'Dangerous, Unethical': Can E-Pharmacies Recommend Medicines to You?

Are E-pharmacies legally allowed to recommend certain products that are not in a client's prescription?

Online pharmacy PharmEasy faces backlash from the medical world. 

(Photo: iStock/altered by FIT)

Popular online pharmacy, PharmEasy recently drew flack when a Twitter user alleged that the company tried to push him to buy herbal supplements that he wasn't prescribed.

In the now-viral Twitter thread, Abhijit Majumder, a professor at IIT Bombay, claimed that after placing an order for diabetes medicines, he received a call from a PharmEasy pharmacist who recommended additional herbal supplements that are "very good supplement for blood sugar".

"While herbal meds may have some good effects, pushing a health product without knowing the details (of the drug as well as patient) is dangerous and unethical," adds Majumder in the Twitter thread.

While the Tweet garnered the attention of medical practitioners on the social media platform, who condemned the practice as dangerous and unethical, a closer look at the law reveals a much murkier picture.

Why Are Experts Calling Out this Practice?

First, here is a quick run through of what happened.

The Twitter thread lead to a flurry of responses from others who also claimed to have similar experiences with e-pharmacies.

Furthermore, some medical professionals jumped in too, saying such a practice is both unethical and dangerous. Taking to his Twitter, Hepatologist Dr Cyriac Abbey said, "Pharmacists cannot practice & prescribe medications. An e-pharmacist does not even see the patient face to face. They have no clue about the patient's history and disease management."

Another Doctor in the app, Dr Deepshika Ghosh wrote, "Don’t let anybody except your doctor make decisions for you about the medicines you put in your body. Don’t let anybody who is not a registered medical practitioner strong-arm you into buying and consuming any medication at all, herbal or otherwise."

PharmEasy's Response

In their defence, the Indian pharma company said that they were within the law to recommend over-the-counter drugs and medication to their clients.

Since these herbal supplements are OTC (over-the-counter) products, and don't require a prescription under the law, "there are certain cases where qualified and trained pharmacists may recommend specific wellness products based on their professional opinion."

Is This Legal?

Here's where things get a bit murky. Let's break it down.

According to The Drugs and Magic Remedies (Objectionable Advertisement) Act, 1954, no person is allowed to advertise drugs used for diagnosis, cure, mitigation, treatment, or prevention of any disease, disorder, or condition specified in the schedule.

"From a general reading of it, you would think that what the E-Pharmacy is doing is illegal," says Shreya Shrivastava, Senior Resident Fellow at the Vidhi Centre for Legal Policy.

However, a closer look at the Pharmacy Practice Regulations, 2015 reveals that registered pharmacists can, in fact, recommend products to their customers, as long as they are not soliciting a particular brand.

A Registered pharmacist shall undertake a pharmaceutical assessment of every prescription presented for dispensing. For the purpose of the act, pharmaceutical assessment is defined as the point at which Registered pharmacist applies his knowledge to establish the safety, quality, efficacy and rational use of drugs treatments specified by a prescriber.

Pharmacy Practice Regulations, 2015, Chapter 4.9

"It also says that the pharmacist is supposed to initiate discussion of the matter that will enhance or optimize drug therapy of each patient or caregiver of such patient," says Shrivastava, adding, "I think this is broad enough to say such discussions are allowed."

The nature of the discussion, how they are carried out, and to what end remains in question.

"This is a gray area," she adds.

Shrivastava also goes on to point out that PharmEasy in their response has underscored that these 'consultations' are done by their team of pharmacists, and not just regular sales or marketing staff.

"In that case, this will be completely valid and legal," she says.

Shrivastava also points out that it is, however, possible for a pharmacy to stretch these provisions to suit themselves because the law is vague.

"In the PharmEasy case, its not clear if they were recommending a particular product by a particular brand or if they were just generally giving advice. So we can't really mae accusations of unlawful practice."

Shreya Shrivastava

"The bottom line is that clearer regulations are required," she adds.

E- Pharmacies Vs Regulation

This isn't the first time that E-pharmacies in India have run into trouble with accusations of dubious practices.

During the COVID-19 pandemic, and subsequent lockdowns, E-pharmacies mushroomed and thrived in India, and they continue to boom. However, after reports of spurious drugs being sold, and misuse of user data, E-pharmacies quickly came under the radar of the Government. In fact, there has been a push for stricter regulations on E-pharmacies globally.

In February 2023, the Drug Controller General of India (DCGI) sent show-cause notices to 20 E-pharmacies, including Tata 1mg, Amazon, and Flipkart, for selling and distributing drugs in contravention of provisions of the Drugs and Cosmetics Act, 1940.

This was also around the time when the Centre was considering banning E-pharmacies to put a stop to malpractice.

In October 2022, the Central Government tabled The Drugs, Medical Devices and Cosmetics Bill 2022, meant to replace the 1940 Drugs and Cosmetics Act. This Bill, for the first time, introduced a section to regulate e-commerce for pharma companies.

The draft Bill makes it mandatory for online pharmacies to have licence or permission issued by the Union Government in order to sell, keep stock, exhibit, or distribute any drug.

While this was a much-needed regulation, the draft Bill was met with criticism from experts who said that there are still some queries that the draft Bill doesn’t answer.

The Bill, it was pointed out, does not address some key issues like, What about the over-the-counter drugs that require a prescription from the doctor? What if people fake prescriptions and indulge in the overuse of medicines? How will the authorities make sure that the medicines being sold online are being stored at temperatures below 30 degrees Celsius, or in an environment with 70 percent humidity?

Speaking to FIT for a previous story, Prashant Reddy, a public health activist, said that the Bill was drafted by bureaucrats who are already in the system and are “not interested in altering the status quo.”

According to the experts, Telemedicine, and E-pharmacies are the future of healthcare. However, before we dive head first into it, it's vital to build a strong legal foundation and clear transparent regulations.