E-pharmacies: Navigating through resistance, scepticism

It is time to reflect upon the purview of the E-pharmacy beyond self-medication and addictive drugs. We are at a stage past definitions and must navigate our way to a safe and trouble-free institution of E-healthcare in the country. The regulatory mosaic of online pharmacies in India is evolving day by day; so are the rogue and illegitimate e-pharmacies. Though comprehensive laws – governed by Drug and Cosmetics Act, 1940; Drugs and Cosmetic Rules, 1945; Pharmacy Act, 1948; Indian Medical Act, 1956, Information Technology Act, 2000; – and their amendments are in place, there is a scope for extending the frontiers while focusing on problems yet to be identified.

E-pharmacy is a promising venture with around 50,000 online pharmacies worldwide. It, therefore, necessitates an effective infrastructure. To this effect, four distinct facets need to be subject to quality control viz. drug companies, prescribing doctors, customers and regulatory authorities. A fifth domain can be thought of, which in fact, is an offshoot of the fourth but needs special consideration – active surveillance.

While the charter for registration of online pharmacies has been drawn, illicit online pharmacies are a rapidly growing threat. There is no infallible system in place to weed them out. So it is imperative to have a public accessible list of registered online pharmacies on a centralized portal with basic information about how to spot a rogue pharmacy. Another major concern is the sale of substandard drugs. 

Pharma companies have a great opportunity to save revenue and reach their customers directly which should ideally bring down the cost of medications. Has that actually happened? Small pharmacies also have a chance at online presence but for some reason they have not been able to show up significantly. 

Another issue is the timeline of delivery. How is it regulated that the delivery is not delayed beyond a threshold? This is a critical issue as there are often inevitable delays in delivery of goods even in the major cities in India. Details, contents, format and language of the “Patient Information Sheet” (that should accompany the medication ordered) is a necessity which calls for immediate attention.

The prevailing idea that doctors just have to write a digital or paper prescription, which can be uploaded to order medicine, is a myopic viewpoint. Writing a digital prescription which is linked to Aadhaar or any other national ID requires proper training. Patient details in terms of allergies, sensitivities, economic perspectives, frequency of patient visits, city/place of delivery, and various other issues need to be taken care of. Since, there are many places where postal and courier services are not available, doctors and pharma companies have to make sure that the medication can be delivered to the patient’s address or a convenient place from where the patient can collect it. Medicines like insulin which need to be stored at cold temperatures is another issue. These indicate that doctors may have to undergo training and certifications to write digital prescriptions. 

A mechanism for effective, useful and statistically viable feedback is a prerequisite that enables the customer to document her experience with a particular company. The result will assist patients to decide the best options available and save effort and time. Then there is the matter of spammers working through emails. We often get spam emails fine-tuned to our online search history. This poses the threat of being conned particularly to those who are relatively techno-illiterate and gullible; and, calls for public education to safeguard the people. This can be done in a number of ways involving medical social workers. An example of techno-illiteracy to consider is the online appointments in major hospitals. Since much of the Indian population is not adequately literate, they are unable to book appointments online. They have to seek the help of Internet cafe owners, who charge a very high amount for booking. Similar things could happen with online pharmacies.

E-pharmacy is a great concept with benefits including 24X7 availability, heavy discounts, ease of ordering, opportunity to compare prices and details, scheduling delivery times, availability of audit trail and ability to seek help and complain through customer care. But e-pharmacy is not the same as an online outlet for other commodities. E-pharmacy in India is growing fast and posing various challenges for development of effective regulations. These have to be addressed for it to serve the intended objectives. 

The author is a former clinical researcher at AIIMS and has studied at the Neuroimaging and Visual Science Laboratory, Department of Ophthalmology, New York University School of Medicine. Views are personal.