Can you trust online pharmacies with your prescriptions?

By Deborah Kotz, Globe Staff

After changing health plans two months ago, I’ve now had to shell out $37 per month for generic oral contraceptives. (On my old plan, I was able to receive a four-month supply for just an $8 co-payment at my neighborhood pharmacy.)

I was heartened to learn from my insurance provider that as of January, I’ll no longer have to pay anything out of pocket when I pick up my monthly supply, thanks to a newly-implemented provision in the federal health care law. In the meantime, I can get my prescription for half-price if I use an online pharmacy, my insurance provider told me.

That sounds fine in theory but the US Food and Drug Administration has been firing off a series of press releases warning consumers to stay away from illegitimate online pharmacies, many of which operate in foreign countries. The agency announced on Thursday that it was taking action against “more than 4,100 Internet pharmacies that illegally sell potentially dangerous, unapproved drugs to consumers.”

Some market a generic version of Tamiflu to treat flu symptoms, even though there’s no FDA-approved generic version on the market. The FDA said fraudulent verions of “generic Tamiflu” contained the wrong active ingredient that was similar to the antibiotic penicillin: it’s completely ineffective against flu symptoms and can cause severe allergic reactions in those who are allergic to penicillin.

The anti-nausea drug domperidone -- banned in the United States nearly 15 years ago after it was linked to heart problems -- has also been sold illegally online; and consumers can order the acne drug isotretinoin (Accutane), even though its use has been severely restricted because it has been associated with severe birth defects in women who used it while pregnant. Viagra, too, can be ordered without a prescription from these illegal online pharmacies.

So, how do you know if that pharmacy website you’re ordering from is legit? The FDA set up a website last week to provide some tips. First, you should use only a state-licensed pharmacy based in the United States that requires a valid prescription from your doctor. The online pharmacy should also have a licensed pharmacist to answer your questions.

A quick Google search of “online pharmacy” turned up 158 million results, and most on the first page of results raised my eyebrows.

A place called PharmaExpressRx primarily sells drugs for sexual dysfunction -- such as generic Viagra and Cialis -- and weight loss. It’s located in St. Kitts. There’s a small box to check after ordering, in which the customer promises to provide a prescription, and the customer service folks I chatted with told me they would hold the order for two weeks until they received a faxed prescription or would refund the money if they didn’t get one. (I didn’t verify that by trying to order something myself.)

Another one topping my Google search that appeared to be a US facility but is actually located in Mauritius didn’t even ask for a prescription when ordering, though it asked a few questions about a customer’s height, weight, and current medical conditions that the company said its doctor “may need to review.”

The USonlinepharmacy took the most brazen approach, touting at the top of its website that there’s “no need to see a doctor” and “no prior prescription required.”

CVS, Target, and Walgreens all have online pharmacies that are probably among your safest bets if you don’t want to wade through site after site -- as I did -- to try to find a legitimate one in the United States. Other than these major chains’ sites, the closest pharmacies I found were in Canada, and I’m not certain that they were licensed either.

I’m curious whether the FDA’s crackdown will actually have some impact on reducing the number of online pharmacies. The agency said it had already shut down 18,000 illegal pharmacy websites between Sept. 25 and Oct. 2 and seized about $10.5 million worth of pharmaceuticals worldwide. But that doesn’t seem to have made much of a dent, judging by my Google searches.