Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 18, 2020
Date Accepted: Sep 23, 2021
Accessibility of Low-Cost Insulin from Illegitimate Online Pharmacies: A Cross-Sectional Study
ABSTRACT
Background:
There is much public debate regarding the high cost of insulin. With 1-in-4 patients in the U.S. with Type 1 Diabetes reporting difficulties affording insulin, there is concern that some of these patients might look for cost-savings online, unaware that 96% of online pharmacies are illegitimate. Patients who purchase insulin from illegitimate online pharmacies remove themselves from traditional healthcare systems that ensure safe and effective drug use. In addition, patients using illegitimate online pharmacies are at risk of receiving low-quality medications.
Objective:
We sought to determine the accessibility of Humalog® and NovoLog® insulin from online pharmacies and characterize how these sites approached patient safety, priced, and marketed their products.
Methods:
From September 2019 to December 2019, we queried the phrases ‘buy insulin online’, ‘buy Humalog online’, and ‘buy NovoLog online’ in common search engines. The first 50 search results were screened for Yahoo and DuckDuckGo and the first 100 search results were screened for Google and Bing. Websites were included if they claimed to sell Humalog® or NovoLog® insulin, were active, free access, English language, and had a unique URL. Websites were classified with LegitScript. Safety and marketing characteristics, as well as price, were collected from included online pharmacies.
Results:
We found that 60% of the 49 online pharmacies in our analysis were illegitimate. From these pharmacies, Humalog® and NovoLog® insulin were 2-5 times cheaper as compared to legitimate online pharmacies. Risks associated with the use of illegitimate online pharmacies were evident in that 57% did not require a prescription, 43% did not display drug warnings or information, and only 21% offered access to a purported pharmacist.
Conclusions:
There is concern that patients might purchase from lower-cost illegitimate online pharmacies, placing them at risk of poor-quality medications and sub-par pharmacy services, resulting in adverse events and poor diabetes control.
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