Understanding the Rise of Digital Pharmacies
The rise of digital pharmacies, while beneficial in some respects, comes with its own set of drawbacks for patients, payers, and providers.
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- As the world advances in the digital era, it is no surprise that more and more consumers are turning to the internet for healthcare information, advice, and even medications. While online pharmacies have been around for decades, they gained more traction throughout the COVID-19 pandemic because of their convenience during quarantine protocols. However, the rise of digital pharmacies is not without its drawbacks. Comparing and understanding the differences between online and traditional pharmacies is essential for public health and patient care.
When they hear the word pharmacy, most people think of traditional retail pharmacies — brick-and-mortar pharmacies. For example, a local CVS, Walgreens, supermarket, or family-owned pharmacy where patients can drop off and pick up their prescriptions are considered brick-and-mortar retail pharmacies.
While these pharmacies once dominated the retail pharmacy space, online pharmacies have encroached on that territory. Born out of convenience and necessity, online pharmacies — sometimes referred to as mail-order or digital pharmacies — have grown drastically.
The first online pharmacy, Soma.com, began operation in 1999. Since then, the digital landscape has changed dramatically, and there are significantly more online pharmacies than there used to be.
In a publication for the Journal of Medical Internet Research, András Fittler, PharmD, PhD, and his colleagues write, “an online pharmacy is an internet-based vendor (legal or illegal), which sells medicine and may operate as an independent internet-only site, an online branch of “brick-and-mortar” pharmacy, or sites representing a partnership among pharmacies."
Benefits of an Online Pharmacy
As previously mentioned, online pharmacies are exceptionally convenient for consumers, which is why many opt to use them. The main incentives for using an online pharmacy are convenience, accessibility, price transparency, privacy, and availability.
The survey conducted by the International Pharmaceutical Federation states that approximately 25% of those surveyed said that the most significant benefit of online pharmacies is improved access. Unlike brick-and-mortar retail pharmacies, online pharmacies are available to nearly everyone at the touch of their fingertips without issues of distance or timing.
Meanwhile, 23% and 10% cited convenience and reduced patient cost as the main benefits. Convenience benefits are like accessibility benefits. Patients can order their prescriptions and have them delivered right to their door without going out of their way.
Additionally, digital pharmacies are heavily marketed as cheaper because part of the cost decrease comes from travel reduction. This could mean significant savings for people living in rural communities without a nearby pharmacy. Furthermore, a study published by Software Advice revealed that “61% save over $20 on average through online pharmacies. Depending on how often these patients fill prescriptions, that could translate into thousands of dollars saved over the course of a year simply by electing to use online pharmacies.”
Other benefits are considered, such as the following:
- access to medicine for rural communities
- a more comprehensive range of products
- enhancing pharmacy brands
- customer comfort
- easing work
- facilitating communication
- enhancing patient care
- community pharmacy opportunities
Drawbacks of an Online Pharmacy
Despite the marketed and perceived benefits of digital pharmacies, they are imperfect and come with many risks for patients, providers, and payers.
Counseling, Access, Patient–Provider Interactions, and Security
While there may be many benefits, online pharmacies are not without drawbacks. The main disadvantage is a lack of counseling customarily experienced at a standard brick-and-mortar pharmacy. Of the participants surveyed by the International Pharmaceutical Federation, 12% noted that lack of counseling was the biggest pitfall of online pharmacies.
In a traditional brick-and-mortar pharmacy setting, when a patient picks up a prescription, there is a pharmacist on site to explain or answer any questions on medication use, side effects, or additional risks.
Lack of counseling may also lead to self-medication, self-diagnosis, and substance use disorders. The International Pharmaceutical Federation states, “while online pharmacies provide increased access to medicines and services, consumers may inappropriately self-diagnose or self-medicate, engage in medically unnecessary behavior or substance abuse, or potentially encounter drug-to-drug interactions, contraindications or adverse effects.”
Additionally, 8% of those surveyed believed that lack of face-to-face interactions was the biggest issue with digital pharmacies. Another 8% stated that cybersecurity threats were a concern with digital pharmacies.
While many people cite access for rural communities as a benefit to online pharmacies, it is also important to note that many rural communities do not have reliable internet access.
Counterfeit, Substandard, or Falsified Medications
According to an article published by Pharmaceutical Technology, drug products sold online can be counterfeit, substandard, or falsified. Falsified drugs may be sugar pills, eventually leading to missed doses and threatening patient health. The International Pharmaceutical Federation also states that substandard or falsified medicines are considered a public health threat.
According to Pharmaceutical Technology, the counterfeit pharmaceuticals market rakes in $200 billion annually and is growing at a rate of 20% annually. That growth is double that of legitimate pharmaceutical practices.
“Most of the burden falls on low- and middle-income countries because of poor pharmaceutical governance and poor supply-chain management. Poor-quality medicines increase risks of morbidity and mortality through adverse drug interactions, prolonged illness, and heightened risk of treatment failure,” it stated.
The Journal of Medical Internet Research also notes that, in developed countries, the prevalence of counterfeit drugs may be less than 1%, while other, less developed countries may have a rate over 30%. The global average lies around 10%. Illegal online pharmacies aim to provide convenience, speed, discounts, and speed to appeal to patients, but illegal distribution has many ramifications for patient health and survival.
Aside from patient dangers, the financial outcomes can be severe. According to an article published in the SAGE Journal of Medicine Access, “Over the past five years, the cost of Internet crime-related losses have more than tripled, reaching an estimated cost of $3.5 billion (USD) in 2019. Over 1 million of this total cost stems from healthcare-related crimes that range from insurance fraud to diversion and fabrication of prescription medications that may be sold on illegal online pharmacies.”
Competition with Brick-and-Mortar Pharmacies
Researchers in the International Pharmaceutical Federation also analyzed the effects of online pharmacies on brick-and-mortar companies. Most respondents stated they are neutral or do not know if online pharmacies threaten brick-and-mortar pharmacies.
One respondent noted, “not all online pharmacies present the same level of threat. The largest threat now is perceived from larger online vendors (such as Amazon).”
Regulatory Issues
Regulation and jurisdictional issues are significant drawbacks of the online pharmacy industry. The US National Association of Boards of Pharmacy states that 96% of online pharmacies are illegal.
John Hertig, associate professor of pharmacy practice at Butler University, told Pharmaceutical Technology that up to 40,000 online pharmacies operate globally, and the vast majority are illegal.
Global Regulation of Online Pharmacies
A natural and obvious solution to the drawbacks of online pharmacies is regulation. Unfortunately, laws vary drastically by territory. Because the internet is readily accessible to most people worldwide, regulation of digital pharmacies is not restricted to the country the patient or pharmacy is in.
Regulation of Medications
The survey conducted by the International Pharmaceutical Federation notes that online access to nonprescription medications (NPMs) varied. Researchers pointed out that a brick-and-mortar company distributed 61% of online NPMs.
“Twelve countries (15%) indicated that NPMs could be purchased by consumers on online pharmacies that are not linked to a brick-and-mortar pharmacy. Other online avenues for NPMs to be purchased by consumers included generalist outlets (e.g., supermarkets) (n = 20; 25%) and online non-pharmacy supply (n = 16; 20%). Interestingly, 19% of countries (n = 15) indicated that the online sale of NPMs is not allowed,” researchers said in the paper.
In addition to the sale of NPMs, 41% of countries required the online sale of prescription-only medicines through a brick-and-mortar pharmacy. An additional 32% of countries prohibited the online sale of POMs.
Only 49% of countries have regulatory policies in place for online pharmacies.
Jurisdictional Concerns
A significant issue with online pharmacies is jurisdictional boundaries. In the Journal of Medical Internet Research, Fittler notes that internet pharmacies can be accessed anywhere in the world. With differing regulations across global markets, there are multiple considerations.
The Journal of Medical Internet Research states, “while the country of operation determines the licensing requirements and the quality assurance standards in support of the practice of internet selling of medications, mail-order must be performed in accordance with the latter. However, since many illegitimate websites are unwilling to indicate their actual location, one cannot be certain of the regulatory framework under which the internet pharmacy is operating.”
Looking Ahead
In the current consumer-driven digital age, online pharmacy use is inevitable. The world and the pharmaceutical industry must adapt to invite technology into healthcare while maintaining safety and regulatory standards.
Nearly 50% of participants in the International Pharmaceutical Federation believe that better regulatory practice for online pharmacies is necessary for their improvement. Regulation should go beyond simple policy and include guidelines and enforcement strategies. It should be mindful of the roles of patients, pharmacies, providers, and payers.
The survey concludes, “cooperation is imperative, particularly if cross-border operations of online pharmacies become increasingly commonplace in the future. However, competition authorities alone cannot achieve this goal, as pharmacy markets are primarily regulated by sector-specific regulators. Consequently, cooperation must be enhanced between different regulators within each country as well as at a global level.”
