Online pharmacies: A trouble maker or game changer?

Bejon Kumar Misra, Founder, Partnership for Safe Medicines (PSM) India Initiative, feels that online pharmacies are here to stay as they offer myriad advantages but recommends better regulation and more consumer awareness to mitigate concerns and optimise the potential of these online entities

Consumers globally have the right to access products and services, which are healthy and safe, based on credible information, choice and fair business practices. At no cost should the quality of products and services be compromised, especially those concerning life and safety. Today, the consumers are capable of deciding what is best for them and seek transactions online without physically visiting the point of sale, thanks to technology. India is no exception, nor is the Indian consumer. Online sale has emerged as a game changer, not only in metro cities but also in tier-I and tier -II cities and towns. Slowly, it is also penetrating the rural areas of India, touching 638,000 villages spread over 36 states with a population of 1.34 billion consumers.

Online pharmacies: Serving a need

Purchasing cloth, food, books, cinema tickets, tours and travels – even groceries – over the Internet is perceived as normal behaviour by all.  Online shopping is convenient and products are delivered directly to your doorstep, promptly and efficiently. Similarly, purchasing medicines online is becoming popular amongst the consumers in India and also globally. Online pharmacies will soon be seen as the most reliable mode of purchase, giving tough competition to the existing chemists’ and druggists’ brick and mortar stores.

Concerns galore…

But, despite the ease of use, purchasing products like medication over the Internet can be dangerous, if not deadly. Medications purchased from illegal online drug sellers are often not what patients expect. These products have been found to contain dangerous substances such as powdered concrete and antifreeze. Additionally, prescription drugs, if taken without a prescription, lack necessary and appropriate medical supervision. Drug overdose was a leading cause of injury and death in 2010. Among people 25-64 years old, drug overdose caused more deaths than motor vehicle crashes. Accidental overdose is increasingly common when using drugs online.

Thus, online pharmacies can become a troublemaker if not handed appropriately by the regulators and the consumers. We must agree that we can never ever afford to ignore the hazards of accessing medicines in an indiscriminate manner. They have to be efficiently governed by a robust regulation based on global best practices and applicable to all the agencies, whether online or off-line to ensure safety and quality to the consumers.

“Selling medicines without prescription is a common practice in India,” say 50 per cent of people in a survey conducted by Bureau of Research on Industry & Economic Fundamentals (BRIEF). This survey was commissioned by Consumer Online Foundation, a registered voluntary consumer organisation in India, to understand the consumer behaviour towards purchase of medicines online based on the information provided on websites and telephone helpline numbers. A major shift in consumer preference in buying medicines online has been noticed across all age groups. The study reveals the following:

• Rise in unsafe purchase of drugs through offline chemists
• The sale of medicines without prescription seems to be a market norm as reported by half of the respondents.
• Around 36 per cent of the sample consumers reported that they do not get bills with batch number and expiry date for their purchases.
• 50 per cent of people admitted to buying medicines without prescription from chemist shops.

A total of 4600 consumer respondents from all the age groups participated in the survey with a fair representation across all the age groups. Around half the respondents were in the age group of 18 to 34 years.

• A majority (83 per cent) of the consumer respondent’s agreed conducting their banking activities or shopping online. Additionally, online shopping or banking is not restricted to any particular age group, especially the young, which is highly risk taking and can cause addiction unintentionally.
• A majority of the sampled consumers buy medicines on their own by personally visiting medicine outlets (68 per cent) and about 20 per cent of them order medicines over the telephone from such outlets.
• A majority of the online orders are being placed by senior citizens due to convenience, proper systems facilitating easy validation of prescriptions and choice of affordable options were the main reasons. The preference of buying medicines through physical visits to the medical stores decreases (from 72 per cent to 55 per cent) with increase in age. Subsequently, placing orders for medicines over the telephone (from 15 per cent to 29 per cent) increases with increasing age.
• A majority (63 per cent) of consumers need to buy medicines for chronic diseases and with increase in age, the frequency of buying medicines for chronic diseases was found to increase (from 52 per cent to 86 per cent).
• The monthly expenditure incurred over medicine by 86 per cent of the respondent consumers is up to ` 5000. Off them, 39 per cent reportedly spent between ` 1001 to ` 2500 per month.
• Around 48 per cent respondents reported that they have to visit multiple pharmacies to buy medicines as the doctor’s prescription does not allow patients to access all the prescribed medicines from one shop due to large variety of same medicine are available in different brand names, even though they carry the same salts or formulations.
• A significant 67 per cent of the samples have been through occasions where they were charged different prices for the same medicine at different pharmacies and unavailability of qualified pharmacists to dispense medicines at pharmacies has emerged as one of the major issue as reported by 32 per cent of the consumers.
• Approximately 63 per cent respondents don’t get proper counselling about the administration of medicines at their preferred medical stores while majority (67 per cent) of the respondents recalled instances wherein they were offered an alternate or substitute brand for the same composition during purchase. Of them, 42 per cent found the alternate brands to be cheaper in price and 37 per cent found the alternate brands to be of the same price.

…nevertheless a game changer

However, my opening remarks that online pharmacies are going to become game changers is reaffirmed as the study establishes the fact that 90 per cent of the respondents showed inclination towards online purchase of their medicinal requirements in the near future. Further, consumers in the age groups 65 to 70 years (92 percent) and 35 to 44 years (91 per cent) have shown the highest intent to use e-pharmacy in the future. Also, 94 per cent of the respondents currently buying medicines for chronic diseases have shown inclination to accept e-pharmacies in the future. Approximately 76 per cent respondents think that e-pharmacies will be more convenient as compared to the existing mode of purchase they are using. A majority (76 per cent) of the respondents stated that a single store or website would suffice their medicinal requirements and would be a major benefit for consumers.

Around 87 per cent respondents perceive that home delivery of medicines would be a major benefit propelling the increase in acceptance of online shopping of medicines. 84 per cent of the respondents are of the opinion that low prices, discounts and savings on purchases would be a big feature that would attract consumers towards e-pharmacy.

Around 74 per cent of the respondents agreed that convenience in choosing the time and location for delivery of orders would improve acceptability of e-pharmacies in the market. 74 per cent are of the opinion that quality of medicines would not be compromised at e-pharmacy stores, and will eventually be the main factor attracting consumers to this platform.

Approximately 72 per cent of the respondents perceive that ease of tracking orders, convenience in cancellation of orders and the option of reimbursement in online purchase of medicines are advantages that consumers will enjoy if they opt for e-pharmacies.

Clarity in regulation is key

Some of these pharmacies require prescriptions, while others do not. Of those that do not require prescriptions, some ask the customer to fill in a health questionnaire with their order. Many drugs available at legitimate online pharmacies are produced by well – known manufacturers such as Pfizer, Wyeth, Roche, and generic drug makers like Cipla and others. However, it remains difficult for a patient to ascertain whether an online pharmacy is legitimate. Medicines obtained from rogue online pharmacies come with no guarantees with regard to their identity, history and source. A study in three cities of Netherlands found that over 60 per cent of the consumed sildenafil was obtained from illegal sources. In India, we need to conduct similar studies to insulate the consumers from accessing spurious and not-of-standard medicines from online pharmacies.

We must amend the existing Drugs and Cosmetics Act, 1940, and the Drugs and Cosmetics Rules, 1945, as it does not provide clarity about online pharmacies and their functioning in India. The existing law has guidelines on the sale of Schedule H and Schedule X drugs. These can be sold only on by prescription and there are specific rules, including for labelling and bar coding.

It appears that electronic prescriptions should be valid, especially in the light of the Pharmacy Practice Regulations of 2015 declared by Pharmacy Council of India in January 2015. In these regulations, “Prescription” is defined by regulation 2 (j) [3] as “a written or electronic direction from a Registered Medical Practitioner…….” On the basis of existing regulations it appears that a scanned copy of the prescription will be perfectly valid. However, whether such electronic prescriptions can be used to buy medicines from online pharmacies has been questioned.

The way forward

It is very difficult – if not impossible, to tell which websites are legitimate. You can never spot the fake website unless you are an expert on the subject. Fake online pharmacies can manipulate their websites to appear legitimate, so checking the pharmacy’s license through your state drug regulator is an important step to know whether you are using a safe and legal online pharmacy. Unfortunately, in our country the state drug regulators never make such information public and accessible. However, certain states like Gujarat, Maharashtra, Karnataka, Tamil Nadu and others, with support from the Government of India have established portals for sharing such information online, in the interest of the consumers. If you cannot confirm that an online pharmacy is licensed and safe, consumers should avoid using them till they are not fully satisfied about its credentials and credibility. Even if you have identified a proper online pharmacy, be sure that the pharmacy requires a valid prescription from your doctor before dispensing the medicine and you are provided with a physical address and telephone number in India by the online pharmacy, which would have issued the license to conduct the business as per our existing laws. It should also have a licensed pharmacist to answer your questions. You should never think of compromising your health and safety while purchasing medicines online or offline.