Online search for oral chemotherapy drug will likely lead your patient to ‘rogue’ pharmacy

September 07, 2022

3 min read

The authors report no relevant financial disclosures.

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As patients with cancer look to the internet for deals on costly medications, results of a study showed most online pharmacies that claimed to sell the oral chemotherapy drug imatinib engaged in illegal, unsafe or misleading activities.

Only three of the 44 online pharmacies identified had LegitScript monitoring service certification, according to the findings, published in Journal of the National Comprehensive Cancer Network. LegitScript classified 23 of the websites as “rogue,” indicating they may be unlicensed, ignore safety precautions, steal information or sell substandard formulations.

Classifications of online pharmacies that offered imatinib
Data derived from Sun Y, et al. J Natl Compr Canc Netw. 2022;doi:10.6004/jnccn.2022.7007.


Not all pharmacies operating online provide substandard medications or perpetrate scams, but it can be hard to distinguish between legitimate and rogue pharmacies, according to Sachiko Ozawa, PhD, MHS, associate professor in the division of practice advancement and clinical education at The University of North Carolina at Chapel Hill’s Eshelman School of Pharmacy.

Sachiko Ozawa

Sachiko Ozawa

“LegitScript found that there are 30,000 to 35,000 websites selling prescription medicines online, and 96{2c3a8711102f73ee058d83c6a8025dc7f37722aad075054eaafcf582b93871a0} of online pharmacies are not legitimate,” she told Healio. “This means there are many online medicine stores that are illegal and unsafe, selling medicines without a prescription or not complying with pharmacy regulations to keep customers safe.”

Ozawa and colleagues have conducted previous studies examining the ease of obtaining medications from online pharmacies without a prescription, including insulin and mixed amphetamine salts such as Adderall (Takeda), which is a controlled substance.

“We found it was straightforward to try to buy medicines [that] were touted for COVID-19 — such as hydroxychloroquine, dexamethasone and lopinavir-ritonavir — without prescriptions, even though current clinical evidence does not support people taking them at home,” she said. “So, we wanted to see what it would look like to search for an oral chemotherapy medication online.”

Imatinib (Gleevec, Novartis) is an oral tyrosine kinase inhibitor commonly prescribed to treat chronic myeloid leukemia. Ozawa and colleagues chose this drug for the analysis because it is typically required to be taken for the duration of a patient’s life, requires frequent monitoring and dosage adjustments, and can cost up to $700 per month at commercial pharmacies.


Ozawa and colleagues conducted a search of online pharmacies using four commonly used internet search engines (Google, Bing, Yahoo! And DuckDuckGo). They used the search term “buy imatinib online” and limited results to the first 10 pages each search engine displayed.

The investigators included websites that sold imatinib, published in English and shipped within the United States as part of their analysis.

Researchers identified websites meeting their criteria as either “certified,” “unclassified,” “unapproved” or “rogue” according to LegitScript classifications.

Key findings

The investigators identified three of 44 online pharmacies (7{2c3a8711102f73ee058d83c6a8025dc7f37722aad075054eaafcf582b93871a0}) offering imatinib as certified, with the remainder classified as rogue (52{2c3a8711102f73ee058d83c6a8025dc7f37722aad075054eaafcf582b93871a0}; n = 23), unapproved (30{2c3a8711102f73ee058d83c6a8025dc7f37722aad075054eaafcf582b93871a0}; n = 13) or unclassified (11{2c3a8711102f73ee058d83c6a8025dc7f37722aad075054eaafcf582b93871a0}; n = 5).

Thirteen websites (30{2c3a8711102f73ee058d83c6a8025dc7f37722aad075054eaafcf582b93871a0}) labeled as “online pharmacies” sold imatinib without a prescription. Notably, 23{2c3a8711102f73ee058d83c6a8025dc7f37722aad075054eaafcf582b93871a0} of pharmacies selling imatinib did not provide drug-related warnings, 48{2c3a8711102f73ee058d83c6a8025dc7f37722aad075054eaafcf582b93871a0} did not have limits on quantity for purchase and 77{2c3a8711102f73ee058d83c6a8025dc7f37722aad075054eaafcf582b93871a0} did not offer consultations with a pharmacist.

Nearly one-third of pharmacies classified as “rogue” promoted false accreditations on their website.

Clinical implications

Patients who obtain imatinib without a prescription are less likely to receive close laboratory and clinical monitoring by a prescribing physician, Ozawa said. This could lead to over- or underdosing of medication, which may cause adverse events and failure to achieve desired treatment outcomes, she added.

“Rogue or unclassified pharmacies may also sell substandard or falsified medications, which can cause harm,” Ozawa told Healio. “If your health is on the line, you want to make sure your medication is at least legitimate.”

Ozawa encouraged clinicians to ask their patients where they buy their medications and advise them to consult with their pharmacist, social workers, financial counselors or other members of the health care team to steer them in the direction of legitimate sources and direct them to any financial assistance that may be available. Patients also should be advised to consult the LegitScript website ( to verify which online pharmacies are legitime providers.

“It is important for clinicians to ask where patients are buying their medications,” Ozawa said. “If they say online, then clinicians should educate patients that illegitimate online pharmacies are very prevalent and can harm patients’ efforts to get better.”

For more information:

Sachiko Ozawa, PhD, MHS, can be reached at Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, CB#7574, Beard Hall 115G, Chapel Hill, NC 27599; email: [email protected].