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Friday, 14 December, 2018

Online pharmacies: Healthy or unhealthy dose?

A local community pharmacist from Aldona, Savio Figueiredo, shares his industry’s insight on the pros and cons of the ongoing debate on medicines for sale on the online platform

24th September 2018, 03:38 Hrs

Savio Figueiredo


The all-India bandh called on September 28 by the All India Organisation of Chemists & Druggists (AIOCD) to protest against sale of medicines via the internet/ePharmacy has necessitated a closer understanding of the nature and impact online sales of medicines will have in Goa and across the country.   

I must clarify that I’m a community pharmacist in Aldona and online sales of medicines will affect my business substantially, but I will try to be fair in my opinion.   

HOW IT WORKS

Medicines manufactured by pharma companies usually go through a pipeline before they reach customers, offering trade margins at each point: CNF Agent/Superstockist (4%), Stockist/Distributor (10%), Retailer (20%) and the total margins work out to 34%. Besides, pharma companies offer various schemes seasonally or throughout the year, e.g. Gelusil Susp is available at 19+1 free (5%) or 40+3 free (7.5%).   

Further, when products approach their expiry date, companies offer large discounts to offload short expiry stocks and prevent a total loss. Hence, online companies have a 30% plus margin to play with, of which it will offer 15-20%, but at no point owning/stocking medicines like pharmacies do. 

Thus far, online pharmacies are illegal and if operating, are doing so illegally.     

ISSUES OF e-PHARMACIES

1. The process is digital and consumers need to be computer literate and have the required devices to upload their prescription onto the platform. Payments would either require a card, smartphone or internet banking facility, wiping out a vast majority of people using this facility, benefiting only the rich and those in metros.   

2. Online pharmacies promise delivery the next day in metros, leaving out people living in villages, more so, in cases of urgent medicines like antibiotics and lifesaving drugs.   

3. Many medicines like insulin and vaccines need to be stored at temperatures between 2-8oC. This is feasible for larger quantities to be transported in refrigerated trucks, but in smaller quantities, it would be difficult to maintain the cold chain and unsuspecting people would receive spoilt medicines.   

4. Return of excess medicines due to change in prescription or damaged medicines is a grey area. 

5. India is a big nation with 6 to 8k pharma companies and most small companies concentrate on localized areas. Medicines from these companies will most probably not be available with online sellers in metros, which would likely be available with the local pharmacists.

6. A local pharmacist is more likely to be able to read the local doctor’s prescription and in case of doubt, will find it easy to clarify. Local pharmacists have a better rapport with customers and know more about the medical history, enabling him/her identify errors.   

7. The government has mandated that certain medicines are likely to be abused like psychotropic drugs (e.g. sleeping tablets) should be strictly controlled and not dispensed without the prescription of a RMP and that too, in the quantity specified. Pharmacists are bound to apply a dispensed stamp on prescriptions, however online companies, may be duped by uploading the same prescription multiple times. 

8. The UK medicines regulator Medicines and Healthcare products Regulatory Agency (MHRA) has warned that it is completely impossible to control the vast numbers of unlicensed pharmacies illegally selling drugs online. 

In conclusion, India has among the most advanced pharma industries and is considered the Pharmacy of the World, supplying medicines to many corners of the world, including rich nations. It has grown and done so without online pharmacy and can continue to do without it. 

(Savio Figueiredo is a Community Pharmacist based in Aldona)




PROPONENTS OF e-PHARMACIES

Consumers can order medicines from the convenience of their mobile or computer, helping patients already sick and unable to go in search of a pharmacy

Online platforms can aggregate supplies, making otherwise hard to find medicines available to consumers across the country   

Online pharmacies have the technology infrastructure to provide value-added information to consumers, such as drug interactions, side effects, medicine reminders and information on cheaper substitutes

All medicine purchases online can be tracked, effectively reducing the problem of drug abuse and self-medication

With full tracking systems and solid technology, counterfeit medicines can be traced back to the channel/ manufacturer/ supplier, thereby ensuring that authenticity is strictly maintained

Organized online players would have systematic records for all transactions, with full taxes paid, a great benefit to the state considering the market size

Online pharmacies can store and analyse large amounts of data on consumers across the nation which can be very useful to plan public health policies



REBUTTALS FROM THE LOCAL PHARMACISTS
Many community pharmacies also offer door-to-door services. They collect prescriptions and deliver medicines to the doorstep
Local pharmacies keep a large inventory of medicines based on prescription patterns of the local doctor. Generally, doctors prescribe medicines based on visits my medical representatives, who then ensure that products promoted are available with nearby pharmacies. If they don’t have a particular brand, they can either replace it with an equivalent brand in consultation with the doctor   
Verbal communication between a patient/customer and the local pharmacist is much more powerful than pages of typed information in a language that may be foreign to a patient   
Tracking all online medicine purchases is contradictory to the fact. A patient may upload the same prescription multiple times or on multiple platform and avail of abused medicines. This is not possible in local pharmacies, who stamp such prescriptions with “Dispensed Stamp” so that medicines cannot be dispensed again against the same prescription
Local pharmacies buy products exclusively from registered dealers, virtually eliminating the question of counterfeit medicines 
Local pharmacies use computerized software for billing and inventory and keep a unit to unit record of medicines. They are registered under GST and follow all government norms and regulations  
Online pharmacies can cater to only 5% of India’s population at the most considering the level of digitalisation. Hence, information garnered would reflect only part of the affluent society

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