DRAFT Best practices for online pharmacy-to-pharmacy marketplaces

The development of these guidelines has been an interesting experience.

Here’s what’s happened:

We had a long, thoughtful consultation with one of the nation’s leading experts on drug shortages.

We heard from platforms themselves that pharmacies used them to resolve temporary shortages. Our expert told us that they never resort to these platforms to ameliorate shortages, primarily because acquiring medicines directly from a pharmacy introduces too much risk. They prefer to have pharmacies return product to the prime wholesaler they got it from, in exchange for a refund and a promise of preferential future fulfillment. Shortages are resolved by moving product through the supply chain at the wholesale level.

A brand protection team discovered the interstate sale of counterfeit product through one of these online marketplaces while we were developing these best practices.

While disappointing, this was not shocking. These incidents are the reason we are developing these recommendations. Note the marketplace in question has not chosen to engage with us on these guidelines.

A platform owner shocked us with tales of fraud.

A platform owner regaled us with tales of the fraudulent activity and the compliance efforts he had to go to to stop sales of diverted and counterfeit medicine on his platform. Even though he implemented fraud controls that go above and beyond what larger platforms were doing, misbehaving sellers still found ways to evade them.

DSCSA compliance and regulatory experts told us these platforms shouldn’t exist.

Several DSCSA and regulatory compliance experts opined that these platforms were on shaky ground legally, as were pharmacies that sold on these platforms without wholesale licenses. They discouraged us from developing best practices because that might legitimize the platforms.

PSM pointed out that the marketplaces continue to exist despite this observation, so it is worthwhile to try and make the market safer, with or without regulator buy-in.

Some critics said that if the platforms provided an audit account for pharmaceutical manufacturer brand protection teams to monitor listings, it might be construed as a platform endorsement by the manufacturer. We pointed out that it doesn't constitute an endorsement when brand protection teams monitor the dark web for unsafe sales of their medicines.

Brand protection teams at major pharmaceutical manufacturers were hopeful about future cooperation with these platforms.

This effort was spawned by frustrations we heard from brand protection teams that they: a) did not have sufficient contact with these platforms to resolve concerns, b) had no access to monitor sales of their products on these platforms, and c) think platforms that have seen criminal activity are knowingly tolerating it to make sales fees. Universally, we heard from brand protection teams that they are eager to see progress from these platforms on transparency and cooperation.

These same professionals also wish these platforms did not exist, but cannot ignore them when pursuing their mission of protecting patients.

At least one of these platforms seems to have abandoned the pharmacy-to-pharmacy marketplace business model.

TRxADE appears to have changed its name to PrimeRX Marketplace, and seems to have moved from pharmacy-to-pharmacy sales to wholesaler-to-pharmacy sales.

Several of the platforms have not answered our queries.

As of May 2025, we are aware of seven platforms in this space, not counting unofficial sales that happen on WhatsApp. We spoke to four of them about our concerns before drafting guidelines.  Three of the seven gave us feedback on our guidelines draft. The other four platforms have not responded.