E-pharmacies, chemists at odds as govt mulls a stop to home delivery of drugs

At a meeting on 24 April, the drugs technical advisory board (DTAB), India’s top expert panel on drugs, had recommended that a sub-committee be set up to examine the possible withdrawal of a March 2020, pandemic-era notification that legally permitted such deliveries, according to the minutes of the meeting that Mint has reviewed, and according to three government officials who spoke on the condition of anonymity.

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The Centre’s move followed a representation by the All India Organization of Chemists and Druggists (AICOD), which opposed home delivery of medicines on the back of misuse of prescriptions. The move has the potential to disrupt the businesses of e-pharmacies such as Tata 1mg, Amazon, Flipkart, NetMeds, MediBuddy, Practo, and Apollo Pharmacy, even quick commerce apps such as Swiggy that deliver medicines home.

While spokespersons for these companies declined to comment, the founder of a leading online pharmacy business told Mint on condition of anonymity that the government should first take a survey of consumers on doorstep delivery of medicines.

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“Even at the local chemists’ shops, approximately 20% of the medicines are sold walk-in and 80% is home delivery business,” this executive said. “If there is a problem in the online drug delivery practice, then the government should fix the loopholes, make the system more secure and transparent,” this person added.

“The withdrawal of the 2020 notification could lead to more government regulation but it is unlikely there will be a ban on e-pharmacies,” said an executive at an e-commerce platform that delivers medicines, requesting anonymity, adding that many patients, especially elderly ones, use WhatsApp to send the prescription to their local pharmacy and make the payment via UPI after the delivery.

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The executive emphasised that such a ban would set even the offline pharmacy lobby back because of changed customer behaviour and use of digitised systems and databases.

The AICOD, on its part, said the notification has resulted in medicines being delivered without validated prescriptions. “Such unchecked practice of distributing medicines poses a significant threat to patient health,” said AICOD general secretary Rajiv Singhal. “Who is going to check how many times your prescription is being circulated on social media channels like WhatsApp? Even controlled medicines are being delivered to the patients.” 

“About 95% of the delivery of medicine is done by online pharmacy firms. As per Drugs Rule, 1945, medicine is a commodity which should be delivered in the presence of the pharmacists,” Singhal said.

Meanwhile, medical practitioners said there is no harm in supplying medicines as long as strong checks and balances are built in.

“I am not sure of the logic behind the proposal for withdrawal of the notification,” said Dr Soumya Swaminathan, former chief scientist at the World Health Organization (WHO). “Convenience for the patient is important. There’s no denying that people nowadays have multiple chronic diseases and home delivery is certainly a boon, especially for the elderly and disabled. But, at the same time, we have to make sure the system is not being abused.” 

The Centre’s move

“The DTAB panel has recommended to set up a sub-committee on this matter, which will submit its report shortly for final decision,” the first official cited above said.

“Withdrawal of the March 2020 notification is being explored due to the reason that drugs which are prohibited are being delivered,” said the second official cited above. A third official added that the notification should be withdrawn due to concerns related to unregulated practice of sale of medicines.

The development assumes significance for India’s domestic pharmaceuticals market, which amounts to $23.5-billion, according to the department of pharmaceuticals. The business of e-pharmacies add up to around $4.5 billion, according to data from Invest India.

The doctors’ point

Swaminathan said it is important to keep a check on the class of drugs and volume being delivered. “In the US, the doctor emails or phones in their prescription to the pharmacists, and they deliver the medicine or the patient can pick it up. But there is a record of every sale and purchase. However, this is not the case in India.”

She added that India has an opportunity to create such checks now because the country is very well connected digitally. 

“This will also improve our prescription records, which we can then analyze,” she said. “So, digital systems are a good way to do that because traceability is possible. Ayushman Bharat Digital Mission (ABDM) can be leveraged for this. We must also do away with the over-the-counter sale of regulated medicines and misuse of antibiotics. We have the regulations and rules already in place, but we need to find good ways of implementing them.”

Dr Mohsin Wali, senior consultant in the department of medicine at New Delhi’s Sir Ganga Ram Hospital, said that home delivery is a useful service for a population the size of India’s, but chemists’ associations have problems because they are losing business. 

He also pointed to loopholes. “The harm is that if there is a sleep medicine prescribed to a patient, s/he gets it from five different sources on the same day; there is no central monitoring registry to know that the patient has purchased 50 sleep drugs in one go and from whom,” said Dr Wali.

He added that while there should be separate regulations for e-pharmacies so that procurement of harmful medicine is curtailed, stopping door-to-door delivery of medicine altogether may not work. “If a patient is sick and cannot go to the local pharmacy store, then we can ask the pharmacy store to deliver the medicine,” Wali said.

Ranjani Raghavan in Mumbai contributed to the story.