More than half of India’s population doesn’t have access to health care. Situation is more acute in small towns and villages where physicians don’t want to practice, and subsequently, there are no pharmacies. In our discussions with MOH, it clearly emerges that use of digital platforms is essential for India’s unique problems.
E-Pharmacies are emerging as an important part of the solution for the Indian situation. E-pharmacies offer several advantages to Indian citizens, which are even more desired during situation due to C-19 related issues.
Apart from providing access to even the remotest part of the country and making medicines affordable, E-pharmacies also ensure complete authenticity of medicines with full ‘track and trace’ capability, ensuring integrity of medicines right from manufacturers up to patients’ homes.
All over the world, wherever e-pharmacies operate, they co-exist peacefully with retail pharmacies. While e-pharmacies are viable due to their focus on chronic therapies, retail pharmacies are necessary for immediate requirement of acute medicines such as pain killers and antibiotics.
However, there is an unnecessary and vicious campaign that has been launched in India by the retail pharmacies’ association viz. AIOCD due to reasons beyond comprehension.
The retail pharmacy sector in India is a broken, porous system that suffers from systemic failure. AIOCD, instead of working with the Govt and public to improve the system, is focused on a fruitless attack on e-pharmacies.
The ills that prevail the Indian retail pharmacy systems are too numerous to count:
Lack of trained pharmacists: It has been documented as well observed by the courts that in several states, such as UP, number of pharmacies far exceeds the number of registered pharmacists in the state. As reported by Outlook India, the Allahabad High court’s Lucknow bench in 2017 said
“A large number of either fictitious and unqualified persons or one person using his registration certificate in several shops, are looking after such shops but the state government has not taken any effective preventive steps,” in response to PIL filed in the honourable court.
AIOCD, instead of trying to correct the situation, has been trying to put the blame on regulators and trying to lobby that pharmacist should not be mandatory at retail pharmacies. This is dangerous for the patients and is a precedent not seen anywhere else in the world. In 2013, as reported by Pharmabiz, they even went on a nationwide strike and wanted the government to permit the partner or the proprietor of a drug store as a qualified person to dispense the medicines taking into account the shortage of qualified pharmacists.
‘Renting’ a pharmacist license, without having an actual pharmacist actually dispensing has become the standard and acceptable practice in retail pharmacies. Progressive trade associations like AIOCD should pro-actively address such pertinent sector issues as it compromises the safety of the patient.
Technology driven learning solutions can be deployed to meet the specific and lifelong learning needs of individual pharmacists, ultimately improving patient and public health outcomes.
E-Pharmacies, on the other hand, are meticulous in employing pharmacists for validating the prescriptions and dispensing medicines in tamper proof containers as per Pharmacy Act 2015.
Sale without prescription: It is a known fact, and has been observed by judiciary and bureaucrats too, that one just need to call a retail pharmacy, or send a driver, and medicines are delivered at home. No prescription required. The Hon’ble Delhi High Court in 2019 had directed the Centre and State Government to act against those pharmacies selling prescription medicine without prescription.
E-pharmacies, on the other hand, systematically record each prescription digitally, and have offered to the Govt to be audited by any competent regulatory agency.
Storage and Logistics: Given that India is the most fragmented and scattered pharmaceutical market in the world, making fresh medicines available that retain their full potency, is also a challenge. We all know that India falls under WHO zone 4 for storage and stability of medicines. Medicines in India must be stored below 30*C and 70% relative humidity, to retain full potency over the entire shelf life.
This would require constant air-conditioning of products. Unfortunately, majority of retail pharmacies are not air-conditioned, putting stability of medicines at risk. E-pharmacies are perhaps the only ones that follow WHO ‘model guidance for storage and transport’ of medicines and ensure that patients get the medicines with intact integrity at their homes.
Track and trace: We all know that pharmaceutical distribution system in India is totally porous. Places like Bhagirath Place in Delhi, Agra ki Mandi and Bagri Market in Kolkata are periodically raided unearthing trading of counterfeit or stolen medicines as well as trading of samples.
Before GST, when sales tax rates were different across states, there are examples of traders from Agra and Gwalior coming to Delhi to buy insulin, when sales tax on insulin in Delhi was 0, and was in double digits in UP and MP. These unscrupulous traders would carry refrigerated products like insulin in gunny sacks, and retailers in UP and MP would buy these without bills, just to make few extra bucks.
We all experience that even today, majority of retailers do not provide invoice bearing correct batch numbers and expiry dates. The amount is written on the back of the envelope and payment is made. Law requires not only details of batch and expiry to be mentioned on the invoice, each invoice must be signed by a Pharmacist. Not really possible when Pharmacists are not even present at the Pharmacy!
Counterfeiting and substandard medicines have been an industry problem with estimated percentage of ‘Not of Standard quality’ medicine in the retail channel accounting for approx. 3% of the total, as per the National Drug Survey 2014-2016.
After the survey it was recommended to “Facilitate regulation for transparent and secure drug distribution system which results in product traceability and reconciliation throughout the supply chain in case of quality issue or nation-wide recall.”
It also said “Retailers and distributors should modernize and digitize the mechanism of procurement and inventory control of all their operations and ensure presence of qualified pharmacists to dispense Drugs as required by law.”
On the other hand, e-pharmacies scrupulously record batch and expiry of each unit as it proceeds in the logistics chain, protecting the customer.
Anti-Competitive Behavior of AIOCD: In case no 30 of 2011, Competition Commission of India clearly labeled AIOCD as ‘anti-competitive’ and charged AIOCD with grossly using its dominant position and fined it heavily.
The Competition Commission of India (CCI), in its 2018 report pointed out that certain activities carried by trade associations mute the competition and result in higher prices of medicines for Indian citizens. It mentioned that “Self-regulation by trade associations also contributes towards high margins as these trade associations controls the entire drug distribution system in a manner that mutes competition.” Further it said, “The entire supply chain of drugs is self-regulated by the trade associations who regulate entry by mandating a NOC prior to the appointment of stockists, control distribution by restricting/controlling the number of stockists and influence price by deciding the wholesale and retail margins of drugs.” The issue of anti-competitive behaviour by certain pharmacy trade association has been raised and discussed multiple times at the CCI.
It is important to highlight that since 2015, multiple writ petitions in several courts of the country have been filed against e-pharmacies by various groups to curb competition. Most of them have been disposed of. AIOCD and its proxies have abused the process of law and have spread misinformation.
Hon’ble Madras High Court in its 2018 order has clearly stated “that the petitioner, by instituting vexatious and obstructive action in the Court of law, is not only guilty of abuse of multiplicity of proceedings, but also guilty of suppressio very and suggestio falsi.”
While the Media headline was sensationalist, and quoted the Delhi High Court order 2018 as blanket ban on the sale of drugs online across India; the fact is that the order specifically mentions that it is for online sales of medicines without license. In e-Pharmacy model, all sales happen through licensed premises under supervision of registered pharmacist. However, if any person/entity found violating any rule, drug regulator can prosecute under Section 27(b) (ii) of the drug and cosmetic Act.
Pharmacies and pharmacists do a noble job of providing medicine and health care services to population at large. The adoption of innovative technology models will make the entire process more robust, reliable, transparent, and efficient. The debate should not be about e-Pharmacies vs brick-and-mortar pharmacies, rather between complaint vs non-compliant, irrespective of the channel. The debate should be about how best these model work together to fulfill the health care requirement of 130 crore Indian citizens and create a future ready resilient health care system.
By Dr Rajiv Gulati
He is the Former President, Ranbaxy and also President on the Board of Several Reputed Companies.
(DISCLAIMER: The views expressed are solely of the author and The Health Master does not necessarily subscribe to it. The Health Master shall not be responsible for any damage caused to any person / organisation directly or indirectly.)