Pharmacists are finding new opportunities and challenges within virtual drugstores.

Short of quaffing an egg cream at an old time soda fountain, consumers today can fulfill most apothecary needs online. This means no waiting in lines, being able to consult 24/7 with pharmacists, receiving e-mail reminders for refills, and, with no real estate or retail employee overhead, often paying significantly lower drug prices. So it's not surprising online pharmacies like to present themselves as extensions of the "neighborhood drugstore," where one can do it all, from filling a prescription to buying shampoo and toothpaste.

Small wonder then that indicators point to a continued upswing, with consumers projected to spend $10 billion on health commerce - including $4.5 billion on pharmaceuticals - by 2004, up from $200 million in 1999, according to research firm Jupiter Communications.

In addition, a recent study by Media Metrix shows those ages 45 to 64 are the fastest-growing group of Internet users, growing 18 percent in 1999 to comprise 20 percent of online users. With 85 million calcifying baby boomers in this country, it stands to reason that current and future seniors will find an online pharmacy conveniently fits their ongoing care needs in the coming years.

Undeniably, virtual drugstores present a bevy of new opportunities and challenges for the 21st century pharmacist.

Chains and Indies Get Wired

Banking on this burgeoning consumer interest, pharmacies, both major chains and independent stores, are working hard to make online drugstores an integral part of their business plan.

While chains like CVS, Drug Emporium, Walgreens, and Rite Aid have made a splash on the e-pharmacy front, independent pharmacies, which make up roughly half of the 52,000 U.S. pharmacies, have not ceded ground to the major players, primarily because they can provide same-day delivery, something chain-operated sites cannot.

Since the vast majority of their online orders are local, an indie drugstore can deliver a prescription the same day; while the best a chain can dispense is next-day delivery, although most chains do offer same-day pick up at a local store.

Of course an online pharmacy operated by a chain has resources a smaller one probably doesn't, such as 24-hour consultation. Or, says Bruce Taylor, RPh, clinical services manager for CVS.com, the support of pharmacy technicians. "We have a lot of technician support, which the typical community pharmacy wouldn't have available. [That allows] more time for the pharmacist to do what [they] really need to do, and that is the quality control check we have throughout the prescription filling. Beyond that, we generally see the pharmacist as the provider of expert drug information to the patient."

The Process

Filling prescriptions online is easy for consumers, with primary requirements being Internet access and a credit card. Once an account is opened, the prescribing doctor can be called or phone in the prescription, as well as fax or mail it to the online pharmacy. Standard delivery is usually free, with overnight or second-day transport available for an additional fee.

Unfortunately, it's as easy for consumers to access drugs through illegitimate website pharmacies, where the primary concern is profit rather than patient well-being.

Roguish Behavior

So-called "rogue" pharmacies are websites where popular lifestyle drugs like Viagra, hair-loss treatment Propecia, and weight-loss drug Xenical can be gotten with no real prescription or consultation, as well as more dangerous substances like abortifacients and date rape drugs.

The potential dangers to consumers are clear. Unfortunately, because of limitations on federal authority, it's difficult to regulate such online commerce. While the Clinton administration has proposed allotting  $10 million in its FY 2001 budget to allow the Food and Drug Administration to combat such dealings, it's unclear how effective this would be since many rogue sites lie outside the U.S. and are impervious to U.S. law.

One effort to combat bogus websites has been launched by the National Association of Boards of Pharmacy and its Verified Internet Pharmacy Practice Sites (VIPPS™) program. "When the Internet hit," says NABP Executive Director Carmen A. Catizone, MS, RPh, "we looked at this issue and [decided that] traditional regulation doesn't really seem to be the answer. There's no way you can sit behind the shoulders of 70 million consumers that own PCs and watch their every-day activities.

"Similarly, there's no way to regulate pharmacies or Internet sites located outside the U.S. We thought about it long and hard and came up with the VIPPS program as a means of using traditional state regulation and federal cooperation as well as consumer education and em