In Whom We Trust: The Role of Certification Agencies in Online Drug Markets

Roger Bate 1 , Ginger Zhe Jin 2  and Aparna Mathur 3
  • 1 Department of Economics, American Enterprise Institute, Washington, DC, USA
  • 2 Department of Economics, University of Maryland, College Park, MD, USA
  • 3 American Enterprise Institute, 1150 Seventeenth Street, Washington, DC 20036, USA
Roger Bate, Ginger Zhe Jin and Aparna Mathur

Abstract

This article uses an audit sample and a consumer survey to study the intriguing market of online prescription drugs facing US customers and assesses the role that certification agencies play in online drug markets.

On the supply side, we acquire samples of five popular brand-name prescription drugs from three types of online pharmacies: tier 1 are US-based and certified by the National Association of Boards of Pharmacy (NABP) or LegitScript.com, tier 2 are certified by PharmacyChecker.com or the Canadian International Pharmacy Association but not by NABP or LegitScript, and tier 3 are not certified by any of the four agencies. Most tier-2 and tier-3 websites are foreign. We find that 37 of the 365 delivered samples are different from the products we ordered and, therefore, non-testable. Conditional on testable samples, Raman spectrometry test finds no failure of authenticity except for eight Viagra samples from tier-3 websites. After controlling for testability and authenticity, tier-2 websites are 49.2% cheaper (p<0.01) and tier-3 websites are 54.8% cheaper (p < 0.01) than tier-1 sites. These differences are driven by non-Viagra drugs. For Viagra, failing samples are cheaper, but there is no significant price difference across tiers once we condition on testability and authenticity.

To study the demand side, we designed a survey that was distributed by RxRights. Among the 2,522 respondents who have purchased prescription medication and are concerned about the price of US pharmaceuticals, results show that 61.54% purchase drugs online and mostly from foreign websites, citing cost saving as the leading reason. Conditional on shopping online, 41.11% check with a credentialing agency.

Both samples convey a consistent message that certification agencies deliver useful information for foreign websites and online consumers. Further, while these findings confirm the Food and Drug Administration warning against rogue websites, they do suggest that a blanket ban against all foreign websites may deny consumers substantial savings from certified tier-2 websites.

  • Akerlof, George A. 1970. “The Market for ‘Lemons’”: Quality Uncertainty and the Market Mechanism, the Quarterly Journal of Economics, 84(3):488500.

    • Google Scholar
    • Export Citation
  • Arruñada, B. 2004. “Quality Safeguards and Regulation of Online Pharmacies.” Health Economics 13(4):32944.

    • Google Scholar
    • Export Citation
  • Baker, L., T. H. Wagner, S. Singer, and M. K. Bundorf. 2003. “Use of the Internet and e-Mail for Health Care Information: Results from a National Survey.” Journal of American Medical Association 289(18):24006.

    • Google Scholar
    • Export Citation
  • Bate, R., and K. Hess. 2010. “Assessing Website Pharmacy Drug Quality: Safer Than You Think?Public Library of Science One 5(8):e12199.

    • Google Scholar
    • Export Citation
  • Bate, R., P. Coticelli, R. Tren, and A. Attaran. 2008. “Antimalarial Drug Quality in the Most Severely Malarious Parts of Africa – A Six Country Study.” Public Library of Science One 3(5):e2132.

    • Google Scholar
    • Export Citation
  • Bate, R., R. Tren, L. Mooney, K. Hess, B. Mitra, B. Debroy, and A. Attaran. 2009. “Pilot Study of Essential Drug Quality in Two Major Cities in India.” Public Library of Science One 4(6): e6003.

    • Google Scholar
    • Export Citation
  • Bate, R., G. Z. Jin, and A. Mathur. 2011. “Does Price Reveal Poor-Quality Drugs? Evidence from 17 Countries.” Journal of Health Economics 30(6):115063.

    • Google Scholar
    • Export Citation
  • Becker, Bo, and Todd Milbourn. 2010. “How did increased competition affect credit ratings?” Harvard Business School Working Paper 09-051.

    • Export Citation
  • Bugay, D., and R. Brush. 2010. “Chemical Identity Testing by Remote-Based Dispersive Raman Spectroscopy.” Applied Spectroscopy 64(5):46775.

    • Google Scholar
    • Export Citation
  • Cantor, R., and F. Packer. 1997. “Differences of Opinion and Selection Bias in the Credit Rating Industry.” Journal of Banking and Finance 21(10):1395417.

    • Google Scholar
    • Export Citation
  • Catalano, C. S. 2008. “The Viagra Juggernaut: An Analysis of the ‘Rock Star’ of the Prescription Drug World’s Direct-to-Consumer (DTC) Advertising, Mega-Brand Status, and Cultural Iconicity.” Dissertation, Purdue University.

  • Chesnes, M., W. Dai, and G. Z. Jin. 2013. “Consumer Protection or Consumer Frustration? The Impact of Banning Foreign Pharmacies from Sponsored Search.” Working paper.

    • Export Citation
  • Clifton, L. B. S. 2003. “Internet Drug Sales: Is It Time to Welcome ‘Big Brother’ into Your Medicine Cabinet?Journal of Contemporary Health Law and Policy 20:54170.

    • Google Scholar
    • Export Citation
  • Cohen, R. A., B. Stussman, and CDC/National Center for Health Statistics. 2009. “NCHS Health E-Stat: Health Information Technology Use Among Men and Women Aged 18–64: Early Release of Estimates from the National Health Interview Survey, January-June 2009.” http://www.cdc.gov/nchs/data/hestat/healthinfo2009/healthinfo2009.htm.

    • Export Citation
  • Congressional Budget Office. 2012. “Estimates for the Insurance Coverage Provisions of the Affordable Care Act Updated for the Recent Supreme Court Decision.” http://www.cbo.gov/sites/default/files/cbofiles/attachments/43472-07-24-2012-CoverageEstimates.pdf.

    • Export Citation
  • Deloitte Center for Health Solutions. 2009. “Health Care Consumerism: Opportunities and Challenges for Health Plans.” http://www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/us_chs_Health%20Care%20Consumerism_OpportunitiesandChallengesforHealthPlans.pdf

    • Export Citation
  • Dewan, S., and V. Hsu. 2004. “Adverse Selection in Electronic Markets: Evidence from Online Stamp Auctions.” Journal of Industrial Economics 52(4):497516.

    • Google Scholar
    • Export Citation
  • Duggan, M., and F. Scott Morton. 2006. “The Distortionary Effects of Government Procurement: Evidence from Medicaid Prescription Drug Purchasing.” Quarterly Journal of Economics 121(1):130.

    • Google Scholar
    • Export Citation
  • Fox, S. 2004. Prescription Drugs Online. Washington, DC: Pew Internet & American Life Project. Accessed August 23, 2011. http://www.pewinternet.org/~/media//Files/Reports/2004/PIP_Prescription_Drugs_Online.pdf.pdf.

    • Google Scholar
    • Export Citation
  • US Government Accountability Office (GAO). 2001. “Prescription Drugs: Prices Available Through Discount Cards and from Other Sources.” GAO-02-280R.

    • Export Citation
  • US Government Accountability Office (GAO). 2004. “Internet Pharmacies: Some Pose Safety Risks for Consumers.” http://www.gao.gov/products/GAO-04-820.

    • Export Citation
  • US Government Accountability Office (GAO). 2011. “Prescription Drugs: Trends in Usual and Customary Prices for Commonly Used Drugs.” GAO-11-306R.

    • Export Citation
  • Grossman, S. 1981. “The Informational Role of Warranties and Private Disclosure about Product Quality.” Journal of Law and Economics 24:46189.

    • Google Scholar
    • Export Citation
  • Gryniewicz, C., J. Spencer, M. Hankins, and J. Kauffman. 2007. “Spectroscopic Methods for Rapid Determination of Diethylene Glycol in Glycerin.” American Pharmaceutical Review 10(7):2430.

    • Google Scholar
    • Export Citation
  • Hubbard, Thomas N. 2002. “How Do Consumers Motivate Experts? Reputational Incentives in an Auto Repair Market.” Journal of Law and Economics, 45(2):43768.

    • Google Scholar
    • Export Citation
  • Jin, Ginger Zhe, and Andrew Kato. 2006. “Price, Quality, and Reputation: Evidence from an Online Field Experiment.” RAND Journal of Economics, 37(4):9831005.

    • Google Scholar
    • Export Citation
  • Jovanovic, B. 1982. “Truthful Disclosure of Information.” Bell Journal of Economics 13:3644.

  • Keith, A. 2000. “The Economics of Viagra.” Health Affairs 19(2):14757.

  • Lizzeri, Alessandro. 1999. “Information Revelation and Certification Intermediaries.” RAND Journal of Economics, 30(2):21431.

    • Google Scholar
    • Export Citation
  • Michaely, Roni, and Kent L. Womack. 1999. “Conflict of Interest and the Credibility of Underwriter Analyst Recommendations.” Review of Financial Studies, 12(4):65386.

    • Google Scholar
    • Export Citation
  • Milgrom, P. 1981. “Good News and Bad News: Representation Theorems and Applications.” The Bell Journal of Economics 12:38091.

    • Google Scholar
    • Export Citation
  • Orizio, G., A. Merla, P. J. Schulz, and U. Gelatti. 2011. “Quality of Online Pharmacies and Websites Selling Prescription Drugs: A Systematic Review.” Journal of Medical Internet Research 13(3).

    • Google Scholar
    • Export Citation
  • United States Pharmacopeia and USAID. 2009. “Survey of the Quality of Selected Antimalarial Medicines Circulating in Madagascar, Senegal, and Uganda.” US Pharmacopeia. Accessed March 20, 2012. http://www.usaid.gov/our_work/global_health/hs/publications/qamsa_report_1109.pdf.

    • Export Citation
  • Quon, B. S., R. Firszt, and M. J. Eisenberg. 2005. “A Comparison of Brand-Name Drug Prices between Canadian-Based Internet Pharmacies and Major U.S. Drug Chain Pharmacies.” Annals of Internal Medicine 143(6):397403.

    • Google Scholar
    • Export Citation
  • Rajamma, R. K., and L. E. Pelton. 2009. “An Empirical Investigation of Consumers’ Procurement of Pharmaceutical Products via Online Retail Channels.” Psychology Marketing 26(10):86587.

    • Google Scholar
    • Export Citation
  • Skinner, B. J. 2005. Canada’s Drug Price Paradox: The Unexpected Losses Caused by Government Interference in Pharmaceutical Markets. The Fraser Institute Digital Publication. http://www.fraserinstitute.org/research-news/display.aspx?id=12864.

    • Google Scholar
    • Export Citation
  • Skinner, B. 2006. “Price Controls, Patents, and Cross-Border Internet Pharmacies Risks to Canada’s Drug Supply and International Trading Relations.” The Fraser Institute, Critical Issues Bulletin 2006. http://www.fraserinstitute.org/research-news/display.aspx?id=13315.

    • Export Citation
  • Temkin, Bruce, H. Manning, S. Geller and O. Melnikova. 2007. “The Customer Experience Index.” Forrester Research, http://www.forrester.com/The+Customer+Experience+Index+2007/fulltext/-/E-RES43877?docid=43877

    • Export Citation
  • de Veij, M., P. Vandenabeele, K. Alter Hall, F. Fernandez, M. Green, N. White, A. Dondorp, P.Newton and L. Moens. 2007. “Fast Detection and Identification of Counterfeit Antimalarial Tablets by Raman Spectroscopy.” Journal of Raman Spectroscopy 38:1817.

    • Google Scholar
    • Export Citation
  • Veronin, M. A., and B.-B. C. Youan. 2004 . “Magic Bullet Gone Astray: Medications and the Internet.” Science 305(5683):481.

    • Google Scholar
    • Export Citation
  • Veronin, M. A., E. Lee, and E. N. Lewis. 2007. “‘Insight’ into Drug Quality: Comparison of Simvastatin Tablets from the US and Canada Obtained via the Internet.” The Annals of Pharmacotherapy 41(5):111115.

    • Google Scholar
    • Export Citation
  • Waguespack, David M., and Olav Sorenson. 2011. “The Ratings Game: Asymmetry in Classification”, Organizational Science 22:541553.

    • Google Scholar
    • Export Citation
  • Westenberger, B. J., C. D. Ellison, A. S. Fussner, S. Jenney, R. E. Kolinski, T. G. Lipe, R. C. Lyon, T. W. Moore, L. K. Revelle, A. P. Smith, J. A. Spencer, K. D. Story, D. Y. Toler, A. M. Wokovich, and L. F. Buhse. 2005. “Quality Assessment of Internet Pharmaceutical Products Using Traditional and Non-Traditional Analytical Techniques.” International Journal of Pharmaceutics 306(1–2):5670.

    • Google Scholar
    • Export Citation
  • Wimmer, B. S., and C. Brian. 2003. “An Empirical Examination of Quality Certification in a ‘Lemons Market’.” Economic Inquiry 41(2):27991.

    • Google Scholar
    • Export Citation
  • Witkowski, M. 2005. “The Use of Raman Spectroscopy in the Detection of Counterfeit and Adulterated Pharmaceutical Products.” American Pharmaceutical Review. Accessed April 16, 2009. http://www.horiba.com/fileadmin/uploads/Scientific/Documents/Raman/aprraman.pdf.

    • Google Scholar
    • Export Citation
  • Wolinsky, Asher (1983) “Prices as Signals of Product QualityThe Review of Economic Studies 50(4):647658.

    • Google Scholar
    • Export Citation
  • World Health Organization. 2011. “Survey of the Quality of Selected Antimalarial Medicines Circulating in Six Countries of Sub-Saharan Africa.” World Health Organization. Accessed March 20, 2012. http://www.who.int/medicines/publications/WHO_QAMSA_report.pdf.

    • Google Scholar
    • Export Citation
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