title: Internet availability of prescription pharmaceuticals to the public.
abstract: BACKGROUND
  The Internet holds great but uncertain promise for increased access and cost control in health care.
  
  
  OBJECTIVE
  To determine access to and cost of prescription pharmaceuticals over the Internet.
  
  
  METHODS
  An Internet search conducted during February and March 1999.
  
  
  METHODS
  The Philadelphia region.
  
  
  METHODS
  Data were collected on availability and cost of medications and physician Internet visits, requirements for physician prescriptions, and geographic location of Web-based companies and consulting physicians. Costs of comparable physician visits were obtained from Medicare and managed care organizations in the Philadelphia region. Costs of medications came from five Philadelphia community pharmacies.
  
  
  RESULTS
  Forty-six Web sites were identified. Thirty-seven sites (33 based in the United States and 4 based outside the United States) required a prescription from a personal physician or from an Internet physician consultation. Nine sites based outside of the United States did not require a prescription or physician consultation. The median cost of an Internet physician visit was $70 (range, $20 to $90), more than 15% higher than that for a general practice visit in the Philadelphia region. Quality of physician consultation, physician qualifications and specialty, and geographic location were unknown. Median price per pill of the two most commonly offered medications was 10% higher on the Internet (before shipping charges) than at Philadelphia pharmacies ($5.49 and $4.50 for sildenafil; $1.94 and $1.83 for finasteride).
  
  
  CONCLUSIONS
  The Internet may expand patient access to health-related services but at overall increased cost. In addition, the quality of physician Internet care is uncertain, and potential for serious abuse exists. Patients can easily provide incorrect or false information to obtain medications. Furthermore, conflict of interest exists for Web-based firms because they profit from selling medications and physician consultations.
authors.affiliation: Department of Medicine, University of Pennsylvania, Philadelphia 19104-2676, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Bloom
authors.forename: R C
authors.initials: RC
authors.lastname: Iannacone
mesh_terms: D016265:Conflict of Interest; D003365:Costs and Cost Analysis; D011307:Drug Prescriptions / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics* / Q000592:standards; D006801:Humans; D038622:Internationality; D020407:Internet; D010820:Physicians / Q000592:standards; D011306:Prescription Fees; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000191:economics / Q000592:standards; D014481:United States