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Wednesday, November 04, 2015

Online Pharmacies! Just a click away...

The world is changing and e-stores are taking over the online world. It isn't a wonder, then, that the online pharmacy business in India is already taking off and is expected to reach great heights.

However, as all things new, there are very few regulations and laws dealing with the same, with the result that some of them have already faced problems with the authorities over spurious drugs being sold without prescriptions etc etc.

The point of this blog is to let out a few ideas and suggestions as to how this can work, especially in a place like India, where we are so used to service and convenience that we feel it is our birthright to have everything delivered to our homes!! Of course, there are working couples, old and infirm grandparents who can't make the walk to the chemist but at the end it's just a matter of convenience and let's be honest about this point and just agree!

The simplest solution is what is being followed by most portals online today. Partner with a pharmacy which has its licenses in place and use the online portal as just a point of contact with the consumer to collect their orders. I see nothing wrong with this concept as long as the onus is on the pharmacy to maintain the prescriptions it claims is mandatory to be supplied to confirm the order. This puts the responsibility solely on the dispensing pharmacy and leaves the online portal to be free of lawsuits, at least to a point where prescriptions and documentations are concerned.

The other solution which I think is the right way forward is to have stand alone e-pharmacies tie up with Doctors in the area to form a network so as to be able to obtain and confirm prescriptions by them. The model is simple, fool proof and would probably even benefit all involved. An example to highlight this would be if you lived in my area, you visit an online pharmacy which operates/delivers to our area, click on the medications you need as per my prescription and the pharmacy because it has a tie up with me along with others in the area and has some method to receive my prescription in electronic format, digitally signed, so they can legally dispense the medication. There also will have to be a confirmation check in place either via a coded SMS or simply a call to the clinic asking whether the patient did indeed receive this prescription. The best thing would be for the pharmacy to collect the physical copy of the prescription from the patient at the time of delivery. A simple flow chart that Boots online pharmacy uses is shown below.

While this is all good and hearty, the problems that can come up are many. There has to be a regulation on all fronts, from the authorities, to the Doctors using these pharmacies to self regulation by them. Silly things like expired drugs, substitute medications, improperly labelled medications, delayed delivery etc just will not work. An easy and no questions asked return policy is a must in such cases. It will build trust in the consumer and ensure repeat visits and orders online.

The e-pharmacies regulating themselves is an interesting point from another point of view as well. Most e-commerce sites will go to the ends of the earth to provide 100% secure payment gateways to ensure the safety of the consumer. Why not invest the same amount in legal requirements for dispensing drugs. I'm sure the IITian and IIMians can come up with a secure way to obtain electronic prescriptions and keep a check on expired drug stock and illegal medications. We do have a few online pharmacies already who are doing a good job. Off the top of the head, netmeds, mchemsit, merapharmacy and 1mg come to mind.

Despite all this, we will still have problems, because, you know, this is India. Nothing is done without Jugaad!! So, we will have some players, trying to make a quick buck by selling over the counter drugs at lightening deals and discounts. We will have those festival specials where they try and get rid of their soon to expire stock. We will have 'performance enhancing' medications being sold 'exclusively' under the aegis of naturopathy and all herbal preparations. We will have a few shipping stones in place of medications. Look, there are bad eggs everywhere. This doesn't mean we give up. Look at the US. A study conducted by NABP in September 2013 found 96.7% online pharmacies there were 'rogue' meaning they did not comply with US laws and regulations. 

There is one more unique problem in India. We are the land of 'pathies'. We have ayurveda, homeopathy, allopathy, naturopathy, herbopathy, patni ka pati and a whole lot more! Most of these do not have separate regulations and dispensing guidelines. While I have nothing against other pathies, it's only the pharmaceutical problems I am highlighting here.

We also have a host full of quacks! Every neighbourhood white coat man prescribes medications right from a bone setter to a superspecialist PhD. A very eloquent lawyer who wished to remain unnamed laid this argument in court during one of these cases against online pharmacies. "When the physical pharmacies hardly ever follow rules regarding prescriptions and dispensing, how are the online pharmacies expected to fall in line."


Like most law and order problems in India, there are enough laws but not enough enforcement. Hopefully, this new turn of events will make the people in power see reason and bring about a new law and guideline for online pharmacies. Even if they don't, I see a bright future for them. They are here to stay and will probably do better than the online groceries out there. What do you think?

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