Question

Where can I buy PrEP or HCV meds online and is it legal in the UK?

2 February 2017. Related: Access to treatment, All topics, HIV transmission, PrEP.

What do I need to know about buying meds online?

Is this legal in the UK? What at the things I need to think about?

How do I know if the meds are genuine?

Does this apply to new hepatitis C drugs and to PrEP?

Answer

Answer: Simon Collins

Buying generic drugs in the UK for personal use is legal.

Understanding that this legal position is important because this affects medicines that currently have very limited access on the NHS.

In relation to HIV and sexual health this is likely to cover three key types of medicines.

1. PrEP – which HIV negative people can use to protect against HIV.
2. New oral hepatitis C drugs – which are much more effective than older treatment.
3. Drugs to improve erectile function.

For different reasons, you might choose to use a personal prescription to buy these medicines, rather than rely on the NHS.

The legality for doing this relies on you only buying meds for your personal use. It can’t be a business and it can’t be something you buy and then sell to someone else.

It also has to be a personal quantity – defined as sufficient for three months or less.

It also can’t be drugs that are otherwise illegal in the UK or that have very restricted use. The Home Office publishes a list of controlled substances where import is more restricted and that require a special license (for example for narcotics covered in the Misuse of Drugs Act).

Although HM Revenue and Customs have powers to control everything that comes into the UK, as an agency they are only interested in preventing importation if these above personal conditions are not being met. For example if larger quantities are involved, and/or where there is a possibility that this is not for personal use, or if the substances by definition are controlled.

Advice from the MHRA

As a public service the MHRA provide information on the risk from buying medicines online, but this is just advice. Most of this is similar to buying anything online. Luckily, medicines have some safety controls that should minimise these risks.

Information from the MHRA is posted below at the end of this article.

Cautions about buying meds online

When buying medicines online the risk for not getting the active drugs is related to two circumstances.

1. That you might be buying the actual medicine, but from a generic manufacturer that might not be as good as the brand drug. The quality might be less consistent, or the drug levels might not be as high, or it might not be as stable on the shelf etc.
2. That you are buying counterfeit or forged pills, packaged to look like generic medicines, but that might look like either generic or brand medicines but that have no active ingredient.

Both these concerns are important, and are discussed in detail below. There are also ways of checking whether your medicines are real, before relying on them for your health. The risk from either lower quality or counterfeit medicines varies depending on why they are being used for PrEP, HCV or erectile function.

As long as you are buying genuine generic versions that manufacturers that are FDA-approved, generic medicines are just as good as band name medicines. They are just as carefully manufactured and contain the same active ingredients.

Erectile drugs

Buying generic Viagra or Cialis, or other medicines to improve erectile function has very little health or medical risk (compared to using brand drugs). It is mainly a financial one.

Erectile function drugs can have side effects, including serious side effects from drug interactions. This is why you should discuss using erectile drugs with a doctor.

However, in terms of knowing whether the drugs are genuine, you don’t need to test the drugs in a laboratory, because you will know if you get a response or not.

PrEP

The risk from suboptimal PrEP is more serious. If you are relying on PrEP to protect against HIV you want to make sure you are buying the active drugs.

As generic HIV meds are widely used globally, the approval process for generic manufacturers makes it important to check that the online supplier is selling versions that are approved by either the US FDA or the WHO.

This includes versions of tenofovir/FTC manufactured by the following companies: Aurobindo, Cipla, Hetero, Mylan and Strides Arcolab. (Full list of FDA approved generic HIV meds).

Generic tenofovir/emtricitabine for PrEP currently costs from approximately $55-100 for 30 tablets depending on the online supplier, plus delivery costs. This compares to about £400 for the Gilead version (called Truvada) if you are buying this in the UK.

Depending on how PrEP is taken, 30 tablets might be able to cover longer that one month use by a man using alternate day dosing or on-demand dosing.

See: How to take PrEP: what dosing?

If you want to check whether the supplier is providing genuine PrEP, you can have a blood test after you have been taking daily PrEP for a week. This will show whether you have drug levels in your blood. This is one of the tests offered in the private PrEP clinic run by Dean Street.

In theory, if many people are using the same supplier, only one person would need to have this test. Also, once a supplier has been verified, there would be a role for PrEP clinics or community websites listing this publicly.

The NHS is still deciding criteria for how PrEP might be available on the NHS, but this is likely to be restricted to those at highest risk, based on cost. This should change when tenofovir comes off-patent in 2017, although the patent on dual tenofovir/FTC continues for several more years.

Hepatitis C drugs

Three months generic sofosbuvir treatment costs approximately US $1,600 online compared to the approximately £35,000 charged to the NHS.

Generic versions of sofosbuvir have not currently gone through an FDA or WHO approval process in the same way as HIV drugs have. This is likely to happen in the future though, because of the importance of access to these this and other oral medicines to treat hepatitis C.

Hepatitis C treatment requires careful supervision from a specialist liver doctor. It also requires additional drugs and monitoring.

However, the current cost of new hepatitis drugs means that NHS access is currently restricted to people who have the most severe liver disease. This means that generic drugs might become the only way to quickly access the best and most effective treatment.

Although these drugs are recommended in the UK – and they should be available free in the UK – access is likely to remain limited unless the price is reduced.

Recent news stories have also reported the option of traveling to India or Egypt, where three months of generic sofosbuvir costs $900. Several sites are collecting information on buying generic HCV drugs: Online discussion including UK access, Personal HCV blog (Australian HCV activist Greg Jefferys), FixHepC buyers club (Australian site with forum, and testing options for sofosbuvir, ledipasvir and daclatasvir).

Getting a personal prescription

Most online websites require a prescription from a doctor.

Some sites may have different policies for this, and the main reason appears to be to help ensure there are no problems clearing customs.

The MHRA however do not seem to say that a prescription is required legally.

Most doctors are able to write personal prescriptions. The main requirement is that they can justify that the medical treatment is appropriate for the health of the person who they are writing the prescription for.

Personal prescriptions for erectile drugs were very widely used in the UK when Viagra was first approved. This was because the NHS only approved free access for people with a proven medical need, usually requiring referral to a specialist in sexual function.

In practice, many men with mild symptoms preferred to use a personal prescription and to pay for medicine at the UK list price (approximately £60 for 4 x 100 mg tablets).

The circumstances for PrEP have several similarities to the way that people accessed Viagra.

How to buy meds online: what do I need to do?

Although the procedures might be slightly different for each online supplier, you are likely to need:

• A doctor who will advise you on how to take the drugs, to do the appropriate tests. For PrEP this includes an HIV test, a blood test for kidney function and a urine test for protein. Other STI tests are a good idea. For HCV meds it should be your hepatitis doctor.
• A doctor to write you a prescription.
• Internet access, an email address and a way to pay (i.e. – a credit card or PayPal account).
• Email access or a fax machine to send a copy of the prescription.
• Some web sites also need you to send a patient release form. This is to say you are using meds for personal use. These forms can be downloaded from the website.
• If you continue using PrEP, then the tests above (HIV, kidney, urine protein and STIs) should be repeated every three months, especially if you are using daily PrEP. These tests might be free in NHS sexual health clinics (GUM/STI). Some NHS clinics are setting up private services until the NHS process for approving PrEP has been completed. You have nothing to lose from asking – and creating a demand is a good thing.
• If you are buying meds for hepatitis C drugs, your hepatitis C doctor will need to supervise treatment and monitoring, including the use of other medicines as needed.
• When using an online site, you will have to search for the drug you want to buy, check the price and the quantity, check the manufacturer, and follow instructions for ordering and paying. There is usually an additional charge for delivery, approximately $15.
• Check details about how drugs are delivery and how drugs clear customs. A genuine website is likely to provide lots of supportive information for customers. Genuine sites are also likely to have contact email and phone details if you have questions.
• As with other purchases online, you should get an email confirming your order, with details of expected delivery times. This is usually within 14 days.

Which online suppliers can I use for PrEP?

i-Base does not endorse or guarantee any online supplier.

We have no direct link to any online supplier, and no commercial link or conflict of interest.

However, the following three websites sell generic versions of tenofovir/emtricitabine: Tenvir EM (manufactured by Cipla) and Tavin EM (manufactured by Emcure). This is one of the formulations approved by the US FDA and the WHO.

www.aids-drugs-online.com

www.alldaychemist.com

www.unitedpharmacies.com

These suppliers appear to be established suppliers for a wide range of medicines including HIV and hepatitis C drugs.

[NOTE: we sometimes hear of supply issues with generic suppliers but these companies usually try very hard to resolve these. If problems occur, then first contact the company directly as often a replacement will be sent. i-Base have no direct links to these companies but please let us know if you have problems that might change our decision to list them.]

Do I need to pay VAT or a clearance fee?

i-Base has heard that some people ordering PrEP online have been asked for additional payment to cover VAT and a clearance fee.

For example, one person ordering three months of PrEP was asked by Parcel Force to pay Import VAT of £21.60 (and clearance fee of £13.50) before the parcel could be released.

These additional charges are legal, but don’t seen to affect all orders. It might be just good or bad luck whether this happens, depending on whether your parcel is picked up for this duty.

Generic antibiotics

Generic antibiotics are rarely imported for personal use – but they are the mainstay of NHS prescribing. These medicines have manufacturing quality and control that matches the originator brands. (In fact most large Western research companies already own generic companies).

Because antibiotics for sexual health are free and easy to access on the NHS the risk for buying these online is that you would use the wrong meds or the wrong dose. This could seriously complicate any infection. It could lead to drug resistance that would make an STI untreatable.

i-Base does not support buying antibiotics online for personal use.

Advice from the MHRA

The following advice from the MHRA was provided to the National AIDS Trust in August 2015 as part of collaborative community work by organisations in the UK working to improve access to PrEP.

http://www.nhs.uk/NHSEngland/AboutNHSservices/pharmacists/Pages/internet-drugs.aspx

The Common Logo is now in place:

https://www.gov.uk/guidance/register-for-the-eu-common-logo

We can confirm that there is no requirement for a member of the public to notify the MHRA of the importation of medicines for personal use and the legislation does not restrict such importation. Consequently, we do not issue any form of licence, certificate or authorisation to aid personal importation. The agency therefore has no objections, provided that the imported medicinal products are used only for personal use and are not sold or supplied to anybody else.

Up to a 3 month supply of a medicine is considered to be an acceptable quantity for personal use, HM Revenue and Customs can prevent importation if large quantities are being imported and/or they have suspicions that the product is not being imported for personal use.

We recommend that a check is made with the Home Office as to whether the product(s) to be imported to the UK are categorised as controlled substances in the UK – such substances are regulated by the Home Office under the Misuse of Drugs Act, and can require a licence to allow their entry into the UK. The Home Office have published a list (although not exhaustive) of controlled substances on their website and you will need to contact them directly for clarification on whether a Home Office licence is required for importation into the UK:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/164222/controlled-drugs-list.pdf  (PDF)

https://www.gov.uk/controlled-drugs-licences-fees-and-returns

We advise that anyone posting packages containing medicines should include a copy of the prescription and/or a letter from the patient’s doctor explaining why the product(s) are required, we also suggest that the package is clearly labelled on the outside stating the contents of the package and that the products are for personal use. We also strongly advise that the medicines are kept in their original packaging and that they are transported in accordance with storage conditions specified by the Manufacturer (this not only helps identify the medicines, but also helps ensure the product’s stability).

This answer was updated in February 2017 from an original post from September 2015.