'Clicks-and-mortar' pharmacies go for broke

Canadian internet pharmacies try to lay their
fly-by-night rep to rest with shiny new US accreditation.
But can money buy you cred?

By Colleen Gauthier

"The only thing I'm ruling out is compromising safety." So said recently retired FDA chief Mark McClellan back in September in a broadside against the reimportation of Canadian drugs.

The debate over the legitimacy of Canada's internet pharmacies is hot on both sides of the border. We know Americans are buying cheaper Canadian drugs in droves thanks to skyrocketing stateside script costs. At the same time, there have been growing fears in the US, partly due to lobby campaigns, that Canadian standards aren't up to snuff. The whole issue remains a grey area that both countries are struggling to get a handle on.

Despite uncertainties, many states are still keen on reimportation. In January, the state of Minnesota added a page to its website with instructions on how to order drugs from Canada. To quell fears about standards, the state looked to the new Internet and Mailorder Pharmacy Accreditation Commission (IMPAC) for the green light. IMPAC is a branch of the North American-Pharmotherapeutic Consultants Association, an advocacy group made up of pharmacists, physicians, politicians and others, which was partly set up to promote better mail-order pharmacy standards. The organization gives the seal of approval to Canadian internet pharmacies that meet its 92 requirements and pass an inspection. A pharmacy pays around $25,000 US for a two-year accreditation term.

OUTSIDE THE LAW
Though Minnesota was the first US state to use IMPAC, other states are following suit. After Winnipeg-based CanadaDrugs.com got its IMPAC seal of approval, the state of New Hampshire linked them to its website � "Click here to order your prescription from Canada" the link invites. So far, Minit Drugs of Calgary is the only other Canadian pharmacy on IMPAC's list. Others, like Wisconsin, skip this step and send their own inspectors up north. Wisconsin's residents can order their meds directly through the state's website from three different state-approved Canadian mail-order pharmacies � CanadaDrugs, Granville Pharmacy � and Total Care Pharmacy.

"I support the accreditation process entirely," says David MacKay, the executive director of the Canadian International Pharmacy Association (CIPA), a group representing drug-exporting Canadian pharmacies. "IMPAC helps to prove to the US that we're safe. It's an extra assurance."

But some accuse IMPAC of just encouraging people to circumvent the law. There is already an existing North American regulatory program called Verified Internet Pharmacy Practice Sites (VIPPS) a coalition of state and federal regulatory associations, professional associations and consumer advocacy groups run by the National Association of Boards of Pharmacy. However, VIPPS won't give accreditation to reimporters because it remains illegal to reimport drugs into the US � unlike IMPAC, VIPPS says its waiting until the law is changed to start approving online pharmacies.

Associations on this side of the border are taking the whole matter as a cue to tighten up their own guidelines. Ronald Guse, registrar of the Manitoba Pharmaceutical Association (MPhA), says it's clear that the rise of internet pharmacies presents a challenge to existing regulations in the province.

"Three years ago, we were sharp to identify the need to establish additional standards for the emerging internet pharmacies," he says. The MPhA came up with a list of internet pharmacy standards, including requiring them to state on their websites that they're licensed by the province.

Additional reporting by Peter Woodford