An online pharmacy or internet pharmacy is a pharmacy that sells OTC and prescription medications through online portals. The online sale and purchase of drugs have become very popular due to the availability of the internet, lack of physical access to pharmacies (e.g., during COVID-19), ease of working, and lower prices offered by some pharmacies. Some medical centres have integrated pharmacies into their operations, and the prescriptions are dispatched to them online, and the patients receive the medications. However, the whole channel must follow legislative and ethical considerations to maintain standards and provide the best care to the patients.
The legal procedures and guidelines vary from country to country. The concept of online pharmacies is beneficial as it increases patient comfort and convenience and is more economical. However, some issues needed to be addressed, e.g., misleading or inappropriate labelling resulting in inaccurate delivery of drugs, less common or nonexistent patient-pharmacist contact resulting in increased risk of errors, increased risk of poisoning and overdoses, and more chances of adverse effects to common medications. Sometimes, online pharmacies sell products of suboptimal quality. The patients are mostly unable to identify and are exposed to adverse effects. 25% of online pharmacies had treated a person suffering from the side effects of online drugs noted in a survey of general practitioners in the UK in 2009.
Although online pharmacies provide an information pamphlet, some patients ignore it. Therefore, it is advised that online pharmacies be set up in those areas where the quality of healthcare is at par with the community pharmacies. In the UK, many online pharmacies provide services to more than 2 million people annually (Flona Clark, 2015). To curb illegal practices and to ensure better healthcare, the Royal pharmaceutical society of Greater Britain (RPSGB) introduced a logo system in 2008 to identify the legally accredited online pharmacies. The general pharmaceutical council (GPhC) is now engaged in the practice, and it requires European Pharmacies to be accredited with it to sell the products in the UK.
The online pharmacy, mail-order pharmacy, or simply the internet pharmacy is a pharmacy that operates through the internet. It takes orders online and ships the prescribed medications to the patients through mailing channels. Different pharmacies in that category include the pharmacies that incorporate corporate prescription plans (e.g., NHS Prescription Services), legitimate online pharmacies that are present in the same or different countries but are accredited for the Job, and unethical or illegal pharmacies that sell counterfeit or expired medications and didn't follow the ethical and legal protocols. Such pharmacies operate mobile-based applications or websites to interact with patients.
In the UK, the term 'distance selling pharmacies' is used for online pharmacies. However, various terms have evolved, e.g., 'digital pharmacy,' 'internet pharmacy,' 'web pharmacy,' 'virtual pharmacy,' 'e-pharmacy, etc. The names mostly refer to their mode of working. Some companies have designed websites and mobile applications by various names, e.g., Welzo online pharmacy, a UK-based online pharmacy that provides pharmacy and consultation services. Such pharmacies work through online prescription channels and provide consultation to the clients about everything related to the drugs.
Online pharmacy began with mail-order patent medicines in the late 19th century. But, the progress was hindered by tight legislation. By the 1990s, the digital marketplace emerged as an alternative to the classical markets, and in 1999, the first online pharmacy started in the UK, the Pharmacy2U. With the introduction of 2005 NHS pharmacy regulations, the UK became a Frontline state to adopt the ideas. The 2005 regulations legalized the practice of filling NHS prescriptions online.
In 2015, the MHRA (Medicine and Healthcare Regulatory Agency) required online pharmacies to use Europe-wide logos and get accredited by MHRA. In the UK, many online pharmacies are linked to clinics where doctors make online consultants and prescribe medications. The pharmacy in such practice must be registered with Care Quality Commission. The number and reach of online pharmacies have grown considerably from 56 registered distance-selling pharmacies in 2008-9 to 375 pharmacies in 2021-22 (Statista).
The working mechanism of online pharmacies is similar to community pharmacies, except that such pharmacies use digital platforms. The patients need to browse the pharmacy's website. Here, a user-friendly interface allows easy navigation and product selection. The products are selected and added to the cart, and personal information, e.g., name, contact number, mailing address, and payment details, are provided. The patients must provide prescriptions for the prescription-only drugs or engage in an online consultation with the doctors as required by the GPhC. Suppose a patient is using the NHS electronic prescription system. In that case, the prescriptions are dispatched to the nominated online pharmacy that processes the prescription and dispatches the medicines to the patient's mailing address.
Each product has a patent leaflet containing information on its uses, dosage guidelines, potential side effects, safety guidelines, and drug interactions. For prescription medications, the pharmacy uses a short verification period to check the authenticity of the prescription to ensure the right products for the patients. The order is packed and dispatched to the given mailing address. The pharmacies maintain a channel to guide the customers, answer questions and address any concerns of the patients. The customers are able to provide feedback on the website, which helps other potential customers make the choice.
Despite the concerns about safety and health risks, online pharmacies are important due to a variety of reasons, e.g.,
Facilitation of disabled and elderly: The ordering process is very easy and convenient for people who don't have access to community pharmacies, e.g., elderly and disabled people. The shipping cost is far more affordable than travelling to community pharmacies for some people.
It saves time: The process is time-saving. A patient is able to order and get the desired medications within a short time. Time wasted visiting a pharmacy and waiting to process the order at pharmacies is saved.
It saves money: Online pharmacies are way more economical as they often do not take insurance services. Moreover, people have the option to navigate different pharmacies in a short time to look for the best rates.
Confidentiality and privacy: Online pharmacies provide confidentiality and privacy. It is convenient for people who don't want a face to face contact with pharmacists. The people are reluctant to visit the pharmacies due to issues related to adolescence and sexuality.
A wider range of products: A wider range of products is available at many online pharmacies than the community pharmacies, and it allows the patients to search for the best option, as some patients find it hard to explain to the pharmacy staff.
Access to the pharmacy’s information library: Some online pharmacies maintain an information library and provide patients access use health content. For example, the Welzo online pharmacy maintains a vast library of information related to health, disease, and medicine. It is written by health professionals using online library data published by government agencies and researchers. The data is regularly updated to accommodate more research. It helps guide the patients about different aspects of health and safety.
The primary objective of an online pharmacy is to provide an easily accessible and convenient platform for doctors, patients, and pharmacists to engage and enable patients to order medicines online without visiting community pharmacies. Some other specific objectives of online pharmacy are better accessibility to a wide range of products, provide confidentiality and privacy, provide online prescription and consultation services, patient education about various aspects of health, disease, and medicine, saving time, allowing the patients to compare rates in little time, increase the healthcare empowerment to the people and provide customer support.
To achieve its goal of providing healthcare products to individuals at affordable rates, the online pharmacy is engaged in various functions, e.g.,
Online pharmacies offer several benefits over traditional community pharmacies. These are;
To get maximum benefits, choosing accredited and licensed pharmacies that provide all technical guidance is important, as mentioned earlier.
Purchasing drugs from online sources is not free of issues, and there are many things to consider, e.g.,
An illegal pharmacy doesn't inform the clients about its legal status and deliberately tries to hide information. However, some signs show that the pharmacy is illegal, and the patients must look for them before placing an order.
It is a situation when an online pharmacy allows people to buy prescription medications without providing a valid prescription from a healthcare provider or getting online consultations. A legitimate pharmacy needs the prescription to process the request for such medications. If an online pharmacy doesn’t demand it, it raises several red flags, e.g.,
The pharmacy is not abiding by the law: The pharmacy is not paying attention to the legal requirements and is likely operating out of the law without fulfilling the legal procedures.
Patient safety is compromised: Patient safety is severely compromised as unsafe use of prescription medications exposes them to serious side effects.
Substandard medicines: The pharmacy is dealing with substandard or counterfeit products, and the non-requirement of prescriptions is used to attract clients looking for cheaper medications.
There is no supervision: The pharmacy is likely being operated without medical supervision and is not providing the patients with the necessary guidance.
Patients' privacy is at risk: The prescription is a legal document, meaning the patient's information is shared only with licensed healthcare professionals. Buying such drugs without a prescription has a risk of privacy breaches.
There is a high likelihood of drug abuse as the prescription is required for the safer use of drugs. For example, some pharmacies are providing addictive drugs illegally to clients and profiting from the illegal drug trade.
Sometimes, online pharmacies show exceptionally low prices for medicines and other healthcare products than expected from legitimate online or community Pharmacies. It is a sign of illegal pharmacy due to various issues, e.g.,
Risk of scams: The fake pharmacies show unrealistically low prices to attract customers and steal personal data, e.g., contact details, financial details, etc.
No verification process is in place: Legitimate pharmacies maintain a verification channel and have to invest in it. A pharmacy providing low prices is likely to have no such verification process and put the patients at risk.
The legal procedures are bypassed: The accreditation and other legal procedures are costly. Illegal pharmacies bypass such regulations to save money. It is very risky as such pharmacies sometimes sell substandard products not properly tested and approved by drug regulatory authorities.
Hidden costs: Sometimes hidden costs make the final cost close to or even higher than the original price, and a lower price tag is to attract customers.
Compromised product quality: The product quality is likely to be compromised as the prescription medications are sold with high regulatory and quality standards. A website selling at lower prices is likely selling expired or counterfeit products.
For example, if a pharmacy consistently provides products at lower prices than the other sources, it is a sign to worry about. Any deal that is too good to be true must be considered cautiously, as safety and health are more important than money.
No physical address of pharmacy is a situation where the pharmacy doesn't provide the business address or location from where they are operating. All legitimate businesses, including pharmacies, must have a physical location from where they operate. Lack of address is a sign of illegal pharmacies due to various reasons, e.g.
No accountability: Having a physical location is a sign that the pharmacy is accountable to the authorities for its products and services, and the pharmacy avoiding the address is avoiding the legal responsibilities.
No regulatory compliance: A physical business location is needed to ensure legal compliance. For example, the storage of some drugs, e.g., hormones and vaccines, need specific conditions. A physical address shows the commitment of the pharmacy to adhere to such compliances.
Lack of customer support: A physical business location allows the customers to visit the pharmacy and seek support in case of any issues. A pharmacy avoiding such details is avoiding the customers and is likely an illegal one.
Transparent operation: A physical location shows the pharmacy is not hiding its operations. The illegal pharmacies hide their operations from the clients as a physical location allows the clients to verify the legitimacy by checking the accreditations and licenses.
For example, suppose a pharmacy doesn't provide a physical address or a vague location that doesn't exist or only provides an email; it is a warning sign of illegal operation.
It is a situation when an online pharmacy is operating without proper certification and licensing credentials required by local legislation to sell medicines. All online pharmacies must be accredited by the General Pharmaceutical Council (GPhC) in the UK. It is a significant sign of an illegal pharmacy operation. The reasons are;
No legal compliance: Community pharmacies and online pharmacies must meet the legal requirements and get proper accreditation and licensing. A pharmacy that doesn't show such things is likely an illegal one.
Poor quality assurance: The accreditations and licensing are done after external audits and inspection by the concerned authorities. It ensures that the professional, quality and safety standards are followed. Lack of accreditation means there is no quality control.
Patient safety is at risk: The licensed pharmacies must follow strict regulations and avoid selling substandard and expired medications. An illegal pharmacy is likely engaged in such a business.
No prescription verification channel: Only licensed pharmacies have the channels to verify the prescriptions. An illegal pharmacy usually has no such procedures and exposes patients to unverified medications.
Poor trustworthiness: Licensing and accreditation add to the trustworthiness of the pharmacy. It shows that the pharmacy operates responsibly and ethically. An online pharmacy with licensing and accreditation has better trustworthiness.
For example, most accredited and licensed pharmacies display easily verifiable licenses and accreditation details on their web pages, and any pharmacy that doesn't show them is most likely illegal.
It means the absence of a licensed healthcare professional and pharmacist on the pharmacy premises. Such professionals provide guidance and expert opinions and answer the questions asked by the patients about the safe use of medications. An illegal pharmacy doesn't have any such facility and exposes the patients to the risks, e.g.,
Patient safety: The pharmacists ensure that the medications are dispensed safely to the clients along with necessary information about dosing, drug interactions and side effects. It is necessary for patient safety.
No consultation for prescription medications: Prescription medications often need consultation about the right choice of medications, dosages and safety measures. The absence of health professionals means no such thing is available for patients.
Products issued without verification: A pharmacist is responsible for verifying prescriptions and ensuring that licensed professionals issue them. The absence of a pharmacist means there is no such verification process.
Professional oversight: The presence of a pharmacist shows that the pharmacy is committed to its quality standards, and the absence means a lack of ethical and professional standards.
For example, if a pharmacy's webpage or mobile application doesn’t have the option to seek professional guidance, it is a warning sign. It means no such professional is present, and the pharmacy is likely illegal.
No contact information or customer service
It is a situation when the pharmacy needs to mention its physical location or provide the contact numbers or emails of the concerned professional for contact. Sometimes, a fake location or contact is provided that doesn't exist in reality. Legitimate online pharmacies prioritise customer safety and provide clear-cut contact information and the business's physical location to allow the patients to contact them in case of any concerns, issues and questions related to the medicines. It is an attempt by illegal pharmacies to remain hidden and avoid detection. Some red flags raised are;
Avoiding accountability: Contact information and customer care are a way to establish trust and accountability, and legitimate pharmacies use contact channels to show commitment to their clients and law enforcement agencies. The absence means the pharmacy is avoiding its professional responsibility due to some malicious intent.
Avoidance of regulatory compliance: Provision of contact and customer care is among the regulatory compliances required by GPhC. Any pharmacy avoiding it needs to fulfil its regulatory compliances.
No reliable means to seek information: Even if the company delivers quality products, the lack of contact deprives the clients of means to get professional guidance and clarification in case of any issues. Within the guidance, there is a risk that the patients use drugs unsafely, exposing them to side effects.
Fraudulent intentions: Sometimes, the illegal pharmacies deliberately avoid the contact information so customers cannot reach it for any issues, e.g., refund requests.
So, when choosing an online pharmacy, it is essential to consider the factors, e.g., accountability, transparency and a willingness to engage with the patients.
It means an online pharmacy offers controlled substances without prescription or legal procedures. Controlled substances are medications whose sale and purchase are under strict regulations, e.g., Misuse of Drugs Act 1971 and Misuse of Drugs Regulations 2001, due to the risk of side effects, abuse, harm to the patients and addictive nature. Examples are stimulants, e.g., Ritalin, Concerta and Adderall; opioid analgesics, e.g., hydrocodone and oxycodone; and sedatives like benzodiazepines (GOV.UK, 2022). The complete list is provided on the website of the UK Government.
Legitimate and legal pharmacies strictly adhere to the regulations about the sale of such products and require a prescription that the doctor issues after carefully evaluating the patient's risk, history and physical condition to protect the patient's health and avoid the risk of misuse. Illegal pharmacies don't follow such regulations and advertise and deliver such products without verification or require a sham consultation in the form of a questionnaire. It disregards medical ethics and poses a risk to the safety and well-being of the patients.
For example, if a client observes an advertisement where a powerful opioid is offered without any prescription, it indicates an illegal pharmacy. Patients must purchase drugs from legal pharmacies that follow strict regulations to ensure safety.
It is a situation in which an online pharmacy continually sends irrelevant messages or links through mail. The mail advertises the controlled and prescription drugs and promises delivery without prescription. It is a sign of illegal pharmacy for various reasons, e.g.,
Several illegal spammers create and dispatch such illegal emails, using thousands of domains and regularly shifting messaging techniques to flood the inboxes (Brian Jackson, IT Business, 2009). So, even if one email is blocked, it is not likely to stop.
An example scenario is receiving an unsolicited email from a pharmacy with tags like "limited time offer", "discounted offers," or getting some amount free by purchasing a certain amount. The emails have insecure links, which lead to the pages where such medications are ordered. Such products are mostly fake products and harmful to health. The registered and legal pharmacies don't engage in such a practice and offer products only through their community branch or a verified webpage. The advertisements of products are not sent. However, some pharmacies share the links to their informative pages and health blogs.
Verification of the legality of an online pharmacy is essential to safeguard health and wellness. Here is a step-by-step guide for that purpose.
Some patients tend to ignore it and find it to be too time-consuming. However, the safety and health and the cost of medications are expensive, too.
In the UK, nearly 375 online pharmacies operate, providing services to hundreds of thousands of patients. Some operate in a local area, while others run countrywide operations. Some well-known online pharmacies are;
The business address, phone number, email and the contacts of more teams are given at the website. The registration and certification badges and numbers are provided on the webpage to show their authenticity. More than 75,000 customer reviews allow new customers to make informed decisions, and according to Statista, it has a brand awareness of 33% in the country.
With a total staff of 17,000 people, the pharmacy provides more than 150 million prescription items yearly. The essential services, e.g., online doctors, the guide to the online prescription, terms and conditions, etc., are detailed on the website. Besides the address of the main branch, the store locator allows the patients to search the nearby community stores. According to Statista, it has the country's most significant brand awareness of 86%.
It promises 24/7 support to its customers, alongside the commitment to deliver the products the next day on the doorstep. The Welzo Healthhub boosts to provide its services to more than 500,000 customers whose reviews are published on the website.
The online pharmacies publish the return, exchange and refund policies on the websites. Such services are part of every online business. However, as healthcare products differ from others, some conditions are applied that are classified by the pharmacy. The policies vary for different types of healthcare products.
For non-medicinal products: The pharmacies accept the non-medicinal products provided they are not opened and are in the original packing to claim the refund. Usually, a return and refund period is provided. For example, Welzo online pharmacy allows its customers to return unopened non-medicinal products within 14 days of the order receipt. First, the client must inform the pharmacy staff about the reason to return. The staff receives the products and authorizes the refund, which is sent back using the channel used during the initial payment, and the payment reaches the clients within a few working days. If the return was due to issues with product quality, the pharmacy pays the return postage, and if the return is due to the patient's wish, the customer has to pay the shipment costs. However, The pharmacies don’t accept returns if products are opened or are not in a resalable form for any reason.
For medicinal products: The medicinal products are accepted using the same method and channel as used for non-medicinal products. However, the days allowed are variable for different products. For example, vaccines are not accepted for return because their cold chains are usually broken.
Order cancellation: The order cancellation is allowed for some time (1 hour for Welzo), after which the cancellation is not accepted as the order has already been forwarded to the following department. The same criteria are applied for the other services. The online pharmacies maintain a help centre for such claims. The specific guidelines about the return, exchange or refund are provided on the website or pharmacy.
Yes, the online pharmacies in the UK are regulated and accredited after following specific standards related to legality, safety and quality. Various agencies, e.g., the Medicines and Healthcare Products Regulatory Agency (MHRA) and General Pharmaceutical Council (GPhC), are involved in the accreditations and licensing of online pharmacies. The licensing agencies ensure adherence to good dispensing practices and prescription verifications and issue the licensing and accreditation badges displayed on the website. The concerned authorities of the agencies regularly visited the pharmacy's physical address to ensure compliance with the rules.
Yes, the Pharmacies that follow the rules and are properly regulated and licensed are safe. Besides delivering safe and effective products, they provide information about the dosages, potential side effects, drug interactions and contraindications. However, not all online pharmacies are safe, and many risks are associated with buying products from untrustworthy and unverified online sources. Illegal online pharmacies often sell outdated, counterfeit and substandard products and pose the risk of severe health issues to the general population. To ensure safety, patients must verify the legitimacy of the online pharmacies, provide a prescription at the time of ordering, avoid purchases from sources that don't need prescriptions, check the secure website before ordering, check the contact information on the website and contact in case of any issues and avoid being lured into unreasonable and fake deals.
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