Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Center for Innovative Pharmacy Education and Research, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
J Med Internet Res. 2022 Feb 14;24(2):e25855. doi: 10.2196/25855.
There is much public debate regarding the high cost of insulin. With 1-in-4 patients in the United States with type 1 diabetes reporting difficulties affording insulin, there is concern that some of these patients might look for cost savings on the internet, unaware that 96% of internet pharmacies are illegitimate. Patients who purchase insulin from illegitimate internet pharmacies remove themselves from traditional health care systems that ensure safe, quality-assured, and effective medication use.
This study aims to determine the accessibility of Humalog and NovoLog insulin from internet pharmacies and characterize how these sites approached patient safety, and priced as well as marketed their products.
From September to December 2019, we queried the phrases buy insulin online, buy Humalog online, and buy NovoLog online in common search engines. The first 100 search results from Google and Bing, and the first 50 search results from Yahoo! and DuckDuckGo were screened. Websites were included if they claimed to sell Humalog or NovoLog insulin, were active, free access, in the English language, and had a unique URL. The legitimacy of websites was classified using LegitScript. Safety and marketing characteristics were compared across the legitimacy of internet pharmacies. Internet pharmacy prices were compared with the prices offered through brick-and-mortar pharmacies using GoodRx.
We found that 59% (n=29) of the 49 internet pharmacies in our analysis were illegitimate, whereas only 14% (n=7) were legitimate and 27% (n=13) were unclassified. Across illegitimate internet pharmacies, Humalog and NovoLog insulin were 2 to 5 times cheaper as compared with both legitimate internet pharmacies and brick-and-mortar stores. Risks associated with the use of illegitimate internet pharmacies by American consumers were evident: 57% (8/14) did not require a prescription, 43% (6/14) did not display medication information or warnings, and only 21% (3/14) offered access to purported pharmacists. This included 9 rogue internet pharmacies that sold Humalog and NovoLog insulin within the United States, where 11% (1/9) required a prescription, 11% (1/9) placed quantity limits per purchase, and none offered pharmacist services. Rogue internet pharmacies often offered bulk discounts (11/18, 61%), assured privacy (14/18, 78%), and promoted other products alongside insulin (13/18, 72%). The marketing language of illegitimate internet pharmacies appealed more to quality, safety, and customer service as compared with legitimate sites.
The ease of access to low-cost insulin through illegitimate internet pharmacies calls for urgent attention. Illegitimate internet pharmacies place patients at risk of poor-quality medications and subpar pharmacy services, resulting in adverse events and poor diabetes control. A multifaceted approach is needed to close illegitimate internet pharmacies through legal and regulatory measures, develop better search engine filters, raise public awareness of the dangers of illegitimate internet pharmacies, and address the high costs of insulin.
公众对胰岛素的高昂价格存在诸多争议。在美国，每 4 名 1 型糖尿病患者中就有 1 名报告称难以负担胰岛素的费用，因此人们担心这些患者中的一些人可能会在互联网上寻求节省成本的方法，但他们可能并不知道，96%的互联网药店都是非法的。从非法互联网药店购买胰岛素的患者会脱离传统的医疗保健系统，而这些系统可以确保安全、有质量保证和有效的药物使用。
本研究旨在确定从互联网药店购买 Humalog 和 NovoLog 胰岛素的便捷程度，并描述这些网站如何处理患者安全问题，以及如何定价、营销其产品。
在 2019 年 9 月至 12 月期间，我们在常用搜索引擎中查询了“网上购买胰岛素”、“网上购买 Humalog”和“网上购买 NovoLog”等短语。从谷歌和必应的前 100 个搜索结果，以及雅虎和 DuckDuckGo 的前 50 个搜索结果中筛选出网站。如果网站声称销售 Humalog 或 NovoLog 胰岛素、处于活跃状态、免费访问、使用英文且具有唯一的 URL，则将其纳入研究。使用 LegitScript 对网站的合法性进行分类。比较了互联网药店的合法性对安全性和营销特征的影响。使用 GoodRx 比较了互联网药店和实体药店的价格。
我们发现，在我们分析的 49 家互联网药店中，有 59%（n=29）是非法的，而只有 14%（n=7）是合法的，27%（n=13）是未分类的。与合法的互联网药店和实体药店相比，非法互联网药店的 Humalog 和 NovoLog 胰岛素价格便宜 2 到 5 倍。美国消费者使用非法互联网药店存在明显的风险：57%（8/14）不需要处方，43%（6/14）没有显示药物信息或警告，只有 21%（3/14）提供所谓的药剂师服务。这包括 9 家在美销售 Humalog 和 NovoLog 胰岛素的非法互联网药店，其中 11%（1/9）需要处方，11%（1/9）对每次购买都有限量，没有一家提供药剂师服务。非法互联网药店经常提供批量折扣（11/18，61%）、保证隐私（14/18，78%），并在销售胰岛素的同时推广其他产品（13/18，72%）。非法互联网药店的营销语言在质量、安全性和客户服务方面比合法网站更有吸引力。
通过非法互联网药店轻松获得低成本胰岛素的问题亟待关注。非法互联网药店使患者面临劣质药物和服务不佳的风险，导致不良事件和糖尿病控制不佳。需要采取多方面的措施，通过法律和监管措施关闭非法互联网药店，开发更好的搜索引擎过滤器，提高公众对非法互联网药店危险的认识，并解决胰岛素价格高昂的问题。
