Online pharmacy using web based app to buy medicine is the latest trend in India. E – commerce is revolutionizing the health care industry in India. There are around 3000 online pharmacies and most of them are based in USA and others in UK, Canada and India. Most of the western countries are utilizing this facility and in India the growth is significantly escalating and the scope of online pharmacy is to be still examined.
E – pharmacies are required to upload the original prescription or e- prescription when the consumers place the order via internet. Most of e- pharmacy adopts web based or mobile based application. This prescription is then verified by a qualified registered pharmacist and the medicines are obtained from a standard pharmacy. These pharmacy stores need to comply with all the requirements of Drugs and Cosmetics Act and Rules. They are packed in a sealed tamper proof pack in such a way that they are protected from all types of weather and are child proof. Then they are delivered to the customers. Most of the time the required cost is collected via net and some may allow cash on delivery.
There are many benefits of online pharmacy. Ordering the medicine online is extremely easy and convenient as the drugs are delivered with just a click at any time. Many of the online pharmacies give greater discount with free shipping which cuts the cost of medicine. The drugs are packed well and the information on medicine is also provided. People who are suffering from chronic conditions and who consume drugs for a lifelong period need not have to visit pharmacy every time.
But, not all online pharmacies are licensed and reliable. If shipping is delayed, the dose can be missed. Online pharmacies may not care about the health as most of them are only interested in making money especially if non-prescription drugs are ordered. They may also result in serious side effects and the pharmacy would have added hidden costs. They may not have privacy policies. The information may be cracked or the drugs may not have been dispensed from an authenticate source. Online pharmacy can never give the physical touch of a pharmacist in a retail store. Thus the actual contact with the pharmacist is lost, who can advise him on side effects, adverse effects, storage of medication etc, thus leading to self-medication.
e-pharmacy at its nascent stage in India
However, e-pharmacy is at its nascent stage in India. About 8.5 lakh medical shops were closed on May 30, 2017 across the country as the All India Organization of Chemists and Druggists (AIOCD) called for a nationwide protest against the e-pharmacy regulations. Currently there is a lot of misunderstanding between the e –pharmacy and traditional brick and mortar pharmacies. But e –pharmacy can cater to a broader set of customers and also ensures that the inventory is consolidated by reducing the requirement for working capital, removing wastage from system and increasing margins, thus making the model sustainable. It is also possible that physicians can directly e- mail to the pharmacies as e- prescription. This will avoid the confusion in written prescription and as The Medical Council of India (MCI) has made amendments in the Indian Medical Council (IMC) (professional Conduct, Etiquette and Ethics) Regulation 2002 and issued directives to the physicians on September 28, 2016 to prescribe medicines only in their generic names written legibly and preferably in capital letters.
Among the online pharmacies, Tracxn, so far has attracted $92.6 million funding with over $70 million in 2015. Almost 31 start-ups launched, with the major chunk of investment announced by Netmeds ($60 million), followed by 1MG ($6 million) and Zigy ($3.2 million). Investors include IT industry veteran Phaneesh Murthy (in Zigy) and global healthcare fund Orbimed (in Netmeds). Online doctor booking and consultation sites Lybrate Inc. and Doctor Insta Pvt. Ltd to serve their customers are also available.
Some of the Indian e- pharmacies are mCHEMIST.com founded in 2014 to shop for prescribed medicine and health care devices. Netmeds.com is one of the established Indian online pharmacies which provide medicines, healthcare devices and surgical equipment in several different categories. It delivers herbal products, beauty care products, diabetic care kits, dietary supplements and healthcare.
Merapharmacy.com is a one stop platform for buying all pharmaceutical products online. It delivers medicines from authorized sellers only on the basis of prescriptions. This online pharmacy not only delivers medicines at doorsteps but also reminds of the specified times to take the medicines. Medidart.com works on the same model as that of other Indian start-ups in online pharmacy market. It offers cash on delivery payment option besides accepting payments through debit cards, credit cards, net banking and Paytm wallet. Buydrug.in delivers only authentic and prescribed medicines with genuine invoices.
Medplusmart.com is another online pharmacy operating across India, but they don’t have the delivery service facility. They inform about the time to pick up order from the nearest MedPlus store. ApolloPharmacy.in is a venture by the healthcare group Apollo Hospitals into online medicine buying and delivery. Having international quality certification, Apollo Pharmacy operates 24 hours. Its customer care service is available round the clock. They offer merchandise of over 4000 products in different categories including personal care, dietary supplements, OTC, baby care etc.
Legal status of e- pharmacies
There are a lot of questions regarding the legal status of e- pharmacies in India. Recently an FIR was filed by the Maharashtra FDA against the online seller Snapdeal for selling prescription drugs. On October 29, 2015, the Bombay High Court declared that the online sale of medicines given under schedule H of DCA without a prescription or a cash memo is illegal and asked the Maharashtra government to take the steps necessary to prevent unauthorized and illegal selling of scheduled drugs on the internet.
Section 4 of the Information Technology ( IT) Act deals with legal recognition of electronic records and section 5 of the IT Act provide the legal recognition of electronic signature. Rule 65 of the Drugs and Cosmetic Rules 1945 says that a prescription should be in writing and signed by a person giving it with his usual signature and dated by him. Thus these rules are to be applied for the legality of e- prescription. Pharmacy Practice Regulations 2015, Section 2(j) (3) of the regulations gives the definition of the prescription as a written and electronic direction from a registered medical practitioner or other properly licensed practitioners to a pharmacist to compound and dispense a specific type and quality of prescription or prescribed drug to a patient. Thus e- prescriptions are valid and legally recognized.
In India, the sale of prescription drugs is regulated by laws formulated under the Drugs and Cosmetics Act, 1940, Drugs and Cosmetics Rules, 1945, and Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954. Many online pharmacy websites have taken the regulations given under the Drugs and Cosmetics Act for running physical pharmacies as being applicable to online pharmacies.
In July 2015, the health ministry of India ordered the constitution of a subcommittee to look into the issue of online pharmacies. The committee has been constituted under the headship of the Food and Drug Administration (FDA) Commissioner of Maharashtra. The issue before the subcommittee was the examination of the online sale practices carried out by developed countries and how they have impacted public health in these countries and whether their implementation is possible in India. The committee has invited comments and inputs from various stakeholders such as public companies, trade bodies amongst others.
Global e-pharmacy market
The global e-pharmacy market, led by North America and Europe, was approximately US$ 29.3 billion in 2014 and has been estimated to grow at a CAGR of 17.7 per cent to reach a valuation of US$ 128 billion by 2023. Within this global perspective, industry analysts have projected that Internet pharmacies will generate US$ 15 billion in prescription drug sales by 2017 and over US$ 30 billion by 2020.
In order to use a legal site the United States National Association of Boards of Pharmacy (NABP) has developed the Verified Internet Pharmacy Practice Sites (VIPPS) programme. To be VIPPS certified, a pharmacy must comply with the licensing and inspection requirements of their State and each State to which they dispense pharmaceuticals. If the pharmacy has demonstrated to NABP compliance with VIPPS criteria, it will display the VIPPS hyperlink seal on its website. VIPPS criteria include patient rights to privacy, authentication and security of prescription orders, adherence to a recognized quality assurance policy, and provision of meaningful consultation between patients and pharmacists.
The VIPPS accreditation program introduced by the NABP in the US can be incorporated in India as well to make e-pharmacies safe for Indian consumers.
Often, the source country from where the medicines are shipped is different from those claimed by the website, a practice that is considered fraudulent and illegal. In addition, illegal websites may disappear without trace, at a slightest hint of a regulatory action. Consumers seeking overseas options to purchase medicines also pose a threat to the pharmaceutical industry and pharmacists of the respective country.
WHO has published a document “Medical products and the Internet: A guide to finding reliable information”. National authorities such as the US Food and Drug Administration (FDA) has published tips and warnings for consumers in the Internet to make people aware of the dangers of buying medical products online. Professional pharmaceutical and medical bodies such as the Pharmaceutical Group of the European Union (PGEU) and Standing Committee of European Doctors (CP) have released their own document “The Internet and Medicines: enjoy the Internet but don?t risk your health!”
In this modern technology the consumers must accept the concept of e- pharmacy and government should implement stringent regulatory control to protect the interest of the consumers. A separate license and registration of e-pharmacy should be created. All medicines should be dispensed especially prescription drugs, only under the supervision of registered pharmacist. The entire prescription with name and address of the patient must be digitally stored for any legal issues. Narcotic and habit forming medicines should be restricted for sale by e- pharmacy. The entire detail of the e- pharmacy including license number and registration number of registered pharmacist must be placed on the drug envelope to make sure from where the drugs are dispensed. Online firms, however now formed a lobby of their own called the Indian Internet Pharmacy Association (IIPA). Thus specific regulations for the online pharmacies allow them to operate and consumers are most benefited.
(The author is Director, Agnihotri College of Pharmacy, Wardha)