Even as a committee of experts is currently working to bring in a set of rules on online pharmacy to help regulate it, the Indian Medical Association (IMA) has opposed the idea saying that if online pharmacies are allowed, the Pharmacovigilance Programme of India (PvPI), initiated by the Union health ministry, will become a futile exercise and may not be in the interest of patients. Among other major issues with reference to online pharmacy, IMA has also raised the apprehension that there is no way to check the storage conditions of the drugs sold by the online pharmacies.
Exposure of medicines to high temperatures in storage or in transit could diminish their efficacy and are a potential health risk. IMA has also released a white paper on the same and sent recommendations to the ministry on the same to sound an alert that there should be no misuse or abuse of drugs and devices sales via online mode.
Said Dr K K Agarwal, secretary general, IMA, "In March this year, the health ministry has also launched the Materiovigilance Programme of India to monitor adverse events associated with medical devices. If there is no system in place to monitor and analyse adverse drug reactions, this will directly affect the health of the patients."
He added that regulatory authorities continue to monitor a drug for any adverse effect even after it has been on the market. If the safety/quality of the medicine comes under question or, if it is potentially contaminated, mislabeled or is improperly packaged, then they may recall or withdraw a prescription or OTC drug from the market even after it has been approved. Sometimes, the manufacturer may voluntarily recall a drug. If online pharmacies are permitted, the drug recalls may become very difficult, almost next to impossible.
According to IMA, online pharmacies may provide rebates and commissions to doctors to provide prescription on the basis of online information that has been filled by the patient. This way doctors will be vulnerable to malpractice suits. Regulation 6.4 of MCI Code of Ethics prohibits doctors from giving or receiving any rebates or commissions.
It also stated that similar to the online search services, online pharmacies may also promote doctor substitution, which is unethical. Ultimately online pharmacies will be taken over by MNCs and Indian laws may not be applicable. This will encourage substitution of cheaper and spurious drugs and the doctor patient confidentiality will also get affected. It will deny the patients doctor's supervision for rationale use of medicines and hence encourage drug abuse. The medico-legal liability will also fall on the doctor, when a patient misuses the facility.
Meanwhile, e-pharmacy firm PharmEasy begs to differ and has strongly advocated use of technology in medicine distribution to ensure greater transparency, better coordination and benefits to general public. “Online pharmacies in India are only market-places in the form of an electronic platform. Orders placed by a consumer are routed directly to a neighbourhood brick and mortar pharmacy with all licenses, systems and procedures required by state laws. The consumer’s order is filled by a registered retail chemist with all required legal safeguards," said Dharmil Sheth, co-founder and director, PharmEasy.
"Online pharmacy is a well established concept in developed countries such as China, USA, Australia and United Kingdom. The online platform collaborates with local pharmacists and druggists for last mile delivery and hence fear of loss of business for traditional brick and mortar drug outlets is grossly unsubstantiated," he added.