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Over the counter or online?

Some consider e-pharmacies a boon, as long as licensing and prescription prerequisites are observed. But the Delhi High Court has banned online sale of medicine

Login, upload your prescription or simply add medicines to your cart that do not need an Rx (doctor’s prescription), make the payment and your medicines will be delivered at your doorstep. This not only sounds convenient, but it also has a monetary lure — significant discounts ranging from 25% to 40%.

According to estimates, currently the total e-pharma industry in India is less than 0.5% of the retail pharmacy landscape but it is growing at the rate of more than 100%. However, like every digital advancement, this too comes with its set of drawbacks, which need to be dealt with efficiently.

The growing need for convenience, increasing incidence of chronic diseases and tech savviness are among the reasons that have contributed to the growth of e-pharmacies. But this was bound to affect the business of offline chemists, which is why it was strongly opposed by them. Many a times, the All India Organisation of Chemists and Druggists (AIOCD) has called for nationwide strikes against online pharmacies. In short, there is a constant tussle between online and offline pharmacies, which leaves the consumer mired in confusion.

Medical stores have been trying to highlight the flaws in e-pharmacies and the online platforms have been trying to attract more consumers with their heavy discounts, offers and advertising. No less than MS Dhoni is the brand ambassador for the e-pharmacy Netmeds. Websites like Pharmeasy and Netmeds also have the option of booking a consultation with a doctor, in case one does not have a prescription.

But recently, e-pharmacies received a blow when the Delhi High Court banned the sale of medicines online across the country and directed the central government and AAP to immediately implement the order. The court acted on a PIL filed by Delhi-based dermatologist Zaher Ahmed, who complained that medicines were being sold online without much regulation, which poses a huge threat to both patients and doctors.

Ahmed further pointed out that online sale of medicines is not allowed under the Drugs and Cosmetics Act, 1940 and the Pharmacy Act, 1948. He complained that even though the Drug Controller General of India in 2015, clearly directed all state drug controllers to protect the interests of public health by restraining such sale online, lakhs of medicines continue to be sold online, many even without prescription.

The plea argues, “Unlike common items, drugs are highly potent and their misuse or abuse can have serious consequences on human health, not just for the person consuming it but for humanity at large as some drugs can be addictive, habit forming and harmful for the body. A large number of children/minors or people from uneducated rural background use internet and can be victims of wrong medication while ordering online.” It further blames the government for not doing enough and adds that many pharmacies are operating online without a valid license.

Many medical professionals feel that the unregulated sale of medicines online will increase the risk of spurious, misbranded and substandard drugs being sold. Illegal or unethical online pharmacies sometimes sell outdated, counterfeit medications or substitutes. But many doctors argue that this can happen at medical stores too. “We cannot be sure that the medicines sold at pharmacies are not fake. The same is true for the online ones. It is not a debate about online and offline medical stores, rather on the kind of regulation and scanner they are put under,” says Dr Rekha Anand, a private practitioner.

Man Mohan Gupta, co-founder of Mymedicinebox.in, says, “E-pharmacies have created challenges for medical stores. But they will improve the overall healthcare quality in India and will support e-healthcare and Digital India initiatives. Many medical stores sell medicines without prescriptions and do not abide by the regulations. Sometimes, patients are forced to buy substitutes on the recommendation made by pharmacists at these stores.”

Online pharmacies are being viewed with suspicion, but online or offline — there are certain issues that need to be addressed for both. From the seller’s end, it should be ensured that the medicines are genuine and the seller is licensed. For protecting against any misuse by the buyer, offline and online stores while selling drugs, other than OTC (over-the-counter) drugs that do not require prescription, should always ask for a valid prescription.

Jyoti Verma, a 24-year-old, who works in the IT sector and stays alone in Delhi, ordered medicines online when she fell ill a few months back. “Since I stay alone in Delhi, it proved to be a very convenient option for me when I was too sick to go outside and buy medicines. I think whether it is e-pharmacies or offline medical stores, without guidelines, the buyer is always in a vulnerable position. I have seen that many times, chemists sell medicines that are not supposed to be sold without prescription. But maybe, the online world is so vast that it increases the risks.”

The main argument against online pharmacies is that they might encourage self-medication and illegal purchases of habit-forming drugs. Also, prescriptions are not verified online and patients might buy drugs without original prescriptions. “Some drugs have psychotropic substances and can be easily ordered on the Internet and misused for criminal activities or substance abuse,” the plea reads.

But on checking, it was found that well-established e-pharmacies like Netmed, Medlife, 1mg and Pharmeasy ask for prescription for ordering drugs like Methergin, Phenergan, Fortwin, Alprax, Trika and Nimesulide (Nise). There is a section that says, “I don’t have a prescription” — however, it is available only for OTC drugs. But there are several unlicensed websites thriving too, which is why the buyer needs to be cautious and well-aware while buying online.

Pradeep Dadha, Founder and CEO of Netmeds, says, “We only sell products against prescription and do not sell any habit-forming substances. Benefits of affordable and accessible medicines through our services have been appreciated by customers and as a fully-licensed pharmacy, Netmeds is committed to adhering to all guidelines and standards as prescribed under the Drugs and Cosmetics act of 1940.”

When Patriot went to Narang Chemists and asked for Alprax (which is drug that should not be given without Rx), we were asked to show the prescription. The owner, Jaideep Narang, says, “We always ask for the prescription. I don’t think medicines should be available online. It is a sensitive affair. Even at medical stores, people try to persuade us to give them medicines even when they do not have the prescription. So, imagine how unregulated this can become in the online world.”

In September, the Health Ministry had come up with draft regulations for e-pharmacies to provide patients genuine drugs from authentic online portals. A panel set up by the centre also cautioned about the risks involved in the online sale of medicines — including selling of medicines without prescription, habit-forming and the unregulated sale of addictive medicines.

The Madras High Court too, recently put an interim ban on e-pharmacies, based on a petition by Tamil Nadu Chemists and Druggists Association (TNCDA). “In this case… though there is a statute, rules are yet to be notified in the wake of advancement of technology. Unless legislation keeps pace with technology, commerce based on technology has to lag behind,” said Justice Pushpa Satyanarayana in her order.

“Many patients, especially the elderly who need a regular supply of medicines and those who stay in remote areas, depend on e-pharmacies for medicines. When the world is online and everything is available on the Internet, why is the sale of medicines being banned? It is the government’s responsibility to come up with the necessary regulations. There are many benefits of e-pharmacies and fake medicine can also be sold offline.

Nonetheless, there should be certain regulations to avoid its misuse,” says Shekhar Gurnani, a 35-year-old engineer, who often buys medicines for his ailing father online.

The Indian drugs and pharmacy rules do not cover e-pharmacies as they were formulated much before the advent of such online portals. Currently, there are no laws governing these e-pharmacies, which is the biggest drawback. In the absence of any laws, in November 2016, Federation of Indian Chambers of Commerce and Industry (FICCI) came up with their own “Self-Regulation Code of Conduct for the E Pharmacy Sector,” to ensure patient safety. But these are not enforceable.

Dr SE Reddy, Drug Controller General of India (DCGI), says, “We are not against online stores as we understand it is beneficial for people who cannot access medical stores due to chronic conditions or for people who live in a difficult-to-reach terrain where certain medicines may not be available. This is why we have made obtaining licenses easy.” Licensing and strict regulations should govern not just e-pharmacies but also the offline ones. Medicines are crucial and life-saving, but it also has the propensity to be misused, which is why its sale cannot be kept unregulated — be it online or offline.