Filling Prescriptions with a Click

Proponents of the legalization of mail-order medicine say it has one major advantage -- it will lower the costs of health care.

Patients clicking online to fill prescriptions should pay 10 to 30 percent less for drugs, according to Dr. Peter Weber, who already runs an online pharmacy offering around 10,000 products -- mostly vitamins and cough drops, since "real" medicines can't yet be sold online under current law.

He set up the server for his cyberpharmacy in the backroom of his "real" pharmacy in the city of Cologne five years ago and has done a brisk business ever since.

"We get about a million hits per month and send out thousands of shipments in that time," he said. He hopes he'll be able to add other medicines to his online selection in the near future. "Think about people with chronic illnesses, who need medicines for diabetes and high blood pressure. I think it's possible to send out these kinds of medicines without any risk," he added.

Still, Weber said, online pharmacies need to have very clear guidelines. "If they're legally allowed in Germany then there needs to be a quality management system," he said. "Only real, functioning pharmacies should be allowed to operate online versions and they have to be officially licensed." Only then could online consultations, either by e-mail or phone, be safeguarded, he said, and would the client be sure he is getting the right medications.

Patients protecting themselves?

Pharmacy associations in Germany warn that the introduction of mail-order drugs could be bad medicine for patients. A "seal of approval" for Internet providers has never been successfully established, according to Thomas Preis, chairman of the North Rhine Association of Pharmacies. In his opinion, such a scheme would not work for mail-order drug providers either.

He categorically rejects any kind of online drug sales, even if a licensed pharmacist is behind the online drug store: "The consumer cannot discern whether the drug came through appropriate trade channels. He can't know, where the medicines came from."

He fears that consumers could receive medicines which have passed their expiration date, are of poor quality or only include instructions in a foreign language. In his opinion, mix-ups are likely.

He also rejects the argument that online medicines will end up being less expensive in the long run, saying while online commerce is touted as leading to cost savings, in the end, studies have show the opposite is often true.

Moreover, Weber said, online pharmacies could threaten the existence of their brick and mortar cousins, since they could corner the market on inexpensive drugs. As a result, real pharmacies would be left with expensive, seldom-used drugs on their shelves in additional to the costs for staffing and consultation. That, he said, could close them down.

Positive experience in the Netherlands

However, Dieter Hebel, head of Gmünder Health, sees in a mail-order medicine future the possibility of real savings and perhaps of lowering consumers' health insurance premiums. "The pharmacies should not always talk about keeping hold of their monopoly," he argues. "Rather they should realize that as local service centers, they have a different relationship with customers and can offer them alternatives."

He disagrees that mail-order medicines can pose a danger to the public. Consumers should be able to differentiate which medicines they can buy on the Internet and which ones require consultations with a real pharmacist, according to Hebel. He points to experiences in Dutch online pharmacies, all of whom have official licensing.

"I don't think quality will be endangered," he said.