Chat transcript: Online pharmacies
June 29, 1999
Web posted at: 11:46 a.m. EDT (1546 GMT)
(CNN) -- Following is an edited transcript of a Health chat with Stephanie Schear of PlanetRx and Susan Winckler, director of policy and legislation for the American Pharmaceutical Association. The chat took place Friday, June 25, 1999.
Chat Moderator: To kick off our chat, we'd like to ask PlanetRx to tell us about what they do and how long they've been on the Web.
Stephanie Schear: PlanetRx.com is an online pharmacy. We offer many different types of health, beauty and wellness products. We fill new and refill prescriptions. We stock health and beauty products like cosmetics and fragrances, and personal care products like shampoo and toothpaste. Medical diagnostic kits and vitamins, herbs and nutritional supplements are also offered. We are open 24 hours, seven days a week. You can get access to all sorts of products as well as information about health conditions and expert advice. We have a service called "Ask the Pharmacist" where you can get answers to your specific individual questions. By calling up a 1-800 number, you can go online and communicate one on one with a pharmacist. We launched on March 18, and a couple of weeks ago, we launched Diabetes.com. We have a whole series of disease domains that we own that we will be launching soon.
Chat Moderator: Susan, can you tell us a little about the APhA, and what your philosophy is about online pharmacies?
Susan Winckler: The American Pharmaceutical Association is the national professional society of pharmacists. APhA then represents pharmacists in all practice settings, including those now working in the online environment like PlanetRx.
Chat Participant: Stephanie, how do you verify prescriptions?
Chat Participant: How long does it take to get your prescription?
Stephanie Schear: We have our own pharmacists on staff, and we call the doctor to verify the prescription. We have many layers of authentication, and you can get the prescription overnight or in two days, via regular priority mail. It just depends on your choice.
Chat Participant: Do you warn of dangerous drug interactions like my corner pharmacist does?
Stephanie Schear: Yes, we do that. In fact, we have a drug interaction database, and we will send people e-mails and check for drug interactions, and prior to filling a prescription, we carefully check for drug interactions. We have an extensive database of drug-to-drug, drug-to-food and drug-to-vitamin interactions.
Chat Moderator: We'll ask Susan to respond as well.
Susan Winckler: It's important to remember if you use more than one pharmacy -- if you use an online pharmacy and a local pharmacy, for example -- both pharmacies need to know all medications you are taking.
Chat Moderator: What precautions are you putting in place to prevent abuses?
Susan Winckler: As Stephanie has mentioned, PlanetRx and other pharmacies have verification services where they verify with your physician and verify that information. There is an emerging program to verify the sites, to give a site like PlanetRx a "seal of approval." That program (Verified Internet Pharmacy Practice Sites, or VIPPS) is sponsored by the National Association of Boards of Pharmacy, and it is a program to verify the licensure of Internet pharmacy sites. So in the future, you would be able to pull up a site and see if they had gone through the voluntary verification process with VIPPS.
Chat Moderator: Stephanie, would you like to speak to this issue as well?
Stephanie Schear: I wanted to let consumers know that we have licenses in 50 states, so we have been approved by all the state boards, and we are working with the National Association of Boards of Pharmacy to develop the seal of approval. Because we believe that we adhere to the strict standards that the NABP is trying to implement, we are helping with this process.
Chat Participant: Which database do you use for the drug-drug/food interactions, and when was this database last updated?
Stephanie Schear: We are using Medispan, as well as drkoop, and a couple of other smaller databases. We have put other smaller databases together.
Chat Participant: Will customers be allowed to get medical drugs online without prescriptions?
Stephanie Schear: No.
Susan Winckler: No.
Stephanie Schear: It is illegal to prescribe medicine without actually physically seeing a doctor and getting a consultation. We fill prescriptions that come from doctors.
Susan Winckler: It would be illegal to dispense the product without a valid prescription.
Chat Participant: What do more traditional pharmacies think of the online growth?
Susan Winckler: Some of the traditional pharmacies are forming alliances with online pharmacies, and some traditional pharmacies are launching their own online pharmacies, and many see it as a way to improve service, and to improve contact with patients to help them use their medications correctly.
Chat Participant: Will this online service add to the cost of these drugs?
Stephanie Schear: No. Ultimately we believe we can provide better value to consumers. It will not increase the price, and potentially we can offer lower prices in many areas.
Chat Participant: What will be the appeal to shop online for your prescription?
Stephanie Schear: There are many different reasons. Better convenience -- you don't have to wait in line. Much better selection. We have 27,000 products available, which is more than a traditional drugstore in the health, beauty and wellness area. We have much better information. We have information on over a hundred disease categories, and on alternative health care, and ultimately we will probably have better prices than the traditional chains.
Chat Participant: What about shipping costs?
Stephanie Schear: Our shipping costs are actually the most competitive today in the online pharmacy space. We ship overnight by FedEx for about $10; our competitors are at about $17. We ship U.S. Priority Mail, and it delivers within 48 hours, and it is about $3.95 or so. And we ship all prescriptions for free.
Chat Participant: Stephanie, I'm assuming that any medication sent to patients is shipped packaged according to the drug, i.e., tetracycline in dark container, liquid antibiotics cold. How do you ensure that when those leave your site the proper environment is maintained?
Stephanie Schear: For special products like insulin and others, we have very careful refrigeration in our facility and very careful shipping, and we haven't had a problem to date. All of our pharmacists are licensed, and they have a lot of experience in dealing with different types of prescriptions and packages.
Chat Moderator: Susan, can you speak to whether or not the APhA will publish guidelines associated with shipping?
Susan Winckler: There is an initiative to design standards for shipping products, not just online, but in any product.
Chat Participant: Do you plan to ship internationally?
Stephanie Schear: We are not shipping internationally today, but we are looking into it. We actually have shipped to Canada.
Chat Participant: Susan, what particular concerns will the AphA be addressing as it assesses an online pharmacy for receipt of the "seal of approval"?
Susan Winckler: We should first confirm that APhA would not be assigning the seal of approval. The seal of approval will be offered by the National Association of the Boards of Pharmacy. In that program, they will be looking to verify the licenses for the online pharmacy in all of the states where they would ship prescription medication and serve patients as well as to verify the availability of certain services, and compliance with some standards that have been built into the program.
Chat Participant: Will you take my insurance for prescriptions?
Stephanie Schear: Yes. We will handle your co-pay, so all you have to do is come to our site and pay your co-pay with your credit card.
Chat Participant: Do you have any plans on electronic prescriptions sent directly from the doctors?
Stephanie Schear: There are many initiatives to develop electronic prescriptions from the doctor's office, and we are evaluating these initiatives.
Susan Winckler: The process of accepting an electronic prescription is subject to state law, and some states do not allow that practice.
Chat Participant: How does it improve contact if you don't actually talk to a pharmacist?
Stephanie Schear: Well, we have licensed pharmacists on our staff, and you can talk to a pharmacist. We have a 1-800 number, and you also talk to our pharmacists on our Web site. We are actually using technology to bring the community back to pharmacy, because you can have a conversation one-on-one with one of our pharmacists. We can provide answers to all your health-related questions. We have a great deal of information on our site, but we also have the pharmacist available to answer questions.
Chat Moderator: But doesn't it seem so impersonal? I mean my corner drugstore pharmacist actually knows me.
Stephanie Schear: Many people don't like to go into a traditional pharmacy and ask private questions, and they feel uncomfortable in a brick-and-mortar environment. For example, people generally are not comfortable asking questions about depression, fertility or infertility, and impotence. There are many issues that are private that people would like answers on. We provide a forum where they can get private answers to their questions in a one-to-one communication with a pharmacist.
Susan Winckler: It's really a question of patient preference. Many community pharmacies do have a private counseling area available for one-on-one communication, and it's more a question of whether the customer prefers a face-to-face communication or prefers communication on the telephone or online.
Chat Participant: What if you need to talk to a pharmacist right away? What is the response time?
Stephanie Schear: It's immediate. You call up our 1-800 number, and you will talk to a pharmacist right away.
Chat Participant: What percentage of people actually order online as opposed to calling the 800 number?
Stephanie Schear: A significant majority, well over 75 percent of people, are ordering online today, much to our surprise. We thought we would get more telephone calls. Many people have indicated that they are comfortable ordering online.
Chat Participant: It must take many pharmacists to answer 800 calls and questions online. How many pharmacists do you employ?
Stephanie Schear: We have not disclosed how many pharmacists we have on staff, but if you go to www.PlanetRx.com, you can try the service yourself, and you will get a very fast response time.
Chat Participant: Where does the content for your site come from? Do you have real doctors answering questions?
Stephanie Schear: We have our own editorial team with pharmacists, journalists and MDs that help review and write content to make it consumer-friendly and informative. However, for our "Ask the Pharmacist" service, we have pharmacists answering questions, not MDs.
Chat Participant: What do you see as key differences between yourself and other sites like drugstore.com?
Stephanie Schear: Well, first of all, we have our own distribution center and customer service, so we have been rated in the industry as having the best customer service. Second, we provide a great deal of information for consumers. We have over 100 disease categories. We have what we call eCenters, areas where we combine content and commerce. For instance, we have a women's health eCenter, and a weight loss eCenter, as well as an eCenter focused on cancer. So what we've tried to do is to really provide the right information for people to manage their health.
Chat Moderator: Can't this be subject to misuse? Ordering antibiotics and their uncontrolled use is not a thing to be taken likely, is it?
Susan Winckler: Again, medication may not be dispensed legally without a prescription, so a physician or other prescriber must decide that a patient requires antibiotic therapy before a prescription will be issued, and thus before PlanetRx or another pharmacy could dispense that product.
Chat Participant: Susan, does your site at www.aphanet.org have any consumer information that addresses these issues? Or at any associated Web site?
Susan Winckler: APhA does maintain a consumer Web site. That address is www.pharmacyandyou.org, where we have general information about how to best use your pharmacy and get the most information from your pharmacist.
Chat Participant: Is it possible to keep a personal health record on the site?
Stephanie Schear: We do have an area on the site called My Planet where you can store your prescription history and basic medical information like allergies and drug interactions. You can also store this information for your family. Like America OnLine, we are able to have multiple accounts within an account.
Chat Participant: Susan or Stephanie, what's been the reaction of pharmacists to these online services?
Stephanie Schear: Well, since we've hired quite a few pharmacists, they are in favor of it.
Susan Winckler: Online pharmacy is a new venue or opportunity for pharmacists to work with patients. Some will choose to continue to work in a community pharmacy, others in a hospital pharmacy, etc. And some will choose to work in an online pharmacy and work with their patients in that manner.
Chat Moderator: Stephanie, do you see filling prescriptions as your primary revenue, or like traditional drugstores, is the real business in the retail?
Stephanie Schear: We only focus on three areas compared to traditional drugstores. We focus on health, beauty and wellness. We do not have photo finishing, greeting cards or candy. But we believe that we will see a mix of revenue. Prescriptions will be part of it, but vitamins and cosmetics and medical supplies will also be a significant part of our revenue.
Susan Winckler: Many community pharmacies are adding additional services to focus on the health care of their patients. For example, in many states pharmacists can administer immunizations, allowing patients to have easier access to a flu shot, or they will work with patients to monitor their blood cholesterol levels and blood glucose levels.
Chat Participant: Since I put a lot of personal information on the site, is it protected from advertisers?
Stephanie Schear: We do not advertise on that area. We do not have advertising on PlanetRx.com. We do not provide any individual data to any third party. We have strict privacy policies, and we are partnered with TrustE to protect our consumers.
Chat Participant: Susan, what are your feelings on herbal remedies?
Susan Winckler: Many patients use herbal products. It's important to use those products carefully, and to remember to tell your physician and your pharmacist about your use of herbal products so that they can check for interactions between those products and your prescription medications and also any over-the-counter medications you may take.
Chat Participant: In "real life" most pharmacists consult personally with people getting a prescription for a new medication. How does this work when a person orders a prescription online?
Stephanie Schear: We perform consultations through telephone or online, just like you would in a traditional environment. One hundred percent of new prescriptions we fill, we provide consultation on the phone.
Chat Participant: How do you provide patient counseling upon filling a script or allow the patient to decline it?
Stephanie Schear: We call the consumer to make sure they have the right information if it is a new prescription. We also put information in the box.
Chat Moderator: How does that work, since you mentioned previously more than 75 percent of your prescriptions are handled online?
Stephanie Schear: Consultation is required by law. They do not decline consultations.
Susan Winckler: Actually, an offer of consultation is required by law.
Chat Moderator: Can you describe the verification cycle?
Stephanie Schear: There are many different ways that we can receive a prescription. The doctor can call us directly, the doctor can fax us, the consumer can fax us, the consumer can call us, the consumer can go on the Web site and register the information, and then we call the doctor. So we have multiple layers of verification, and we do not hesitate to call the doctor if we have any question about the prescription. Basically we call all the doctors for all prescriptions.
Chat Moderator: But at what point do you call the consumer?
Stephanie Schear: We do not call the consumer. In some cases, we may e-mail them if we get verification from a doctor. We will e-mail the consumer to tell them their prescription is verified.
Chat Moderator: Then in the cases that you don't call the consumer, please speak again to when the counseling occurs?
Stephanie Schear: The way counseling works is, if you have a new prescription, we call the consumer and offer consultation.
Chat Moderator: How receptive in general have doctors been to you? Or is it simply invisible to them that you are an online pharmacy as opposed to traditional?
Stephanie Schear: It's fairly invisible. The process is fairly similar.
Chat Participant: How do you get the doctor's number? Do you have a database matched to DEA numbers? For example, if I call in my prescription, do I give the number, and if so, how do you know you are calling my doctor?
Stephanie Schear: We have built a database of doctors. Also, when we get a fax prescription, we put new doctors into the database.
Chat Participant: Will PlanetRx provide any follow-up? For example, some local pharmacies call to find out how a patient is doing with a certain medication.
Stephanie Schear: Yes, we do, and in many cases we have received a lot of prescriptions that have been transferred from retail pharmacists, and we've taken a lot of refill prescriptions from those pharmacists. We do provide multiple consultations.
Chat Moderator: How do you maintain your physician database? Isn't there opportunity to continue to fill for a doctor whose license has been revoked, etc?
Stephanie Schear: The opportunity is not greater. It is not that different, actually, than a traditional environment where pharmacists and doctors talk on the phone. We actually go beyond what traditional pharmacies are doing, and check multiple times with a doctor.
Susan Winckler: Which some traditional pharmacies may do also.
Chat Moderator: We'd like to thank both our guests for being here with us today and for sharing this information with us. I'll ask both Stephanie and Susan if they have any final comments to share with us.
Susan Winckler: The most important thing to remember about all medications is that medications are safe when they are used correctly. So if you have questions about your medications, whether you use an online pharmacy or a pharmacy down the street, ask your pharmacist and get the information.
Stephanie Schear: I would just encourage consumers to come to PlanetRx.com and try our Web site, and to use the information that we provide and get access to the products that we have to better manage their health. Thank you.
Susan Winckler: Thank you.
Chat Moderator: Thanks so much to both our guests! You can visit the Planet Rx site at http://www.PlanetRx.com, and the APhA site at http://www.aphanet.org/ Thanks, everyone, for joining us in Health Chat.
We'll be here same time, same place next Friday.
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American Pharmaceutical Association
PlanetRx Online Pharmacy & Drugstore
National Association of Boards of Pharmacy
Pharmacy and You
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