Hospital Pharmacy - April 2020 - 85

868406
research-article2019

HPXXXX10.1177/0018578719868406Hospital PharmacyHertig et al

Director's Forum

Current Threats to Maintaining a
Secure Pharmaceutical Supply Chain
in an Online World

Hospital Pharmacy
2020, Vol. 55(2) 85-89
© The Author(s) 2019
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https://doi.org/10.1177/0018578719868406
DOI: 10.1177/0018578719868406
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John B. Hertig1, Libby Baney2, and Robert J. Weber3,4

Abstract
Background: Maintaining integrity of the pharmaceutical supply chain is critical to providing medications that are free
from adulteration (counterfeit, substandard or unapproved medications), making them safe for patient use. Purchasing
pharmaceuticals through the Internet can be associated with a risk of receiving adulterated medicines. Objective: The
objective of this study was to review the current threats to maintaining a secure pharmaceutical supply chain, specifically
focused on Internet-based procurement of medications. Methods: A review of the literature was conducted along with
collating important up to date resources and other publications that provide foundational information to understanding
the risks and prevention strategies for online purchasing of pharmaceuticals. Conclusion: The information provided in this
article helps to properly inform pharmacy leaders to the resources available to protect against the risks of on-line purchasing
of pharmaceuticals.
Keywords
pharmaceuticals, online, quality assurance, safety, counterfeiting

Introduction
The pharmaceutical supply chain is designed to efficiently
deliver legitimate medications from their original source to
hospitals, dispensing pharmacies, and other providers (physician offices, clinics, surgery centers). This global complex
system begins with raw materials, which are in turn processed by manufacturers and properly distributed throughout the world. The pharmaceutical supply chain includes
primary and secondary wholesale distributors and packaging, and dispensers such as hospitals and community pharmacies, all ultimately leading to patients and consumers.1
The US pharmaceutical supply chain is one of the safest in
the world, but also increasingly complex. External threats-
importation of substandard and/or falsely labeled (SF) drugs,
Internet commerce, and expanding gray markets-challenge
the resiliency of safe guards. These threats result in unsafe
and ineffective medication entering the US pharmaceutical
supply chain.2 There are growing examples of supply chain
failures resulting in patient harm and death.3 The Drug Supply
Chain Security Act (DSCSA) was signed into law in 2013,
and the resulting provisions have been implemented to limit
the patient safety impact of supply chain threats. The DSCSA
helps ensure supply chain safety and integrity, thus enabling
pharmacists to provide patients with quality medication.1
Despite the enactment of the DSCSA, challenges to safe
medications remain. Growth in e-commerce and health care
consumerism introduce new dangers to safe sources of care.4

Although not intended to be a comprehensive review of all
supply chain security issues, this article will highlight emerging trends and threats to maintaining a secure pharmaceutical
supply chain, focusing on the intersection of the Internet and
medication sales. Strategies to navigate this complex environment will also be introduced, including information that
can be used to educate and support health care providers and
their patients.

Illegal Online Drug Sales
Background
The Internet is constantly expanding, with over 1.7 billion
Web sites active in March 2017.5 Due to this evolving nature
of the World Wide Web, there is potential for an increase in
cybercrime. The US Federal Bureau of Investigation reported
a cost of $1 070 711 522 due to Internet crimes in 2015. These
1

Butler University, Indianapolis, IN, USA
Faegre Baker Daniels, Washington, DC, USA
3
The Ohio State University Wexner Medical Center, Columbus, USA
4
The Ohio State University, Columbus, USA
2

Corresponding Author:
Robert J. Weber, Administrator, Pharmacy Services, Assistant Dean
for Medical Center Affairs, The Ohio State University Wexner Medical
Center, 368 Doan Hall, Columbus, OH 43210, USA.
Email: robert.weber@osumc.edu
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Hospital Pharmacy - April 2020

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