Insights into Editorial: The correct prescription
The increasing popularity of e-commerce, including e-pharmacies, is undeniable.
E-Pharmacies, operate through websites or smartphone apps on the Internet. E-pharmacies offer the comfort of shopping from home, privacy, and price discounts. It also allows access to drugs, not available locally.
They offer medicines for sale at a discount of at least 20%, when compared to traditional pharmacies.
For scheduled drugs, patients can submit photographs of prescriptions, while placing orders.
In India, in the absence of any legislative framework, existence of e – pharmacies are per-se illegal. The Drugs Controller General of India (DCGI) banned sale through e – pharmacies on 30th December, 2015.
Yet, e-pharmacies have grown rapidly as against the traditional “brick-and-mortar” or offline pharmacies.
On Dec.12, the Delhi high court ordered a complete ban on online pharmacies across the country with immediate effect, asking the central government to implement the order.
The court order is in response to a petition which stated that the sale of drugs and prescription medicines online was illegal and without any mandate of law and, therefore, a health risk.
Opponents to E-Pharmacies:
The fiercest opponents of e-pharmacies are trade associations of existing pharmacists and chemists.
They argue that their livelihoods are threatened by venture capital backed e-pharmacies and that jobs of thousands are on the line.
There is enough evidence on record to demonstrate how existing pharmacies contribute generously to drug abuse and sale of sub-standard medicine. There is no reason to suspect that e-pharmacies are going to worsen the situation in anyway.
Defects in Brick-and-Mortar Pharmacies:
The history of India’s trade associations of pharmacists is one of rampant, unabashed cartelisation that has resulted in an artificial inflation of medicine prices.
This practice of two competitors colluding to fix the sale price and area of operation is called cartelisation, and is illegal under India’s Competition Act.
The premise of this law is that a free market is efficient only if all sellers are competing with each other to offer the lowest price to the customer.
A second, more insidious strategy is the practice of requiring pharmaceutical companies to apply for a no-objection-certificate (NOC) from the regional trade association before they appoint new stockists in a region to sell a particular drug.
This has the effect of artificially restricting competition in certain markets because more stockists mean more competition.
By creating such artificial, extra-legal barriers to the free trade of medicines within India, these trade associations create huge distortions in the Indian market. It is suspected that these practices continue despite multiple restraining orders by the Competition Commission of India.
Risks Associated with E-Pharmacies:
India’s pharmacy laws are derived from the Drugs and Cosmetics Act, 1940, Drugs and Cosmetics Rule, 1945, and the Pharmacy Act, 1948.
These laws predate the advent of online commerce in India, leaving the business out of the purview.
Unlike common items, drugs are highly potent and its misuse or abuse can have serious consequences on human health, not just for the one person consuming it but for humanity at large as some drugs can be addictive, habit-forming and harmful to the body.
A large number of children/minor or people from uneducated rural background use the internet and can be victims of wrong medication while ordering medicines online.
The risks exist in buying drugs online:
- Supply of fake and illegal drugs;
- Abuse on account of fake or forged or no prescriptions;
- Lack of verification of the ultimate user;
- Unhealthy competition;
- Abuse of critical health data generated online; and
- Mishandling during transport; are some of them.
Making draft guidelines is the need of the hour:
E-pharmacies market is $18 billion and will grow to $55 billion by 2020.
Industry experts estimate the market to be generating 3,000-4,000 orders on a daily basis.
According to the draft guidelines that are yet to be formalised, e-pharmacies have to register for a licence with the Drug Controller General of India (DCGI), which will be valid for three years.
They do not allow e-pharmacies to sell narcotic drugs, tranquilisers, and Schedule X drugs, and neither are they allowed to advertise.
These draft guidelines are along the lines of laws in the US, where the regulators monitor e-drug sales.
The National Association of Boards of Pharmacy (NABP), the apex pharmacy body in the US, gives registration and certification for e-pharmacies and they have to display the certification logo on their website.
Specific and clear-cut rules should be made for selling, prescribing, dispensing, and delivering prescription drugs through e-pharmacies.
In its recent policy note on “Making markets work for affordable healthcare”, the CCI noted, “One major factor that contributes to high drug prices in India is the unreasonably high trade margins.”
One of the culprits for this phenomenon identified by the CCI was “self-regulation by trade associations also contributes towards high margins as these trade associations control the entire drug distribution system in a manner that mutes competition”.
One of the solutions proposed by the CCI was encouraging more e-pharmacies.
As stated by the CCI in its policy note, “Electronic trading of medicines via online platforms, with appropriate regulatory safeguards, can bring in transparency and spur price competition among platforms and among retailers, as has been witnessed in other product segments.”
The fact that the government has come out with draft regulations means it is not keen on killing it. It is a regular course of evolution of an industry which is very nascent. It is important to weed out the unruly players.