How do international mail order pharmacies work?

January 3, 2023 8:30 AM

I have wondered for years about how people are ordering medications from India or Mexico. *this is not a question about how to do an illegal thing* I don’t understand how the logistics of this work.

Are people … testing pills they receive? Are there like … verification sites for which illegitimate site will send you real product? How does it even make it through the mail system? Is this a situation where people are comfortable taking some risk and hoping for the best? Do these sites have doctors or pharmacists on staff? Do people need prescriptions? I am curious about all this because it feels like this cultural phenomenon that gets talked about that I know literally nothing about, and I don’t trust sensationalized news media takes that feel like copaganda. It seems like people must be doing this safely.

As an example of what I hear a lot of - Assuming someone wanted viagra, had been prescribed it by a doctor but couldn’t afford it in the United States and wanted to mail order it, what would doing that look like?

posted by Bottlecap to Grab Bag (11 answers total)

https://www.npr.org/sections/money/2016/05/11/477377662/episode-430-black-market-pharmacies-and-the-spam-empire-behind-them
posted by bq at 8:37 AM on January 3, 2023

My cat has asthma and needs an inhaler once a day (the looks I get when I tell people this...), and the vet that prescribed it recommended getting it from Canada through an online service because of the outrageous cost in the US.

I googled and found a company that seemed decently reviewed, Canada Drugs Direct. It did seem super sketchy at first (they require a check to be mailed or emailed (?), no credit card payments, they clearly outsource their customer service, and the inhaler comes from NOT Canada, usually New Zealand or Europe, and takes like five weeks to arrive after ordering. But, they are super on top of my order every time, they inform me of they're missing a prescription, they remind me when it's time to refill, and it seems to be a legit inhaler (l have no way to test it but the cat coughs when he's off it and doesn't when he's on it). It's the same exact medicine humans use for daily asthma inhalers.

And it's pretty much the only way I can afford to get him his medicine. It's $284 at the local Costco, versus $50 through the Canadian website.
posted by carlypennylane at 8:47 AM on January 3, 2023 [8 favorites]

I order my dog's medication from a Canadian pharmacy because it is much much cheaper than paying full retail at a US pharmacy. Logistically, the vet can either transmit the prescription directly to the pharmacy or I can upload/fax/mail a paper prescription to them. You upload a check for the first order so they have your banking information. Subsequent orders are paid for by direct draft on your bank account. Canadian pharmacies are licensed and subject to strict safety protocols, so no worries about authenticity. I've been doing this for 2+ years with no problems; the one time my order didn't arrive, they replaced it with no hassle.
posted by DrGail at 8:51 AM on January 3, 2023 [4 favorites]

It's pretty easy to look up what the pills and packaging for various Indian pharmacies look like and check what you get against that.

As someone who has bought medications online a few times, my concern has always been more that the seller will just keep my crypto (can't do a chargeback) and not ship my meds than they will send me a counterfeit product.

A lot of drugs that are prescription-only and expensive in the US are over-the-counter and cheap in other countries, to the point where making a counterfeit version would be more expensive and time consuming than just going to the store and buying the real thing.

Think about it -- if someone was paying you a 5-10x markup plus shipping to send them a bottle of Tylenol, wouldn't it be much easier to just go to the store and buy some actual Tylenol instead of getting all the necessary equipment to manufacture fake Tylenol in passable fake Tylenol-branded packaging? Especially if you're looking for repeat customers?

Now, straight-up illegal drugs like ecstasy, those you want to test because you know no one is just buying that from the store and thus there's no legitimate product to compare them to.
posted by Jacqueline at 9:00 AM on January 3, 2023 [9 favorites]

The person in my life who does this regularly does it because their disabilities, their poverty, and the American medical system make it so that they simply cannot reliably see doctors or pay for prescriptions through American pharmacies. It is less “comfortable taking small risk” than “the other alternative is not to have the meds at all, which is a large known risk, so this is least bad of the uncomfortable options.” They hope for the best, share information with other people in the same boat about which providers have worked for them, and once they’ve found a company that works, stick with that one as much as possible.

To the best of my knowledge, though we haven’t talked about this lately so I don’t know if pandemic supply chain issues have added new fuckery to the proceedings, they’ve always received their packages and have as far as they can tell always received the real expected product.
posted by Stacey at 9:23 AM on January 3, 2023 [3 favorites]

In trans communities, the sites are known by word of mouth. Self-medding of estrogen is, to my understanding, legal in the UK and people do it because they can't reasonably access hormones "legitimately" (the NHS GIC system has essentially collapsed, GPs largely won't prescribe without the GIC (though, in principle they can), so it's self-med or go private). My understanding is that packages do sometimes get delayed or confiscated by customs.

Testosterone is significantly more tightly controlled in almost all countries (there are one or two where it's actually available without prescription) meaning DIY is not a thing in transmasculine circles.
posted by hoyland at 9:38 AM on January 3, 2023 [2 favorites]

I do this, with a prescription. I know nothing of how this gets done without a prescription. In my case, even with my very good health insurance, the cost of the medication in the US would be $1200 a week. I found a community on Reddit centered on my medication, because the cost issue with this med is common. From that community I gained enough confidence in the two Canadian pharmacies recommended to give it a try. (One has a brick and mortar presence; the other does not.) I uploaded my doctor's prescription and I placed the order using a credit card. A live human from the pharmacy called me to ask a follow-up question to be sure I received what I wanted. What I received is authentic and effective. I have ordered refills and received the same authentic, effective med each time. My doctor said many of her patients do the same thing with expensive meds--but she didn't share this info until after I told her I'd done it.
posted by ImproviseOrDie at 9:55 AM on January 3, 2023 [1 favorite]

i have been getting my cat's inhaler from overseas for a decade. the pharmacies i've used has changed a few times due to price or shipping time vagaries, but i've never had a problem. some require scripts, some only "require" them. credit cards are not accepted by most for hand wavey legal reasons, but i've had no fraud issues come from mailing a check to the US address provided. shipping is often quite long, and the first year or two of covid shipping was even longer and slower than usual, but i could plan for it. the only thing that's a real risk to me is if customs decides to be a dick that day and not let my meds into the country. but since so little is actually looked at at the border, i'm not really worried about that either.
posted by misanthropicsarah at 10:06 AM on January 3, 2023 [1 favorite]

Yep, thirding the overseas sourcing of asthma inhalers for a cat! I think most recently we've been getting them from New Zealand. The slow shipping times are the biggest problem. But the cost savings are so dramatic.
posted by Artifice_Eternity at 10:42 AM on January 3, 2023 [1 favorite]

The entire country I live in ran out of a common prescription drug a while back so I ended up grey-marketing (sans prescription) it from an Indian pharmacy. I was cheered by how cheap it was — who goes to the trouble of producing professionally packaged medication for next to nothing? — but I still monitored things pretty closely for a while in case there were quality issues.

It was sent via air mail and marked as "health supplements." It’s not like there are prescription medication smelling dogs watching the mail, so there was little reason for it to be flagged.

After the initial purchase the country supply problem got worked out but I placed another order, a big one, as a backup supply in case it happens again.
posted by Tell Me No Lies at 12:16 PM on January 3, 2023 [2 favorites]

Response by poster: Thank you everyone! I feel like I understand now, and I truly appreciate your generosity in helping me “get” what’s happening. I’m really thankful to know that people are receiving genuine medication and that it’s an accessible route for people who have trouble accessing the truly disastrously expensive medical system.
posted by Bottlecap at 3:32 AM on January 4, 2023