online pharmacy online pharmacy an online pharmacy, internet pharmacy, or mail-order pharmacy is a pharmacy that operates over the internet and sends orders to customers through mail, shipping companies, or online pharmacy web portal. e-commerce online goods and services digital distribution ebooks software streaming media retail services banking dvd-by-mail delivery (commerce) flower delivery food delivery online food ordering grocery pharmacy ride-hailing travel marketplace services advertising auctions comparison shopping auction software social commerce trading communities wallet mobile commerce payment ticketing customer service call centre help desk live support software e-procurement purchase-to-pay super-apps online pharmacies include: pharmacy benefits managers – entities that administrate corporate prescription drug plans. legitimate internet pharmacies in the same country as the person ordering. legitimate internet pharmacies in a different country than the person ordering. this type of pharmacy is usually licensed by its home country and follows those regulations, not those of the international orders. illegal or unethical internet pharmacies. the web page for an illegal pharmacy may contain lies about its home country, procedures, or certifications. the "pharmacy" may send outdated (expired shelf life) or counterfeit medications and may not follow standard procedural safeguards. home delivery conventional brick and mortar pharmacies usually have controlled drug distribution systems from the manufacturer, sufficient validation, and follow good distribution practices. home delivery of pharmaceuticals can be a desirable convenience, but sometimes it can lead to problems with uncontrolled distribution. the shipment of drugs through the mail and parcel post is sometimes a concern for temperature-sensitive pharmaceuticals. uncontrolled shipping conditions can include high and low temperatures outside the listed storage conditions for a drug. for example, the us fda found the temperature in a mailbox in the sun could reach 136 °f (58 °c) while the ambient air temperature was 101 °f (38 °c). shipment by express mail and couriers reduces transit time and often involves delivery to the door, rather than a mailbox. the use of insulated shipping containers also helps control drug temperatures, reducing risks to drug safety and efficacy. risks and concerns illegal or unethical pharmacies sometimes send outdated, substituted, or counterfeit medications to the person who ordered the drug instead of the real medication. sometimes, an online pharmacy may not be located in a country that is claimed. for example, one study of drug shipments claiming to be from canada revealed many of the drugs actually originated in several other countries and were often false medications. minors can order controlled substances without adult supervision. other concerns include potential lack of confidentiality, improper packaging, inability to check for drug interactions, and several other issues. the british community pharmacy patient safety group was concerned that online pharmacies should implement “appropriate safeguards”, “particularly when prescribing and dispensing medicines that are liable to abuse, misuse and overuse”. the coroner in leicester investigating a death found that a patient requesting drugs “has potential access to multiple online pharmacies”, each of which “have no knowledge of what each other have been prescribing”. discussion canisters containing pharmaceuticals are loaded into an automatic dispensing machine at a mail-order pharmacy. legitimate mail-order pharmacies are somewhat similar to community pharmacies; one primary difference is the method by which the medications are requested and received. some customers consider this to be more convenient than traveling to a community drugstore, in the same way as ordering goods online rather than going to a shop. while many internet pharmacies sell prescription drugs only with a prescription, some do not require a written prescription, as prescriptions may not be necessary in some countries. some customers order drugs from such pharmacies to avoid the cost and inconvenience of visiting a doctor or to obtain medications their doctors are unwilling to prescribe. people living in the united states and other countries where prescription medications are costly may turn to online pharmacies to save money. online pharmacies in the united states are required to be approved by the national association of boards of pharmacy (nabp). many of the reputable websites employ their in-house physicians to review the medication request and write a prescription accordingly. some websites offer medications without a prescription or a doctor review. this practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit, and the suitability of a medication for a specific individual. pharmacies offering medication without requiring a prescription, doctor review, or supervision are sometimes fraudulent and may supply counterfeit, ineffective, and possibly dangerous medicines. international consumers main article: consumer import of prescription drugs international consumers sometimes purchase drugs online from online pharmacies in their own countries or those located in other countries. a distinct increase in the frequency of buying medicines and health products online was measured since the breakout of the covid-19 pandemic. some of these pharmacies require prescriptions while others do not. of those that do not require prescriptions, some ask the customer to fill in a health questionnaire with their order. many drugs available at legitimate online pharmacies are produced by well-known manufacturers such as pfizer, wyeth, roche, and generic drug makers cipla and ranbaxy of india and teva pharmaceutical industries of israel. however, it remains difficult for a patient to ascertain whether an online pharmacy is legitimate. medicines obtained from rogue online pharmacies come with no guarantees concerning their identity, history, and source. a study in three cities in the netherlands found that over 60% of the consumed sildenafil was obtained from illegal sources. roger bate from the american enterprise institute tested hundreds of prescription drug orders purchased over the internet and discovered that properly credentialed online pharmacies, ones selling domestically and internationally, only sell lawfully-manufactured medicines. u.s. consumers drug costs are a big point of attraction for online pharmacies. shoppers can sometimes obtain 50 to 80 percent or more savings on u.s. prices at foreign pharmacies. the "washington post" reported that "millions of americans have turned to mexico and other countries in search of bargain drugs" and that "u.s. customs estimates 10 million u.s. citizens bring in medications at land borders each year. an additional 2 million packages of pharmaceuticals arrive annually by international mail from thailand, india, south africa, and other countries. still, more packages come from online pharmacies in canada." according to a wall street journal/harris online poll in 2006, 80 percent of americans favor importing drugs from canada and other countries. factors independently associated with importation by u.s. residents are age greater than 45 years, south or west region of residence, hispanic ethnicity, college education, poor or near-poor poverty status, lack of u.s. citizenship, travel to developing countries, lack of health insurance, high family out-of-pocket medical costs, trouble finding a healthcare provider, fair or poor self-reported health status, filling a prescription on the internet, and using online chat groups to learn about health. former us president barack obama's budget supported a plan to allow people to buy cheaper drugs from other countries. a 2016 study suggested that providing health insurance coverage may significantly reduce personal prescription drug importation and the subsequent risk of exposure to counterfeit, adulterated, and substandard medications. furthermore, health insurance coverage is likely to be particularly effective at reducing importation among hispanic persons; those born in latin america, russia, or europe; and people that traveled to developing countries. a report in the journal clinical therapeutics found that u.s. consumers face a risk of getting counterfeit drugs because of the rising internet sales of drugs, with worldwide counterfeit drug sales, offline and online, projected to reach $75 billion by 2010. in 2015 the organisation for economic co-operation and development (oecd) estimated that counterfeit sales approximated around $200 billion us in 2013. independent research published by the national bureau of economic research demonstrates that online pharmacies, u.s. and foreign, verified by certain credentialing entities, sell genuine medication and require a prescription. in that study, all tested prescription drug orders were found to be authentic when ordered from online pharmacies approved by pharmacychecker.com (both international and u.s.-only); u.s. online pharmacies approved by the nabp, verified internet pharmacy practice sites (vipps) program, or legitscript; and canadian-based online pharmacies approved by the canadian international pharmacy association. nine percent of tested products ordered from uncredentialed online pharmacies were counterfeit. there are two verification programs for online pharmacies that are recognized by the national association of boards of pharmacy (nabp). one is vipps, which is operated by the nabp and was created in 1999. the food and drug administration (fda) refers to internet users interested in using an online pharmacy to the vipps program. the other is legitscript, which as of september 2010 had approved over 340 internet pharmacies as legitimate and identified over 47,000 "rogue" internet pharmacies. canadian and all non-u.s. online pharmacies that sell prescription medication to americans, regardless of credentials, are not eligible for approval in the vipps and legitscript programs. overseas online pharmacies and u.s. law legality and risks of purchasing drugs online depend on the specific kind and amount of drug being purchased. the fda believes that organized criminal networks control many online pharmacies that sell illegal pharmaceutical products without prescriptions. in 2014, the u.s. fda, in partnership with other federal and international agencies and technology companies like google, took action against websites that were selling drugs to u.s. consumers. mail order pharmacies are regulated by the federal laws of the u.s. and hundreds of them operate legally in the us. the u.s. fda believes that icann should do more to block and seize what the agency views as illegal online pharmacy websites. icann has articulated the position that it does not have the organizational mandate to take down online pharmacies, stating in one post on its website, "that icann is not a court and is not empowered to resolve disputes when parties disagree over what constitutes illegal activity in multiple countries around the world." the electronic frontier foundation, a non-profit organization defending civil rights on the internet, views the influence of the pharmaceutical industry on the internet as a form of censorship that threatens the ability of american consumers to access medicines in other countries purchased from online pharmacies that sell legitimate medicines. a proposal called the safe importation action plan would allow states, wholesalers and pharmacies, but not patients, to buy drugs from canada. enforcement in the u.s. it is illegal to purchase controlled substances from an overseas pharmacy. a person purchasing a controlled substance from such a pharmacy may be violating several federal laws that carry stiff penalties. any package containing prescription drugs may be seized by u.s. customs and border protection. the package may be held and eventually returned to the sender if the addressee does not respond and provide proof that they are allowed to receive these drugs (e.g., a valid prescription). in practice, the number of packages containing prescription drugs sent to the united states daily far exceeds cbp's capabilities to inspect them. in the past, packages often passed through customs even if they were not sent from canada or otherwise didn't meet the requirements of section 844 of 21 usc. in 2006, some canadian pharmacies reported that "as much as 5 percent" of orders from american consumers were being seized. the dea and the fda generally do not target consumers unless drugs are imported in large quantities (suggesting an intent to distribute) or represent a perceived danger to public health (opiates, amphetamines). rarely, drug importation laws are enforced on the local level. for example, in june 2005 in baton rouge, louisiana, several customers in online pharmacies were arrested by local law enforcement officers and charged with possession of a controlled substance without a prescription. the act of the importation of the controlled substance from overseas violates 21 usc, section 952 (up to 5 years in prison and $250,000 fine for the importation of non-narcotic schedule iii, iv, or v drugs; possibly more for narcotics and schedule i and ii drugs). the act of simple possession of a controlled substance without a valid prescription violates 21 usc, section 844 (up to 1 year in prison and $1,000 fine). the fda does not recognize online prescriptions: for a prescription to be valid, there must be a face-to-face relationship between the patient and the healthcare professional prescribing the drug. what exactly constitutes a "face-to-face" relationship is considered by many online pharmacies to be a subjective definition that would allow them to operate as