Understanding the Challenges and Limits of Online Prescriptions

Obtaining prescriptions through online pharmacies provides advantages such as expedited access to doctors via digital consultations, greater privacy due to the ability to consult with physicians remotely, and the convenience of having medications delivered directly to your home, bypassing the need to visit a public pharmacy. Commonly referred to as e-prescriptions or mail-order prescriptions, this method can also lead to potential cost savings.1 

However, due to the way online prescriptions work, they have several consistent challenges and limitations that may be significant enough that they cause potential customers to seek out conventional prescriptions at their local brick and mortar pharmacies instead. 

Before you order medications online, consider all these potential drawbacks to make the best decision about what is right for you. 

• Telehealth evaluations for prescriptions lack the hands-on physical exam of in-person visits with a doctor that may be needed for some health concerns.  

• While you might see a doctor quicker through the digital route, shipping your medication often takes longer than picking it up at a local pharmacy.  

• Pharmacies based outside your home state may adhere to different standards and regulations.  

• There are limits to the types of prescriptions you can order online, as some medications require in-person consultation.  

• Some users may find the digital consultation process less personal and less reassuring compared to face-to-face interactions with their healthcare provider.  

• Internet connectivity issues may disrupt telehealth consultations, leading to delays in obtaining prescriptions.  

• Some insurance plans may not cover medications ordered through online pharmacies, potentially increasing out-of-pocket costs.  

• Online pharmacies may have limited stock of certain medications, leading to longer wait times for fulfillment. 

The first step to getting an online prescription is scheduling an appointment with a doctor for a consultation. Without a doctor’s visit, you legally cannot get a prescription. While it is possible to see a doctor through a phone or video call to obtain a prescription, your doctor will be limited in their ability to look at and evaluate your body. 

They cannot measure your blood pressure, examine your throat or ears, or perform any other physical exam. Depending on your condition, the absence of a physical exam may be a factor that limits the possibility of getting a prescription or medical care, resulting in advice to be seen in person instead. For some health issues, it might not be crucial, but if you need to check for physical issues, an in-person visit is better. 

Despite these limitations, telehealth doctors can get more information than you might expect. They can order diagnostic lab tests sent to you via mail or conducted at an in-person lab nearby. 

While there is some risk with ordering prescriptions online, if you take a few cautionary measures, you can expect to receive medications that are the same as any in-person pharmacy. The challenge for online prescriptions is not necessarily improving the safety of how legitimate pharmacies are operating, but instead communicating with and educating customers where they can find safe prescriptions. 

If you are ordering from a different e-pharmacy website and you are unsure about their credentials, see if it is VIPPS certified or registered with the National Association of Boards of Pharmacy (NABP). There are three options for looking up to see if a website selling prescriptions is operating legally and safely, safe.pharmacy (run by the National Association of Boards of Pharmacy), LegitScript (an independent safety certification company), or Verifybeforeyoubuy.org (a project of the nonprofit Center for Safe Internet Pharmacies). 

When you engage with an online pharmacy, you might not be aware of it, but the pharmacy fulfilling your order may be operating under different rules and regulations than your home state.  

While there is a nationwide organization of pharmacist boards connecting all pharmacists, and some national rules, most of the laws regarding pharmacy safety standards are set at the state level. There are states like Idaho that have recently reduced their rules set on pharmacists to 25% of what they previously were operating under the guideline “eliminate all unnecessary regulations”. 

Sometimes prescriptions are more difficult to fill if either the pharmacist or you have a question regarding the medication. There may be delays if the pharmacist needs to contact your online doctor with a question. Although, this also occurs when questions arise when prescribed by an in-person doctor so the delay may not be any longer. Furthermore, if you, the patient, has a question for the pharmacist or needs counseling regarding a medication, it will take longer to achieve such online as the wait for a callback is likely longer than the wait when you are picking up a prescription in person. 

The United States Drug Enforcement Agency (DEA) maintains a list of controlled substances, grouping them by roman numerals I through V. Items in schedule I and II are the most restricted and you cannot have them shipped to you without an in-person doctor's visit. Typically, these drugs have similarities to drugs that are used recreationally and likely to be abused or sold illegally. 

Legal restrictions are not the only issue. Some online pharmacies are not actually full-service pharmacies. Often specializing in low-cost generic drugs, they tailor what they offer to what makes them profitable and may not carry more popular brand name prescriptions. 

*Prescriptions are provided at the doctor’s discretion. Learn more about our controlled substances policy and our prescription discount card. 

If you mail order your prescription, you are going to have to wait for shipment. Nowadays, doctors can send prescriptions electronically to brick-and-mortar pharmacies making it so you can pick up your drugs the same day they are prescribed to you. 

Express Scripts and CVS take about one week for prescriptions to arrive. Amazon’s Pharmacy offers two-day delivery. Walgreens offers same day delivery on a limited number of items, 1–2-day delivery on other limited prescriptions and 5–10-day delivery for all others. 

While delivery times have improved over the years, if you have an urgent need for a prescription because you have a time sensitive condition like a viral or bacterial infection, ordering your prescription online might not provide the same convenience as a brick-and-mortar pharmacy. 

There is a wide scale perception that mail order prescriptions are cheaper than in-person ones. Though Consumer Reports found that while certain online prescriptions for generic prescriptions were often cheaper than standard $12 copays for insurance-covered prescriptions in pharmacies, there were also hidden costs associated with ordering from online pharmacies. 

Shipping medication always adds cost to the equation. The convenience of quick shipping comes with a significant cost. If you get two-day shipping, you could spend up to $30 more on shipping.  

While Amazon Pharmacy offers two-day shipping for many prescriptions, they charge customers twice. Once with higher priced prescriptions and once again for the required Amazon Prime membership that costs $139 yearly. If you already have prime membership, this is not an added expense, but for non-members it can be prohibitively expensive.  

While it is possible to pay for prescriptions at certain online pharmacies using a flexible spending account (FSA) or a health savings account (HSA), coverage varies based on online pharmacy. If the merchant you are buying your prescription from has the wrong merchant code, your payment may be declined by the credit card company. 

If your payment fails, you will have the added inconvenience of having to pay upfront using a different payment method and then get a receipt for reimbursement. 

All the potential challenges and limitations of online prescriptions — uncertain compatibility with HSAs, uncertain medication availability, and uncertain safety standards — have the potential to undo any convenience of getting pills online.  

For many people, the most convenient option is still a brick-and-mortar pharmacy which can be combined with digital health care services. For many the fastest way is to get a doctor’s prescription through telehealth services and then pick it up in your local drug store.