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Swallowing a bitter pill
The one-day strike against e-Pharmacies by chemists across India to be held on November 23, brings the spotlight back on the tussle between pharmacists and e-pharmacies, as the former contest that there are no legal provisions for the functioning of the latter
By
migrator
migrator
Chennai
The Indian Medical Association’s white paper says that a patient’s safety may be endangered by availing of e-Pharmacies. However, e-pharmacies maintain that while affordability, convenience and reliance are the core principles, pharmacists continue to be the interface verifying prescriptions for orders.
With medicines being just a click away, e-pharmacies like Netmeds, 1MG, Medidart, Zigy, etc., have been mushrooming in the country. According to a FICCI report on E-Pharmacy in India, ‘The model could account for 5-15% of the total pharma sales in India, largely by enhancing adherence and access to the medicines for a lot of under-served population.’
However, pharmacists across the country went on a strike, calling the sale of medicines online illegal last year. Snapdeal and a few other e-commerce sites too came under the scanner of government for selling medicines online without a license. The slugfest that has ensued brings back questions about the legalities concerning the functioning of e sales of medicines.
The upcoming strike by chemists across the country yet again takes on the e-pharmacy industry. Joined by the state based association, the strike will see more than 40,000 pharmacists participating in it in Tamil Nadu.
KK Selvan, general secretary, Tamil Nadu Chemists & Druggists Association, which is affiliated to the AIOCD, says e-pharmacies flout norms and sell prescription drugs without valid prescriptions.
He says, “The existing laws do not approve e-pharmacies. Moreover, abortion pills are being sold online without any involvement of pharmacists. When emergency contraceptives and abortion pills are bought, the pharmacist explains the effects the medicines can have. Without guidance, such medicines can have an adverse health effect and at times, they can be life threatening. With increasing addiction among youngsters, these online players make indiscriminate use of medicines more easy for them.” He adds that there has been no check on the authenticity of prescriptions. He says, “When we get a prescription, we have to navigate through issues like comprehending the doctor’s handwriting and we manage to overcome it because we know the doctors in the localities and the patients or the patients’ attenders as well. How can the same be done online?”
He adds that the Western model is not suitable for India, where the pharmacy shops are located at a five kilometre radius. While the government is in the process of regulating e-pharmacies, the pharmacists say that without them in the link, the model would only spell disaster as a growing e-Pharmacy industry would mean an end to emergency medicines, putting lives in danger.
IMA against e-Pharmacies
The pharmacists stand has been finding takers among the doctors’ fraternity as well. The Indian Medical Association’s white paper on online pharmacy. The paper says while the model maybe convenient, ‘unlike the local neighbourhood pharmacy or the hospital pharmacy, the patient does not have access to a pharmacist if he/she has any questions about a medicine.’ It adds, ‘There are no well-defined dedicated laws for online pharmacies. Pharmacies in India are governed by the Drug and Cosmetics Act 1940, Drugs and Cosmetic Rules 1945, Pharmacy Act 1948 and Indian Medical Act 1956.’ It further notes that ‘there are no well-defined, dedicated laws for online pharmacies.
Echoing the same thoughts, Dr JA Jayalal, acting president, Tamil Nadu Medical Council, says, “Many painkillers can be addictive. An increased dependence could make someone repeat the prescriptions as many times as they want, without any check. This is easier when one orders medicines online.”
‘E-pharmacists follow rules’
The FICCI report also noted that e-Pharamacy offers convenience to the sick and ailing and is helpful in today’s scenario of nuclear families. The report also noted that all transactions could be efficiently tracked with complete details of the medicines, batch number, dispensing pharmacy name and address, prescribing doctor, name and address of the patient, etc., thereby reducing the problem of drug abuse and self-medication.
A pharmacist continues to have a key role to play in the online sales of medicines. Pradeep Dadha, founder, Netmeds says, “Like in retail medical stores, we have pharmacists checking the prescriptions— they still have a role to play.”
Shailabh Bidwaniya of Kwikmedi, an app for purchase of medicines, says that orders have been rejected many times. He says, “There have been many instances, when we have rejected orders due to doubts about the authenticity of the prescription. Some people upload old prescriptions and in such cases, orders are rejected right away.”
Regarding interacting with customers for educating them about medicines and side effects, the e-Pharmacies have a list of frequently asked questions, and also on side effects. Take the case of mifepristone used for medical abortion and a prescription drug, 1MG another e-Pharmacy, lists the possibility of nausea, adding expert advice that it may not suit those allergic to prostaglandin. Some sources also say it is unfair to point fingers at e-Pharamcies alone as there are many chemists who sell prescription drugs flouting rules.
A question of convenience
When Aneetha Thomas, a media professional, was prescribed isotretinoin for a skin condition, she searched the nook and cranny of Central Chennai to find the oral medication. Later, she decided to buy the same online. She placed the order on Netmeds and the same was delivered in a couple of days. Aneetha says, “I required a higher dosage, as per the doctor’s prescription and couldn’t find it in any of the medical shops. On Netmeds, I only had to upload my prescription and the medicine was delivered at my doorstep in a few days.”
Aneetha is one among those 1 million client base Netmeds has in the country. She says, “I will definitely want to buy more medicines online because it is convenient.”
CLICK ORDER
According to a FICCI report on E-Pharmacy in India, ‘the model could account for 5-15% of the total pharma sales in India, largely by enhancing adherence
- As per a FICCI and Frost and Sullivan report, the e-Pharmacy model could account for 5-15% of the total pharma sales in India.
- Online e-pharma startups in India have already raised $92.6 million in funding so far.
- Some of the popular e-pharmacies operating in India are Netmeds, zigy, 1mg, Medidart, Bookmeds, etc.
IMA white paper highlights
- There are no well-defined dedicated laws for online pharmacies. Pharmacies in India are governed by the Drug and Cosmetics Act 1940, Drugs and Cosmetic Rules 1945, Pharmacy Act 1948 and Indian Medical Act 1956.
- The major issue of concern is that prescription drugs cannot be sold online. There are provisions in the various acts mentioned above regarding the same.
- The prescriptions submitted via fax/email may be fake and it could be difficult to verify their authenticity. Online correspondence and/or scanned copies are legally not permitted.
- Online pharmacies will promote drug abuse, drug misuse, self-medication etc. Any mediation taken without the supervision of doctors may be dangerous and even potentially life-threatening.
- Pharmacists are not allowed to accept and dispense prescriptions that are brought in by children. Online pharmacies will provide easy access to controlled drugs or even street drugs to this vulnerable group.
- Regulation 5.3 of MCI Code of Ethics stipulates that pharmacists and doctors should work together. If online pharmacies are allowed, then this relationship will be lost.
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