Medicine home delivery: is Russia ready for such a turn?

Boris Mendelevich on how online medication sales in Russia will be regulated and when it will become possible to buy prescription medicine on the Internet

Medicine home delivery: is Russia ready for such a turn?
Photo: gorkluch.ru

The situation with the coronavirus pandemic didn’t pass the pharmaceutical industry by too. Moreover, in the conditions of self-isolation and quarantine, it is crucial to organise online purchases and develop a way to deliver medicine, especially for the elderly. The president of the country has already signed a corresponding order. Such a job is also done in the State Duma. In his new column for Realnoe Vremya, the State Duma’s deputy, psychiatrist Boris Mendelevich talks about intricacies of online medicine delivery.

Why are online pharmacies needed?

An online pharmacy is a website like habitual online stores where one can order medicine. As a rule, online pharmacies work 24/7. Delivery is done to one’s door, office or a health institution. The undoubted advantage of this way is an economy of a patient’s resources — time, transport expenses and so on.

Of course, it will be easy to find medication prescribed by a doctor in million cities, but one should understand that a person buys medicine not by choice. If he feels bad, it will be hard for him to go to a pharmacy on foot, and the medicine may not be found at the first attempt. The elderly find it especially hard in such cases.

It is another problem if a patient lives in a remote village whose pharmacy doesn’t have anything more complex than aspirin. In this case, an online order can really become an effective solution.

While the purchase can be paid for and picked up only if one goes to the pharmacy in person. Photo: m24.ru

Where are there online pharmacies?

Now they have been widely spread in the USA and in many European countries, moreover, the rise in the number of online pharmacy visitors and medical advisers in the USA exceeds the amount of most of the other areas of consumer web business. Half of all online users in the USA bought medication in online pharmacies just 15 years ago, while now their number is approaching 100%.

This way of commerce is viable only by half in Russia. An order on the website of a pharmacy (or a pharmacy chain) can be placed: to make sure the good is in stock, to book it. While the purchase can be paid for and picked up only if one goes to the pharmacy in person.

Online purchase: key steps

Unlike another type of online purchase (for instance, clothes or dishware), there are several nuances in case of medicine. For instance, an order can be placed through an online pharmacy only after full sign-up on the website: one must provide as much information as possible, identify oneself and confirm it (website owners promise complete confidentiality). Medication isn’t safe sweets, this is why their remote circulation requires extreme caution: a salesperson must be sure he or she is selling medicine to an adult, able-bodied person, and in case of prescribed medicine, the salesperson must make sure it is the person who was prescribed the medicine by a doctor.

Secondly, there is a nuance when looking for medication. If a purchaser himself deciphers the prescription written down by a doctor by hand, there can be difficulties, for instance, with a dose. It is very important to know the name of a specific medication. One must understand that like cars, medications have something like a model and brand. And it is necessary to pay attention to the full name, not only the model, as it happens at times. For instance, paracetamol alone can have tens of types in the market.

A salesperson must be sure he or she is selling medicine to an adult, able-bodied person, and in case of prescribed medicine, the salesperson must make sure it is the person who was prescribed the medicine by a doctor. Photo: kpfu.ru

What about laws?

To be able to regulate the online sale of medication, corresponding legislation is needed.

The USA and most European countries already have a regulatory framework regulating the activity of online pharmacies. The first online pharmacy in Switzerland began operating in 1997 having obtained permission for such activity as exception The first online pharmacy opened in Great Britain in 1999. This pharmacy faced severe opposition from professional doctors and pharmacists at first (this, in fact, reflects some concerns of modern Russian experts), but they changed their mind in 2000 and accepted special recommendations for online medication turnover, that’s to say, they accepted the possibility of the existence of this type of pharmacies.

What about Russia? Vladimir Putin signed an order almost last week that allows citizens to buy medication online with their further delivery. But the government will still have to create an order of granting permission for such sale and rules of such commerce. We discussed these moments together with our colleagues, deputies, at a session of the State Duma’s Committee for Health Protection a couple of days ago. The way of medicine delivery, especially medicine with certain transportation conditions (for instance, a specific temperature regime) became one of the key issues.

This novelty applies to just above-the-counter medication at the moment. According to new rules, pharmacies can sell medication both their website and mobile app. Delivery of the order to the purchaser’s doorstop isn’t compulsory in this case — he can pick it up in the pharmacy, which is close to his house.

A bill on online medication purchase is being prepared for the second reading at the same time. According to a new version of the document, online commerce is offered, including for prescribed medicine. If the bill goes through all readings, it will be possible to purchase all prescribed medicine online from 1 January 2022. The case is that not all medical institutions have the system of electronic prescriptions operating in the United State Information System in health care. And the sector’s informatisation takes a bit less than a year.

The way of medicine delivery, especially medicine with certain transportation conditions (for instance, a specific temperature regime) became one of the key issues. Photo: pexels.com

Offline vs online: what problems did Europe and the USA face?

Despite the attractiveness of purchase/sale of medication on the Internet, the work of electronic pharmacies raises a lot of questions.

  • According to the World Health Organization, up to 10% of medicine purchased online turn out falsified.
  • Online consultation that accompanies online sales raises big fears — when a doctor of the pharmacy chain consults a purchaser online and sells him or her a prescribed medication. A doctor working in the pharmacy and receiving a salary there may want to write more prescriptions than needed to augment sales. At the same time, we should understand that even in case of no bias, a doctor decides to prescribe medication only according to the information received from a patient.
  • The activity of dishonest online pharmacies that have people or organisations that have nothing to do with pharmaceuticals, so-called pseudo-pharmacies behind is a big problem. However, the community of pharmacists take measures to fight such fly-by-nights. A professional union was organised for this purpose — European Association of Mail Service Pharmacies — whose members go by strict standards.

One of the Dutch pharmacies that, indeed, has a wide multi-channel service is quite a successful example of online sales: purchasers can buy medicine both in the pharmacy and order it online, by phone, fax or post. The pharmacy has a special system for prescription control, identification of doctor and honest practice it works in. A separate job is done to monitor the quality of delivery.

Photo: Maksim Platonov
People must clearly know all aspects: how to distinguish an honest online pharmacy from the fly-by-night, doctors must know how to send a prescription to the provider, the delivery service — how to deliver a medication

What’s our way like?

I think it is necessary to take a number of measures to execute the president’s order successfully.

Firstly, clear regulations and by-laws are needed: people must clearly know all aspects: how to distinguish an honest online pharmacy from the fly-by-night, doctors must know how to send a prescription to the provider, the delivery service — how to deliver medication and so on.

Secondly, in my opinion, insurance of transported products and a system monitoring the delivery process are needed in case of online delivery.

Thirdly, as foreign experience shows, despite all measures, clients of online pharmacies face a high risk of buying a counterfeit or a medication that doesn’t meet standards. This is why quality seals need to be introduced.

Fourthly, some online pharmacies can provide (deliberately or accidentally) personal and financial information about clients. Internet security issues must also be carefully considered.

Given quite a big experience in this area in some foreign countries, now we should single out the best methods from this and adapt them if needed.

By Boris Mendelevich
Tatarstan