On prescription: e-pharmacy

Finally, the idea of e-pharmacy is about to take off in India. The Union government has notified the draft rules on the establishment of legal e-pharmacies in the gazette last month, inviting objections and suggestions within 45 days.  What does it promise to the Indian customer?

After prolonged deliberations and studies, the Union government has notified the draft rules on the establishment of legal e-pharmacies in the gazette on August 28, inviting objections and suggestions within 45 days. In an era of globalisation, e-pharmacies cannot be blocked. However, a section of the community pharmacies lead by All-India Chemists and Druggists Association is agitating against the approval of e-pharmacies by observing a 24-hour strike on September 28.

The brick and mortar community pharmacies have a natural fear that e-pharmacies will take a share of their business. But they fail to understand that such agitations will only help to popularise e-pharmacies. They can very well demand similar renovations in the area of physical pharmacies, majority of which are not in good shape and situations. Government support is needed for bringing quality services and reasonable profit margins in pharmacies which are essential to bring them to global standards.

There are about eight lakh community pharmacies and two lakh hospital pharmacies working with licenses from the regulators in India. Another two lakhs are working without proper licences. Most of the brick and mortar type pharmacies are yet to have a proper prescription filing system in India, though the Pharmacy Practice Regulations 2015 and the Drugs and Cosmetic Rule insists for the same.

Breaking barriers of information and services
Digital India is a flagship programme of the government of India. It aims to transform India into a digitally empowered nation with the support of creating digital infrastructure, digital literacy and digital delivery of services. It aims to empower society to avail government services transparently, conveniently and easily. Digital India is expected to boost the economic growth of the nation and improve the lives of people. There is dramatic growth in the number of online transactions involving citizens and the government ( e-governance) in recent times. If it was 840 million in 2013, it became 2,580 millions in 2015 and increased many folds during 2017-18. E-pharmacy can very well align with the national development objectives and has clear and tangible benefits to the consumers as well as the industry.

A unique feature of information technology is its ability to break barriers of information lying with experts. E-governance, e-health, e-pharmacy are all its beneficiaries. Studies have shown that a significant proportion of the Indian population is willing to purchase medicine, pharmaceuticals and other related products over the internet due to its inherent advantages. Quality assurance, economic prices, incentives, schemes, discounts, convenience in ordering, transparency and tracking system, home delivery with preferred time and address are some of the important advantages that will motivate consumers/ patients to shift towards e-pharmacy, like other e-commerce activities.

Potential for e-pharmacies in India
At the global level e-pharmacies have a market of $29.3 billion in 2014, both North America and Europe sharing it. It is estimated that by 2023, the global market of e-pharmacy will be $128 billion. According to one Boston Group report in 2016, China has an e-pharmacy market share of $1.1 billion. The potential area for the global e-pharmacy market lies in the Asia Pacific market. Though e-pharmacy is only in the gestational stage in India, it has the potential to become a very large industry segment in the very near future. Rapidly changing consumer behaviour, increasing penetration of internet to the rural areas and the availability of smart phones are some of the major driving forces for the popularisation of e-commerce and e-pharmacies in India.

Strength of Indian e-pharmacy rules
Though there are some grey areas in the draft rules, the Indian e-pharmacy rules are better than that of many other countries where legal pharmacies are in existence, including the US. The Central Drugs Control Authority will have to notify all the approved e-pharmacies in their web- portal. E-pharmacies have to disclose all specified information on their websites and can sell medicines only with the support of cash bills. It is to be noted that currently there is no such portal notification even for the manufacturing firms and their products in India.

An analysis of the existing rules for community pharmacies and e-pharmacies shows that the draft rules for e-pharmacies are much better and user friendly than the pre-independence Drugs and Cosmetic Rules for physical pharmacies. In fact, the arrival of e-pharmacies in a professional and smart manner will only help improve the quality of services of existing traditional pharmacies. It will also help modernise our out-dated prescription dispensing practice styles in India. Let there be a healthy and professional style of competition.

E-pharmacies implemented under the new Rules will not promote self medication or irrational use of medicines compared to the existing physical pharmacies. In its proposed structure, e-pharmacies can promote prudent use of medicines. E-pharmacies are expected to open newer avenues for qualified pharmacists with innovative ideas.

Drug regulation including supervision and monitoring will become transparent and effective in the case of e-pharmacies. It will also necessitate to make our drugs control/FDA smart and effective both at centre and state levels. They have to seek the support of IT experts with them.

E-pharmacies Vs physical pharmacies
Currently there is lot of misunderstanding about e-pharmacies in India. Some believe that it will have an adverse impact on the traditional brick and mortar pharmacies and argue it will take away the employment potentials of pharmacists. Others anticipate promotion of unethical practices in pharmacy practice. All are just hypothetical phobias. In reality, e-pharmacy models can help the existing traditional pharmacies to grow and expand. They will help community pharmacies to cater to a broader set of customers and ensure that the inventory is consolidated by reducing the budget requirements, removing wastage from system and increasing margins, thereby making the community pharmacies more sustainable.

Existing physical pharmacies too can start online operations and serve a broader set of customers. Similarly a network of pharmacies also can integrate one platform and access a broader customer base. Since e-pharmacy has a stringent documentation process, the taxes paid on all transactions will largely benefit the Government . Every order dispensed through e-pharmacy will have a valid bill or cash receipt and tax to the Government has to be paid in full.

Grey areas in new rules
The new Rules failed to specify an outline of standard operating procedure (SOP) for the e-pharmacies, including storage, transport inventory control and the role of personnel employed including pharmacists. Storage plays a vital role in preserving the potency of medicines in general and items to be preserved in ‘cool’ and ‘cold’ places in particular. Integrity, quality and effectiveness of medicines have to be preserved while packing, transporting and delivering. The principles of generic prescription and dispensing needs to be addressed specifically.

Since a prescription cannot be over dispensed with respect to items and quantities, can a scanned copy of prescription as such be made valid for dispensing of prescription items through e-pharmacies? Many international e-pharmacies are operating illegally in India and the new draft Rules are silent in that issue. 

It’s advantage customer when sales of drugs go online

Tracking of Data
All the details regarding the e-pharmacy transactions will be properly documented on e-platforms. All transactions could be tracked with details of the medicines, batch number, date of manufacture and expiry, e-pharmacy name and address, prescribing doctor, dispensing pharmacist and patient details, reducing many unethical issues and practices. E-pharmacies can store and analyse data on consumers, which would be useful for planning public health policies. 

Authenticity, quality
The IT-based tracking systems of e-pharmacies will help make the medicine market transparent and authentic. Back-tracing facility to identify the manufacturer/channel/supplier will help identify and avoid the sub-standard or low quality medicines and counterfeit medicines. As the government is working on the introduction of bar codes for all medicines and has already introduced the system of generic dispensing in the country, e-pharmacies can act as a catalyst in cost reduction, quality assurance and availability of medicines at economic costs.

Improved accessibility
With the use of information technology and access to inventory of multiple stores at a time, e-pharmacies can aggregate supplies, making otherwise difficult-to-find medicines available to consumers across the cou ntry. Community pharmacies can generally keep only a limited inventory forcing the consumer to visit multiple pharmacies to procure the medicines. E-pharmacies enable access to rural areas where there is shortage of community pharmacies. E-pharmacies will be much helpful and useful for regular users of medicines and also for senior citizens and disabled who find it difficult to travel to the community pharmacies. Medicines will reach their door steps, quite often at less costs.

Professional service
India has already introduced the system of generic prescriptions and dispensing. Doctors who were not taught about brand names or trade names during the education period are prescribing costly brands to poor people in the name of quality. Quality is not related to brand or generic names, but to the manufacturers and their process. It is the responsibility of the governments to ensure quality of medicines manufactured/ marketed in the country. E-pharmacies allow the consumer to choose from a wide range of generic equivalents for a particular branded drug. This is currently not possible in the Indian community pharmacies. OTC medicines can be sold through the e-pharmacies without prescriptions as in the case of other pharmacies.

Cost benefits
E-pharmacies will help pharmacy entrepreneurs to broaden their customer base while reducing financial investment, working capital and overhead costs. They will also get increased margins. Patients and consumers will get quality medicines at lower costs.

Medicine safety
Questions about medications could also be answered by e- pharmacists using e-mail, Whatsapp or other real-time chat options. As pharmacists at the e-pharmacy will be the final decision maker for dispensing a drug, e-pharmacy shall have a team of competent pharmacists for validation of a prescription and for handling any drug related queries from the patients. Qualified pharmacist would be necessary in e-pharmacies to provide value added professional services. Medication errors can be more effectively addressed through e-pharmacies than the existing Indian community pharmacies. OTC medicines can be sold through the e-pharmacies without prescriptions as in the case of other pharmacies. 

E-prescriptions
E-pharmacies would also enable the doctors to adopt e-prescriptions, which in turn can address issues of errors due to misreading of doctors’ bad handwriting and also help to recording of data for public health planning programmes.