India’s Medicine Problem Predates E-Pharmacies
Lakhs of chemists across the country went on a nationwide one-day strike against online sale of medicines on 20 May. Jan Aushadhi Kendras, pharmacies attached to government and private hospitals, and most major pharmacy chains, however, remained operational. While some state pharmacy bodies opted out of the bandh, citing the larger public interest, the All-India Organisation of Chemists and Druggists (AIOCD) framed the protest around deep discounts by digital platforms, misuse of prescriptions, easy access to antibiotics and habit-forming drugs, and continuation of COVID-19 pandemic-era permissions that allowed doorstep medicine delivery. It wants the government to withdraw the pandemic-era notification that permitted home delivery of medicines, reconsider the regulatory pathway for e-pharmacies, and create a “level playing field” for brick-and-mortar pharmacies.
While the AIOCD would prefer the story be framed around concerns over drug safety, prescription control, regulatory fairness, and the survival of neighbourhood chemists, the deeper story instead is about who gets to mediate access to medicines in India. Should it be the neighbourhood chemist, as it has been for all these years? Or the doctor? Perhaps a platform? Maybe the regulator?
Let us not lose sight of the fact that the chemist lobby has indeed raised a real public health concern. Prescription medicines should certainly not be treated like groceries. Antibiotics, painkillers, and habit-forming substances require safeguards. And for good reason. A platform that promises instant delivery of such drugs without a robust verification system runs the risk of deepening existing problems. But the argument cannot end there. The existing pharmacy system cannot present itself as the guardian of prescription discipline. India’s neighbourhood pharmacies have a rather storied history of dispensing prescription medicines without prescriptions. The app ecosystem has simply made an old disorder faster, scalable, and more difficult to ignore.
Multiple studies, such as this, on over-the-counter antibiotic sales across different states in the country have found that non-prescription antibiotic dispensing is sustained by consumer demand, weak enforcement, competitive retail markets, and the everyday role of pharmacists as informal care providers.
Walk up to your local pharmacy and narrate a list of common cold symptoms, and you are likely to receive Azithromycin. Local pharmacies supply antibiotics for minor ailments such as sore throat, nasal congestion and common cold without a second thought. These are the kind of practices through which antibiotic use becomes normalised and antibiotic resistance becomes harder to control.
Brick-and-mortar chemists are right to argue that apps bypass prescriptions. But apps are essentially mimicking what the counter has long done. A platform simply mediates the in-person informality by unverified uploads, repeated orders, discount nudges, and loosely regulated call-centre verification. A single neighbourhood chemist’s act of dispensing an antibiotic is local and stays largely hidden. When a platform does the same, the act gets repeated across millions of users, hiding inside corporate claims of being only an “intermediary” that connects consumers with licensed pharmacies. The Central Drugs Standard Control Organisation (CDSCO) has not stood completely silent on this. They have issued show-cause notices to firms in the past engaged in online drug sales, to which firms responded by saying that they were only serving as an online platform that linked users with licensed pharmacies.
E-pharmacy platforms’ claim that they are only neutral intermediaries which connect customers to licensed pharmacies rests on specious grounds. Section 79 of the Information and Technology Act, 2000 grants intermediaries’ immunity from liability for third-party content. This protection is not unconditional. Under Section 79 (2), an intermediary only qualifies if it (a) is limited to providing access to a communication system; (b) neither initiates transmission nor selects the receiver of transmission or modifies the information, and; (c) observes due diligence along with central government guidelines. Section 79(3) removes safe harbour for intermediaries if they conspired in, abetted, or induced the unlawful act and if they failed to expeditiously remove or disable access to unlawful content upon receiving actual knowledge.
Measured against these statutory conditions, several routine features and functions of e-pharmacy platforms are difficult to fit within the role of a neutral intermediary. For instance, some platforms algorithmically recommend substitutes or alternative medicines with a significant price drop, essentially incentivising the users to choose them. In such cases, platforms actively take part in a commercially consequential recommendation. Similarly, prompts nudging users toward teleconsultation, backed by a curated panel of empanelled doctors, place the platform in the position of directing care pathways rather than merely enabling access to them. Subscription and auto-refill services that enable repeat dispensation of a prescription without renewed oversight is also a feature we can see in multiple e-pharmacy platforms.
Some of these functions arguably may go beyond the conditions set out in Section 79(2) itself. Nevertheless, the mere existence of value-added services does not automatically deprive a platform of safe-harbour protection. The Delhi High Court made this clear in Amazon Seller Services Pvt. Ltd. v. Amway India Enterprises Pvt. Ltd, but it is to be noted that this was made in relation to general online marketplaces. The e-pharmacy context in this case deserves closer scrutiny than the ordinary e-commerce platforms. The sale of medicine is not the sale of a consumer product. It is governed separately by the Drugs & Cosmetics Act, 1940, and Rules, 1945, and the Pharmacy Act of 1948, which mandate several conditions, including mandatory licensing and the requirement that the sale of drugs be carried out only by a registered pharmacist. Some of the above-discussed platform features, like algorithmic medicine substitution or auto-refilling of standing prescriptions, potentially violate these laws. Depending on the context, such actions might promote or facilitate unlawful activities, thus invoking Section 79(3) of the IT Act and undermining the safe harbour protections provided by the statute.
Even if one were to ignore the safe harbour argument for a moment and look at the broader regulatory structure, presently, there are no dedicated rules which govern e-pharmacy in India. E-pharmacy platforms are also governed by The Drugs and Cosmetics Act,1945, Rules 1948 and Pharmacy Act, 1948 insofar as their activities constitute sale, storage and dispensing of drugs. The only general framework that addresses e-pharmacies from their capacity as e-commerce entities is the Consumer Protection (E-Commerce) Rules, 2020 which requires platforms to refrain from manipulating search results or listings in a way that can lead to biased representation. Such obligations can arguably be read with the Guidelines for Prevention and Regulation of Dark Patterns, 2023, which are also applicable to e-pharmacies in their capacity as e-commerce platforms, prohibit false urgency, confirmation shaming, forced action, subscription traps, and interface interference. Thus, the sector, although not entirely unregulated, is essentially governed through older pharmaceutical laws that were not designed for digital consultations and platform-mediated medicine sales.
To address these issues, in 2018, MoHFW released the Drugs and Cosmetics (Amendment) Rules, 2018 (“Draft Rules”) to create a dedicated framework for the operation of e-pharmacies. The Draft Rules sought to move beyond regulating the dispensing pharmacies alone and proposed registration of e-pharmacy platforms with the Central Licensing Authority. They also required orders to be received through a registered portal and prescriptions to be validated by a registered pharmacist. They introduced a complaint redressal mechanism through State Drug Controllers, banned advertisement of medicines, and required e-pharmacies to maintain records of all prescriptions and transactions, while also prohibiting the online sale of narcotic and psychotropic substances, tranquillisers and Schedule X drugs, allowing regulators to conduct periodic audits.
However, the Draft Rules leave several issues unresolved. Their broad definition of an e-pharmacy does not distinguish between inventory-based platforms that control the stock and marketplace platforms that facilitate sales by independent pharmacies. The Rules, thus, do not clearly assign responsibility among the platform, dispensing pharmacy, pharmacist and logistics provider. They also do not regulate platform-specific practices such as algorithmic suggestions for drug substitution, auto-refills, curated teleconsultations, or disease-specific medicine recommendations. While the Draft Rules require compliance with the IT Act, they do not explain how this requirement interacts with intermediary safe harbour. Thus, while the Draft Rules would impose direct regulatory duties on e-pharmacy platforms, they do not fully address the operational and clinical risks created by platform-mediated drug sales.
The courts have also been drawn into this vacuum, producing more uncertainty than resolution. In Zaheer Ahmed v. Union of India (2018), the Delhi High Court granted an interim injunction restraining e-pharmacies from selling drugs online without a valid license that is required under the Drugs and Cosmetics framework. The order clarified that moving the sale online does not remove the obligations imposed by existing laws. But it failed to answer whether the digital platform must hold the license or whether it is sufficient that the drug be supplied by a licensed pharmacy. The Drugs Controller General of India (DCGI), as a result, directed all state licensing authorities to act against non-compliant platforms. The same court also directed the Central Government to draft rules to regulate e-pharmacies, to which the MoHFW has sought further time to frame the policy, citing the complexity of aligning multiple legislations. The case, now in its seventh year, captures the larger institutional paralysis.
In a parallel case of Tamil Nadu Chemist and Druggist Association v. Union of India (2018), a single bench of Madras High Court adopted a stricter approach directing e-pharmacies to cease operations until the Draft E-Pharmacy Rules (2018) were notified, largely because the absence of a specialised framework made it difficult to ensure prescription verification and prevent unlawful sales. But on appeal, a Division Bench reversed the order, holding that an abrupt ban would cause significant hardship for patients dependent on online access. These cases reveal a judicial attitude that has identified the problem but has repeatedly deferred its resolution to a government that has yet to act.
The Indian state, hence, appears caught between older laws, unfinished draft rules, pressure from chemist associations, patient convenience, and the difficulty of enforcing prescription discipline in a country where informal access has long substituted for formal care. Pharmacies alone have not created public health concerns like antimicrobial resistance (AMR). Doctors overprescribe, while patients demand quick cures. However, pharmacy-level access remains a crucial route through which misuse becomes normalised. The problem is also not confined to antibiotics. Enforcement drives across Indian states point to illegal or poorly recorded sales of habit-forming drugs. Earlier this year, Telangana’s Drugs Control Administration issued notices to 166 medical shops after detecting unauthorised sale of medicines such as codeine-based syrups without valid prescriptions, weak billing practices, poor record maintenance and, in some cases, absence of registered pharmacists.
The government should avoid succumbing to a blanket defence of the e-pharmacy ecosystem as well as avoid a nostalgic defence of the chemist counter. The old retail system is not safe enough, while the new platform system is not accountable enough. A serious policy would require a clear statutory framework for e-pharmacies. It would distinguish inventory and marketplace models, have prescription verification systems that prevent repeated use of old prescriptions, establish an interoperable system throughout platforms that can track such use, and require audit trails for Schedule H, H1 and X drugs. Liability would extend to platforms with meaningful penalties, suspension, and cancellation for repeated violations. The Draft Rules provide a useful starting point, but do not adequately address these platform-specific risks or allocate responsibility across the digital supply chain.
The nationwide strike by the chemists was merely a symptom of an unresolved transition in Indian healthcare. The debate must be larger than whether e-pharmacies should be banned or chemists protected. India has to build a medicine-access system that is affordable without being casual and convenient without being reckless.
Dr. Rishabh Kachroo is an Affiliate Researcher at the JSW Centre for the Future of Law, National Law School of India University, Bengaluru. He works on the public understanding of science and the larger knowledge politics questions that surround it.
Rahul Pallipurath is a Graduate Research Fellow at the JSW Centre for the Future of Law, National Law School of India University (NLSIU), Bengaluru, whose research focuses on the intersection of law and emerging technologies.