Digital pharmacies, defined as a website that offers a pharmacy service, provide a novel venue for convenient access to medication prescriptions compared to conventional pharmacies. Individuals’ prescription medication data are highly private. However, personal health information obtained by non-HIPAA covered entities either from individuals providing personal information or website monitoring, does not benefit from well-defined regulatory protections.1 Though, the prevalence of data-tracking among digital pharmacies is unknown. We determined the prevalence of data-tracking among accredited digital pharmacies.
We conducted a cross-sectional study of data-tracking among accredited digital pharmacies on September 27, 2021. We obtained a complete list of currently accredited digital pharmacies from the National Association of Boards of Pharmacies (NABP).2 There are 88 digital pharmacies accredited by NABP. We excluded 2 due to redundancy and one due to a nonviable URL. Blacklight, a web-based tool that determines website-employed data-tracking, was used to identify website monitoring and data collection for each digital pharmacy website URL.3-5 Data collected from digital pharmacies included use of ad-trackers, third-party identification “cookies,” tracking that evades “cookie” blockers, session-monitoring services, keystroke capturing, availability of data for Facebook, and Google Analytics tracking. All data are publicly available.
There are 85 included unique digital pharmacies that are accredited by NABP in the current report (Table 1). Of the 7 data-tracking features that Blacklight examines, 18 pharmacies used none, 28 used 4 or more (Figure 1). Over three-fourths (76.4%) of digital pharmacies used ad-trackers, with 1 site using 34. Over one-half (57.6%) of digital pharmacies used third-party cookies, with 1 site using 62. The mean number of ad-trackers and third-party cookies per website was 4.14 (standard deviation [SD] = 5.35) and 5.06 (SD = 9.53), respectively. Software that evaded cookieblockers, monitored session activity, and captured keystrokes were found on 12.94% (11), 10.59 (9), and 8.24% (7) of digital pharmacies, respectively. Data were sent to Facebook and Google Analytics for advertising among 35.3% (30) and 42.4% (36) of digital pharmacies. Of digital pharmacies, the mean number of store-fronts was 198.45 (SD = 1201.43).
Table 1.
Compiled List of Reviewed Websites.
| Company | Stores | Ad-trackers | Third-party cookies |
Evades cookie- blockers |
Session recording services |
Keystroke capture |
Facebook pixel |
Google analytics |
|---|---|---|---|---|---|---|---|---|
| AcariaHealth | 12 | 2 | 3 | 0 | 0 | 1 | 0 | 0 |
| Accredo Health Group | 29 | 7 | 5 | 0 | 0 | 0 | 0 | 0 |
| AdventHealth Expedien Rx Pharmacy | 9 | 5 | 1 | 0 | 1 | 0 | 0 | 1 |
| Allcare Specialty Pharmacy | 1 | 3 | 8 | 0 | 0 | 0 | 0 | 1 |
| Alto Pharmacy | 2 | 4 | 0 | 0 | 0 | 0 | 1 | 0 |
| Amber Specialty Pharmacy | 20 | 5 | 6 | 0 | 0 | 0 | 1 | 1 |
| AON Pharmacy | 1 | 19 | 43 | 0 | 0 | 0 | 1 | 0 |
| AV Pharma | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 |
| BioPlus Specialty Pharmacy Services | 6 | 7 | 4 | 0 | 0 | 1 | 1 | 1 |
| Boston Medical Center Corporation | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
| CareFirst Specialty Pharmacy | 1 | 5 | 3 | 0 | 0 | 0 | 1 | 1 |
| Caremark Rx | 52 | 4 | 7 | 1 | 1 | 0 | 0 | 0 |
| Carepoint Healthcare | 1 | 3 | 0 | 0 | 0 | 0 | 1 | 0 |
| CD (Red Rock) Pharmacy | 1 | 2 | 1 | 0 | 0 | 0 | 0 | 1 |
| CarolinaCARE Pharmacy Services | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Costco Wholesale Corporation | 518 | 8 | 8 | 1 | 1 | 1 | 1 | 0 |
| Curant | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| DEGC Enterprises US, CCS Medical | 3 | 3 | 1 | 0 | 0 | 0 | 0 | 1 |
| Direct Pharmacy Source | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| divvyMED, divvyDOSE | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 |
| Dulivuto Corp | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Eagle Pharmacy | 1 | 5 | 8 | 0 | 0 | 0 | 1 | 1 |
| Elixir Pharmacy | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Express Scripts Mail Pharmacy Services | 15 | 13 | 15 | 0 | 0 | 0 | 1 | 0 |
| Essentia Health | 24 | 7 | 8 | 0 | 0 | 0 | 1 | 1 |
| ExperienceCare Specialty Pharmacy | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Fortis Holding Company Specialty Medical Drugs | 1 | 5 | 2 | 0 | 0 | 0 | 1 | 1 |
| Gentry Health Services | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
| Good Health, Premier Pharmacy Services | 6 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Green Oaks Pharma, DFW Wellness Pharmacy | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Harper’s Pharmacy | 2 | 2 | 0 | 0 | 0 | 0 | 0 | 1 |
| Harris Teeter | 204 | 8 | 11 | 1 | 0 | 0 | 1 | 0 |
| Haysville Healthmart Pharmacy | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| HomeTown Pharmacy | 38 | 3 | 2 | 0 | 0 | 0 | 0 | 1 |
| Hook-SupeRX, CVS/Pharmacy | 1 | 11 | 17 | 1 | 1 | 0 | 0 | 0 |
| Humana Pharmacy | 6 | 6 | 4 | 1 | 0 | 0 | 1 | 0 |
| Hwareh.com | 1 | 12 | 16 | 0 | 0 | 0 | 1 | 1 |
| Hy-Vee | 281 | 5 | 6 | 0 | 0 | 0 | 1 | 1 |
| HYVACS, Hy-Vee Pharmacy Solutions | 2 | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
| Intermountain Healthcare Health Services | 3 | 11 | 24 | 0 | 0 | 0 | 1 | 1 |
| Indiana University Health | 13 | 4 | 0 | 0 | 1 | 0 | 1 | 1 |
| Infinity Compounding Solutions, Infinity C | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Inverness Apothecary Trinity | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 1 |
| Jolanto Corp Memorial Pharmacy | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Kmart Corporation | 100 | 9 | 16 | 0 | 0 | 0 | 0 | 0 |
| Long Prairie Pharmacy | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Magellan Rx Pharmacy | 2 | 1 | 1 | 0 | 0 | 0 | 0 | 0 |
| Meera Giannotto’s Specialty Pharmacy | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Meijer | 242 | 2 | 0 | 0 | 0 | 0 | 0 | 1 |
| Millennial Benefit Management Corporation | 1 | 34 | 62 | 0 | 1 | 1 | 1 | 1 |
| MobiMeds, The Pill Club | 1 | 11 | 8 | 0 | 0 | 0 | 1 | 1 |
| Noble Health Services | 2 | 2 | 0 | 0 | 0 | 0 | 0 | 1 |
| North Coast Medical Supply, Advanced Diabetes Supply | 1 | 4 | 1 | 1 | 0 | 0 | 1 | 1 |
| Novixus Pharmacy Services | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
| OncoMed Specialty Onco360 Oncology Pharmacy | 6 | 1 | 1 | 0 | 0 | 0 | 0 | 1 |
| OptumRx | 14 | 7 | 5 | 0 | 0 | 0 | 1 | 0 |
| Orsini Pharmaceutical Services, Orsini Health Care | 1 | 4 | 9 | 0 | 0 | 1 | 0 | 0 |
| PANTHERx Specialty | 2 | 1 | 1 | 0 | 0 | 0 | 0 | 0 |
| Pharma Buddies Corp | 2 | 1 | 0 | 0 | 0 | 0 | 0 | 1 |
| PharmaMedRx Mint Pharmacy and Skin Clinic | 1 | 10 | 5 | 0 | 1 | 0 | 1 | 1 |
| PillPack by Amazon Pharmacy | 8 | 1 | 3 | 1 | 0 | 0 | 0 | 1 |
| Postmeds TruePill | 1 | 6 | 11 | 0 | 0 | 0 | 1 | 1 |
| Powerhouse Pharmacy | 1 | 7 | 10 | 0 | 1 | 0 | 1 | 1 |
| Ridgeway Pharmacy | 1 | 2 | 0 | 0 | 0 | 0 | 0 | 1 |
| Rx Outreach | 1 | 3 | 2 | 0 | 0 | 0 | 0 | 1 |
| Rx To Go | 1 | 1 | 2 | 0 | 0 | 0 | 0 | 0 |
| Saint Peters Community Pharmacy | 1 | 3 | 1 | 1 | 0 | 0 | 1 | 0 |
| Senderra Rx Partners, Senderra Specialty Pharmacy | 3 | 1 | 1 | 0 | 0 | 0 | 0 | 0 |
| Solara Medical Supplies | 1 | 6 | 3 | 0 | 0 | 0 | 1 | 1 |
| Solera Specialty Pharmacy | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 0 |
| SortPak Rx | 1 | 2 | 0 | 0 | 0 | 0 | 0 | 1 |
| Synergen Rx | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| The MetroHealth System | 2 | 12 | 18 | 0 | 0 | 1 | 1 | 1 |
| Trillium Health | 2 | 5 | 0 | 0 | 0 | 0 | 1 | 1 |
| Triple SR (Hope Specialty) Pharmacy | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 |
| Unicare Pharmacy, MedicoRx Specialty Pharmacy | 1 | 1 | 3 | 0 | 0 | 0 | 0 | 0 |
| Union Pacific Railroad Employees Health Systems | 3 | 1 | 3 | 0 | 0 | 0 | 0 | 0 |
| U.S. Med Acquisition | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Vitalab Pharmacy | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Wake Forest University Baptist Medical Center North Carolina Baptist Hospital | 8 | 6 | 18 | 0 | 0 | 0 | 0 | 0 |
| Wal-Mart | 5188 | 12 | 15 | 1 | 1 | 0 | 1 | 1 |
| Walgreen Co | 9859 | 18 | 24 | 1 | 0 | 1 | 1 | 0 |
| Weis Markets | 129 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| WellDyneRx | 3 | 2 | 0 | 0 | 0 | 0 | 0 | 1 |
| Your Rx Pharmacy | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Figure 1.
Number of data-tracking features employed by digital pharmacies.
Among accredited digital pharmacies, data-tracking services were common, with over two-thirds using at least two modalities for capturing user data. Ad-tracking, third-party cookies, and delivery of data to Facebook and Google Analytics were the most prevalent data-tracking features. The prevalence of data-tracking features on accredited digital pharmacies raises concern for how personal prescription medication data are shared in the digital ecosystem.
The prevalence and use of digital pharmacies has been growing, with recent acceleration triggered by the COVID-19 pandemic.6 According to a poll from the Alliance for Safe Online Pharmacies, 42% of U.S. adults used a website-based pharmacy service in 2021, citing cost and convenience as the driving factors.7 This rapid growth has occurred despite a paucity of knowledge regarding the regulation of digital pharmacies and pharmacy services, nor knowledge on the privacy of personal data.7
Patients use digital pharmacies with the expectation that their data are secure and private. Given the substantial information patients provide to these websites, future investigation into how individual data are collected and trafficked is warranted.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Alexander Zheutlin is supported by the Utah Stimulating Access to Research in Residency Transition Scholar (StARRTS) Award Number 1R38HL143605-01.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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