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■ n Chapter 16, I mention the possibility of buying prescription drugs from

Abroad by mail order as a way to lower expenses in Part D’s doughnut hole (formally called the coverage gap). You need to weigh the pros and cons, but if you decide to go this route, your chief concern is to make sure you order from a legitimate, licensed pharmacy that sends you the drugs your doctor prescribed.

Importing prescription drugs from abroad is still illegal in the United States. (Congress has passed legislation to legalize the practice, but it has never been put into effect, for reasons explained in Chapter 21.) However, no American has ever been prosecuted for importing drugs for his own personal use, and it’s extremely unlikely that anybody would be. For the millions of otherwise law-abiding citizens who’ve ordered prescription drugs from abroad — mostly senior citizens before Medicare drug coverage began in 2006 — it’s a no-brainer. The same meds that cost a fortune without insurance in the U. S. can often be bought from Canada and other countries, where drug prices are nationally regulated, for much less.

Certainly, getting drugs from abroad can be risky — unless you’re careful. Unscrupulous sellers who lurk behind anonymous Web sites peddle counterfeit and other harmful drugs. Scammers will take your money without sending you any meds. The U. S. Food and Drug Administration regularly cites these reasons in warning Americans against buying drugs from abroad.

But many reputable online pharmacies sell bona fide prescription drugs to Americans safely and ethically. This appendix shows you how to find those that offer quality services and how to avoid the ones that are dubious. It also suggests ways of locating pharmacies that have been prescreened for safety and service by state governments or organizations that give seals of approval to online pharmacies that meet certain standards.

In these pages, I focus on ordering drugs from licensed Canadian pharmacies. The Canadian federal and provincial governments regulate pharmacy practices and drug safety as rigorously as American health authorities do, and after nearly a decade of experience in the cross-border trade, these pharmacies have an established track record. They operate mail-order services because that’s the only way most Americans can buy drugs from Canada, although many people living in the northern-most states physically cross the border to fill prescriptions in regular drugstores. The mail-order pharmacies maintain Web sites that state their drug prices and policies and allow you to order online.

What if you don’t have Internet access? You can order meds by phone from a mail-order pharmacy, but first you’ll usually need someone to go online to look for a reputable one (by using the suggestions in this chapter) and find its phone number. Or you can call one of the state-operated services that provide links to prescreened Canadian pharmacies, as described later in this chapter.

Distinguishing the Good Guys from the Bad

Just because an online pharmacy Says It’s based in Canada doesn’t mean it is. And just because it has a Canadian address doesn’t mean it necessarily provides good service. Here are ways to evaluate legitimate pharmacies and avoid dubious sellers so you can be more confident that the medications you’ll receive are the ones your doctor prescribed.

Assessing safe and ethical service

American and Canadian pharmacy experts recommend that you choose an online pharmacy that uses the following best practices of

U Displaying on its Web site its license number and the name of the Canadian regulatory agency that granted it. This means you can check that it’s an authentic pharmacy. As an American, you have the same right to complain about a pharmacy to its licensing agency as a Canadian does.

U Displaying on its Web site the approval seals of organizations that set standards for safety and service and accredit pharmacies that meet the standards. See the next section for details of these organizations and how to ensure that the seals posted on pharmacy Web sites are genuine.

U Requiring a prescription from your doctor. This isn’t a hassle — it’s your best safety protection. Some reputable pharmacies may allow you to fax in the prescription, but will then phone your doctor to confirm the prescription or wait until they receive the original one in the mail before filling your order.

U Requiring you to have taken the drug for at least one month before you order by mail so you and your doctor know it’s working well for you.

U Requiring you to submit details of your medical history, usually through an online questionnaire.

U Stating its policy for ensuring your medical and personal privacy in clear language on its Web site.

U Sending drugs in the manufacturer’s original container with seals intact. This is normal practice among reputable Canadian pharmacies. In some cases, though, they may send drugs in regular pharmacy bottles if the manufacturer’s own containers hold different quantities than you order.

U Sending drugs with labeling written in English that includes strength, dosing directions, expiration date, appropriate warnings, and a Drug Identification Number (DIN) that shows the drug has been approved by the Canadian government health authorities.

U Explaining differences between American and Canadian drug names and labeling. The same drugs sometimes have different names in other countries.

U Explaining why it can’t provide certain drugs. Reputable pharmacies don’t sell drugs that are regarded as controlled substances under American law (like narcotics), or drugs that can’t be sent safely through the mail (such as some that require careful handling or refrigeration).

U Providing a full mailing address and a toll-free phone number on its Web site so you can call the pharmacist with questions, check on the status of an order, or order by phone instead of online if you prefer.

U Displaying on its Web site full information about shipping fees, payment policies, and refunds. Reputable pharmacies offer encrypted (that is, secure) online payment for credit cards, alternative payment options (such as electronic fund transfers and regular checks), and don’t charge any separate fees except for shipping.

U Charging the cost of drugs to your credit card only when they’ve been shipped to you — and not when the order is first placed.

U Refunding your money or shipping replacement drugs immediately if your order doesn’t arrive. Reputable pharmacies will do this even if your shipment is intercepted and confiscated by U. S. Customs, a practice that has happened in the past but has become much rarer in recent years since Congress condemned it.

Avoiding scams and dubious sellers

The snake oil salesmen are still out there and thriving — though these days they’re usually peddling fake Viagra and other drugs that folks feel too shy to ask their doctors about. These are basic guidelines for avoiding unscrupulous sellers and counterfeit drugs:

W Never use an online pharmacy that offers to sell you a prescription drug without a doctor’s prescription. This is the number-one no-no — a clear sign of unethical and potentially dangerous practices.

W Never use an online pharmacy that sends you an uninvited e-mail.

Those unwanted e-mails that pop up so frequently in your in-box should always be seen as outright attempts to scam you. Delete them!

W Don’t trust an online pharmacy that doesn’t display a customer service number on its Web site. If there’s no phone number, you can’t contact the pharmacy — so how can you know it actually exists?

Finding a Pharmacy You Can Trust

The best way to find reputable licensed pharmacies that give quality service is to use some kind of filter — that is, a system that has already identified pharmacies that operate according to the best practices listed in the "Assessing safe and ethical service" section. In the following sections, I suggest two types of filters:

W Programs set up by state governments to link consumers to prescreened Canadian pharmacies

W Organizations that give seals of approval to online pharmacies that meet their standards

Using state links to Canadian pharmacies

In 2003-04, two state governors lost patience waiting for the federal government to legally allow people access to low-cost prescription drugs from Canada. Both governors created Web sites offering links to Canadian pharmacies that state health officials have prescreened and regularly inspect to ensure safety and quality service.

W Minnesota RxConnect: This program, set up by Minnesota Governor Tim Pawlenty in 2003, offers links to four prescreened Canadian pharmacies. Some other states (and the District of Columbia) direct their residents to this program, but residents of any state can use it. Go to rxconnect. dhs. state. mn. us and click "Order Your Medicine from Canada." Or call 800-333-2433.

W Illinois I-SaveRx: This program, created by Illinois Governor Rod

Blagojevich in 2004, offers a link to one prescreened Canadian pharmacy. The program is open to residents of Illinois, Kansas, Missouri, Vermont, and Wisconsin. Call 866-472-8333 or go online to Www. i-saverx. net.

Looking online for seals of approval

Iijj|kB£W Hundreds of advertisements for low-cost prescription drugs litter the Internet, aimed at Americans who are trying to save money on their prescriptions. Every time you go online to search for any medical topic, these ads pop up onscreen in profusion. Some are legitimate, and some are total rip-offs. How can you tell which are which? You can’t. However, you can play it safe. Ignore the ads. Instead, look for licensed pharmacies that display, on their Web sites, the seals of approval awarded by organizations that have screened them to meet certain safety and service standards.

Here’s where those seals of approval come from:

W Internet and Mail-Order Pharmacy Accreditation Commission (IMPAC):

IMPAC was founded in 2003 in Vermont by an independent group of doctors and pharmacists to promote consumer safety and quality service among licensed mail-order pharmacies in the U. S. and other countries. A pharmacy must meet rigorous standards during a two-day on-site inspection every two years to receive and retain IMPAC accreditation. To see a list of the currently accredited pharmacies, go to Www. impac Survey. org or call 800-677-7019.

W Canadian International Pharmacy Association (CIPA): CIPA was formed in 2002 to represent licensed Canadian pharmacies that sell prescription drugs to Americans by mail order and that meet its safety, service, and ethical standards. The group has testified before Congress and state legislatures to address safety issues and to promote U. S. legalization of the cross-border trade for consumers buying prescription drugs from Canada for their personal use. To verify that a pharmacy is currently accredited by CIPA, go to Www. ciparx. ca.

W Better Business Bureau (BBB): The BBB awards its BBBOnline seal of approval to Web sites that meet its standards for ethical service, trustworthy business practices, and truth in advertising. You can check out BBB records for an online pharmacy, including whether the BBB has received consumer complaints about it, at Www. bbbonline. org. If you go to a pharmacy Web site that displays the BBB seal, clicking the seal will take you straight to the BBB report on that pharmacy.

W PharmacyChecker. com: This Web site, run by an independent American consumer research group, provides ratings and drug price comparisons for about 30 online pharmacies in the US. and abroad (mainly Canada). It gives its "verification" seal to those that meet five service standards — it’s licensed, requires a doctor’s prescription, displays its address and phone number, offers secure online financial transactions, and promises privacy for medical information. The site also posts names of "rogue" pharmacies that it considers unethical or unsafe. It compares prices for more than 1,000 drugs at verified pharmacies and posts customers’ comments on quality of service. Check it out at Www. pharmacychecker. com.

JttNG/ Approval seals awarded by these organizations provide a useful guide for

Consumers looking for a legitimate online pharmacy. However — wouldn’t you know? — some scam artists use these seals too to cheat customers by posting copies of them on their own rogue Web sites. The copies are good — you wouldn’t know the difference just by looking at them. However, you can verify whether the displayed seals are genuine or fraudulent. Clicking the image of a seal on a pharmacy Web site should take you straight to the Web site of the organization that awarded it, whether IMPAC, CIPA, BBB, or PharmacyChecker. If nothing happens, you can be sure that the seal isn’t genuine. Or you can go directly to the organization’s Web site and enter the name of the pharmacy. This will tell you whether the pharmacy is entitled to display the seal.