CIPA Certified Pharmacies Recognized as Safe in the US

The National Bureau of Economic Research has confirmed that members of the Canadian International Pharmacy Association (CIPA) sell prescription drugs that are 100% authentic, safe, and significantly cheaper than in the US.

The Study

A study conducted by the Bureau was conducted by Roger Bate, PhD and Aparna Mathur, PhD from the American Enterprise Institute and Ginger Zhe Jin, PhD from the University of Maryland Department of Economics.

This paper examines the role of certification agencies in the online market for prescription drugs in the US. The authors purchased samples of five popular brand-name prescription drugs from three types of online pharmacies:

1. Tier 1: US-based and certified by the National Association of Boards of Pharmacy (NABP) or LegitScript.com
   
2. Tier 2: Certified by the Canadian International Pharmacy Association (CIPA), but not by NABP or LegitScript
   
3. Tier 3: Not certified by any of the four agencies
   

The authors found that most tier 2 and tier 3 websites are foreign, and that tier 2 and tier 3 websites are significantly cheaper than tier 1 websites. The authors also surveyed consumers who have purchased prescription medication online and found that most of them purchase from foreign websites, citing cost savings as the leading reason.

Bate, Jin, and Mathur (2012) also discuss the following:

Price Differences

The authors explain that differences in price regulations and local demand across countries can lead to variations in drug prices.

They note that while the US government does not regulate the listing price of brand-name drugs in retail pharmacies, other countries like Canada and European nations often have price caps. 

These price caps can be lower than US prices, making foreign online pharmacies attractive to US consumers seeking lower costs.

Arbitrage and Price Discrimination

The authors mention that the ability of drug manufacturers to price discriminate (charge different prices in different markets) depends on the ease of arbitrage (taking advantage of price differences). 

Criminalizing prescription drug importation into the US adds difficulty to arbitrage, potentially leading to significant price differences between US and non-US countries. This could result in only the most price-sensitive consumers choosing to buy from foreign websites.

Consumer Price Sensitivity

The authors suggest that consumers’ price sensitivity is related to their income and insurance coverage. In their study, most of the drugs (except Viagra) are typically covered by prescription insurance if purchased through traditional channels in the US. 

However, online purchases from foreign websites are not covered by insurance. This may lead to consumer sorting, where those who buy from foreign websites are more price-sensitive due to lower income or insufficient insurance coverage.

Key findings

Bate, Jin, and Mathur specifically targeted individuals affiliated with RxRights, a coalition concerned about high drug prices in the US. The survey aimed to explore how consumers search for and select online pharmacies, and how online shoppers differ from offline shoppers in terms of demographics and insurance status.

Key findings from the survey include:

• Online Purchase Prevalence: A significant portion (61.54%) of respondents reported purchasing prescription drugs online, primarily from foreign websites. This finding contrasts with previous surveys that reported lower online purchase rates, suggesting that individuals concerned about drug prices may be more likely to turn to online pharmacies.
• Reasons for Online Purchase: The primary reason for purchasing from foreign online pharmacies was cost savings, followed by factors like better service, drug availability, and lack of insurance coverage in the US.
• Consumer Search Behavior: Most online shoppers used internet searches  to find online pharmacies. Personal referrals also played a role, while the cheapest deal was not the primary motivator for most respondents.
• Demographics and Insurance Status: Online shoppers tended to be slightly younger, more likely to be male, and had slightly higher incomes compared to offline shoppers. While the majority of both groups had medical insurance, online shoppers were less likely to have drug insurance, suggesting that insurance coverage is a factor but not the sole determinant of online purchasing behavior.

Overall, the survey results highlight the importance of cost savings as a driver for online drug purchases, particularly from foreign websites. The findings also emphasize the role of certification agencies in helping consumers navigate the online pharmaceutical market and make informed decisions about where to purchase medications.

Tier 2 vs Tier 3 Pharmacies

Given that tier 1 websites are based in the US and the other tiers are not, there is a question of whether the higher prices in tier 1 are due to quality or simply due to them being located in the US. The authors wanted to investigate the role of these alternative certification agencies (which certify tier 2 websites) in the online drug market and compare the price and quality of drugs from these websites to those from non-certified (tier 3) websites.

Specifically, the authors aimed to answer the following questions:

• How do websites vary in price and safety by certification status?
• Are the higher prices of tier 1 websites due to a difference in quality or simply because they are located in the US?
• How do non-certified websites (tier 3) compare to those certified by alternative agencies (tier 2)?

By researching tier 2 versus tier 3 pharmacies, the authors could assess the effectiveness of these alternative certification agencies in ensuring drug quality and safety, and evaluate whether the recommendation against all foreign websites is justified. This research could help consumers make more informed decisions about where to purchase prescription drugs online and potentially access safe and affordable medications from reputable foreign sources.

Here are some key findings on Tier 2 vs Tier 3 pharmacies:

Tier 2 Pharmacies

• Tier 2 pharmacies are not approved by the NABP or LegitScript but are verified by CIPA.
  
• The authors found that tier 2 pharmacies are a middle ground between tier 1 and tier 3 pharmacies in terms of price and quality.
  
• While tier 2 pharmacies are not endorsed by the FDA, the study found no failures in authenticity tests for drugs purchased from these websites.
  
• The authors suggest that tier 2 pharmacies offer a legitimate and cost-effective option for consumers, despite not being officially endorsed by the FDA.
  

Tier 3 Pharmacies

• Tier 3 pharmacies are not certified by any of the four agencies mentioned in the study.
  
• The study found that tier 3 pharmacies are the cheapest option but also have the highest risk of delivering non-testable or inauthentic drugs.
  
• Many tier 3 websites disappeared during the study period, suggesting that they may be fly-by-night operations.
  
• Tier 3 websites often offer discreet shipping and may not require prescriptions, which could be appealing to some consumers but also raises concerns about safety and legitimacy.
  

Overall, the study suggests that while tier 3 pharmacies may offer the lowest prices, they also carry the highest risk. Tier 2 pharmacies, while not officially endorsed by the FDA, may provide a safer and more cost-effective alternative to tier 1 pharmacies.

What is CIPA?

CIPA is an association of pharmacy intermediaries in Canada that provide mail-order pharmacy services to international customers. CIPA members focus on offering prescription medications at significantly lower costs than typical US pharmacies. 

It serves as a quality assurance measure for consumers, ensuring that the pharmacies they interact with adhere to established standards and regulations.

Is Online Pharmacies Canada a CIPA member?

Yes, Online Pharmacies Canada is a CIPA approved Canadian pharmacy intermediary. Based on the research by Bate, Jin, and Mathur (2012), purchasing from CIPA-certified pharmacies (tier 2) was generally considered safe, with no instances of fake or substandard medication found in their study.