Institute Report
Assessing the Impact of Illegal Online Pharmacies in the U.S.
Sales, Volume and Adverse Events
Apr 25, 2023

Report Summary

The sale of prescription drugs in the United States (U.S.) is regulated by a comprehensive set of federal and state laws. Online pharmacies are accredited by the National Association of Boards of Pharmacy (NABP) and need to follow precise rules of practice. Illegal online pharmacies (IOPs) are those that operate online without the requisite valid licenses or supply drugs not approved by the FDA.

The purpose of this report is to summarize the results of research into the nature and use of illegal online pharmacies (IOPs) over recent years and the impact this has on public health and the operation of the distribution system. The research draws on a novel methodology developed by IE University and commercialized by Translucent Datalab (www.translucentdatalab.com), a technology spin-off from IE University, to profile the network of IOPs that are being accessed from the U.S. and used to order prescription medicines. This methodology is part of a project that has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (grant agreement No 715536).  The IQVIA Institute has collaborated with Translucent Datalab in the development of this report.

Key findings:

This methodology identified 19,013 IOPs (15,501 active and 3,512 inactive) as of March 2023. An estimated total of 416 million prescriptions were provided to patients by these IOPs between January 2017 and December 2022. Between 2019 and 2022, the number of prescriptions dispensed annually through IOPs increased from 64 million to 85 million at a compounded annual growth rate of 10%.

Out of the top 30 therapeutic categories by legal prescription volume, those categories with the highest volume share being sold through IOPs included drugs used as part of cancer treatment (including hormone therapies) at 10.4% of total volume; sex hormones 5.5%; dermatologics 3.4%; other cardiovascular drugs (including those used for erectile dysfunction) 3.7%; hormonal contraception, systemic and topical 2.7%; and ADHD drugs 2.7%.

An estimated 12.6% of total adverse events could have been avoided if all drugs purchased from IOPs had instead been purchased from legal pharmacies during the period January 2017 to December 2022. These adverse events represent an estimated additional $67Bn cost for the U.S. healthcare system, in addition to the healthcare consequences for patients.

Assuming the drugs purchased through IOPs were sold legally in the U.S., the average annual economic value of these drugs between 2017 and 2022, using invoice level prices, is $28Bn, and aggregate value for the past six years totals $167Bn.

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