley, MS, RPh, executive director of the Ohio Board, in written testimony to a congressional subcommittee, which was considered at the Hearing on Online Pharmacies and the Problem of Internet Drug Abuse on June 24, 2008. In the testimony, Winsley noted that state laws and rules related to Internet pharmacies vary widely and explained that a federal law would allow federal agencies to take actions even in states that do not have related laws, or in which the law is not strong enough.
The hearing impacted the passage of the Ryan Haight Online Pharmacy Consumer Protection Act, which became effective April 13, 2009. On May 12, 2010, Drug Enforcement Administration (DEA) issued a news release announcing that the first charges in violation of the Ryan Haight Act were filed against two individuals, Carleta Carolina and Wayne White. Allegedly, from at least April 2005 to December 7, 2009, the defendants illegally distributed controlled and non-controlled prescription drugs to individuals without valid prescriptions as part of a large-scale rogue Internet drug outlet operation.
“The Ryan Haight Act has placed pressure on Internet drug outlets especially for controlled substances distribution,” explains Virginia Herold, “But there are still some who are bold enough to continue these illegal operations, and to continue soliciting board licensees for their participation.” The vigilance of the state boards of pharmacy, as well as their partnerships with DEA, remain paramount in the fight against Internet drug outlets that involve licensees of the states.