“E-pharmacies are an obvious eventuality but regulations are imperative”

Tabish Sangrar, CIO, Wellness Forever Medicare Pvt Ltd, on the types of e-pharmacies and the government regulations needed. By Pooja Paryani

Given the technological advancement in all sectors today, it’s only logical that the healthcare industry is also becoming increasingly digital. Tabish Sangrar is the CIO at Wellness Forever and along with being the chief of lights-on IT operations of the company, he’s responsible for executing disruptive web and mobile initiatives in the retail pharmacy space. One particular trend he’s closely following is the rise of e-pharmacies in India. “They’re a growing trend and an obvious digital progression, however, we presently do not have the required government regulations prevalent in mature markets in the West,” says Tabish.

Types of e-pharmacies
“So, broadly there are three types of e-pharmacy models. One type work through pure-play lead generation, the second are marketplaces, and the third are traditional brick and mortar stores that have added online as a channel for business for their offline stores.”

Process of lead generators
“Lead generators typically are mobile-first—they start off with a mobile app; optionally they may have a desktop website. Their customer acquisition strategy relies heavily on providing unsustainable discounts, some going as high as 25 to 30 per cent. The call to action for users is to upload prescriptions and place orders. From here on, there are two distinct modes of operation of lead generators. The first one is pure play lead-gen: a customer uploads the prescription and this prescription is either digitised and then sent or forwarded as-is to a partner pharmacy. The partner pharmacy then delivers the medicines to the customer. The second one is more hands-on, in that the lead-gen platform sends a concierge to a customer’s house and picks up the original prescription; the concierge takes this prescription to the partner pharmacy, which then dispenses the medicines  and these medicines are finally delivered to the customer. Most lead-gens follow the latter model, especially in Maharashtra, as it just about complies with the Drugs and Cosmetics Act, which mandates that there be a pharmacist at the time of dispensing medicine. A couple of questions need to be answered at this point. As per the spirit of the law, the patient’s prescription should either be handled by the patient or a caregiver, so what role does the lead-gen assume in this transaction? Is the lead-gen platform liable for prosecution in the advent of any litigation filed by the end consumer?”

Marketplace e-pharmacies
“This model involves the creation of what we call a demand-aggregator platform. The primary focus of this model is to build a highly engaging and interactive platform (mobile+web) that channels the subsequent user traction toward medicine buying and availing allied medical services. You may have multiple, legally registered and compliant medicine suppliers through whom the platform may choose to service the patients’ uploaded prescription. Certain State governments have come down heavily on this model since it completely indemnifies the platform of any liabilities arising out of any litigation filed by a patient in the event of any mishap. Marketplace models have constantly evolved and ensured stricter compliance, and in their current avatar they operate less as pure-play marketplaces and more as lead-gen channels with designated fulfilment partners.”

Traditional pharmacies going digital
“The third type are tradition pharmacies that have established a digital sales channel. This is a logical progression of any offline retailer who chooses to embrace digital transformation. In most cases, this model works as a closed-loop e-pharmacy model; the customers are known to the pharmacy, and in most cases the prescriptions have already been shared once, either digitally or in person, which enables the pharmacy to service the customer throughout the validity of the prescription. This approach definitely has the most skin in the game with the online sales channel/lead generator, the middle mile and the last mile are all serviced by the same entity. The onus of accurately dispensing medicines against a valid prescription is completely on the retail pharmacy.”

Government regulations needed
“Challenges related to any of the above business operation modes are multi-fold and concerning because medicines are a controlled and regulated commodity. The abuse of regulated medicines may not only prove to fatal to an individual but may end up endangering the entire human race. Scores of antibiotic-resistant viruses have been discovered over the last decade and rampant misuse of antibiotics is one of the primary reasons for this surge. It’s extremely imperative that the government consider the following points before giving a go ahead to e-pharmacies.”

Central certification
“There should be a body constituted by the Center that verifies, registers and monitors online pharmacies. This body should have standardised certifications, similar to those in the US and UK, that can be accorded to legal entities that want to sell medicines online. For example, in the UK it is mandatory for all online pharmacies to register with UK’s Medicines and Healthcare Products Regulatory Agency (MHRA). The latest mandate is that all e-pharmacies are required to display a new European common logo that contains a hyperlink of the seller’s registered entry on the MHRA’s portal. This ensures that first-time or non-tech savvy customers purchase medicines from a credible source online.”

Central legislation
“Different State associations in India have different pharmacy rules and legislation. However, the basic medical ground realities remain the same. Governance and law-making should be shifted to one national entity controlled by the Centre to ensure uniformity in laws and compliance.”

Adequate checks and balances
“When medicines are being sold online there has to be a surety that the entire buying and selling process is happening in a structured and highly regulated environment with clearly defined SOPs. For example, when an e-pharmacy dispenses medicines against a digital copy of a prescription, there’s a high probability that the patient can reuse the same prescription and stock up on prescription medicines way beyond the prescribed limit. This can be avoided by putting in place a simple SOP, one that mandates the physical verification of a prescription prior to the dispensing of medicines and subsequent physical marking of that prescription mentioning the quantum of medicines dispensed. This will prevent misuse and reuse of prescriptions in general and on e-pharmacies in particular.”

Digitisation of prescriptions
“This by far is one of the most important aspects of e-pharmacies. Digitisation of hard-copy prescriptions forms the cornerstone of successful digital health transformation in India. The margin for error in this process is zero; a misinterpreted drug could be the difference between life and death. The Central government has to mandate a standard SOP for prescription digitisation and ensure that this process is laden with enough checks and balances that ensure 100 per cent error-free digitisation. I’d like to add that I’ve designed and implemented a patent-pending platinum standard in prescription digitisation that is multi-layered, multi-faceted and employs machine learning to iteratively improve the pre-emptive error detection engine.”

The way ahead
“By virtue of making medicines available online, e-pharmacies are bridging a very real yet underserved demand of medicine availability. Tier II and tier III cities will benefit greatly from these platforms since most online players have decent pan-India outreach. That being said, the success of India’s digital transformation in healthcare depends heavily on the policies and legislation pertaining to the e-pharmacy business in India. 

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