The Future of Pharmacy -2020 Rajendra Pratap Gupta Vice-Chairman Heartline Telemedical Services...

The Future of Pharmacy -2020Rajendra Pratap Gupta

Vice-ChairmanHeartline Telemedical Services Pte.Ltd.

© Rajendra Pratap Gupta . Email: [email protected]

Some Facts…Varanasi & BHU

• Varanasi is one of the oldest living cities in the world

• Kashi then Benaras & now know as Varanasi

• Varanasi is taken from the fact that town was situated between the river Varuna

& Assi river ghat – Varuna-Assi- Varanasi• Varanasi has more than 1500 temples , mosques & other places of worship


• The city is a center of learning for over 3000 years, with Sarnath, the place

where Lord Buddha preached his first sermon

• BHU is one of the largest universities in Asia spread over 1300 acres

Some Facts…Varanasi

• BHU has an airstrip which was started during the 2nd world war

• BHU in itself is a complete township with post offices, banks and a shopping

center

• BHU has a museum known as Bharat Kala Bhawan.

• Only BHU had a degree course in pharmacy since 1932 & the other was UDCT


• 12th All India Compounder’s Conference was organised in Benaras in Nov 1939

Some Facts…Pharmacy practice…

• During the early days dispensing largely remained in the hands of ill

trained compounders

• With the doctors coming from Portugal, there was always a pharmacist

• In 1846 , a medical school was opened and there was a School of Pharmacy in

the same school in Goa

• In 1860 the first Chemist and Druggist class started at Madras Medical college


• Between 1884-94 only 28 students enrolled in the MMC

• During those days anyone could open a pharmacy as long as he paid the

usual trade and professional tax to the municipality

Some Facts…Pharmacy Practice

• The Pharmacopoeia of India 1868 was a kind of Indian version of BP 1867

• 1885 The British Pharmacopoeia was made the sole authority on all matters

relating to pharmacy


• Work on Indian Pharmacopoeia started in 1948

• Indian Pharmacopoeia list was published in 1946


• In 1881 Census there were 17720 chemists & Druggists in India

• Big pharmacy houses were generally run by British pharmacists

• British Pharmacopoeia 1885 was made the sole authority on all matters

related to pharmacy. BP 1898 had 1900 Indian & colonial addendum

• Calcutta was the first place where the first Chemists & Druggist started.


• In 1892 there were 756 drug stores in Calcutta including 10 established

European houses . There were another 100 dispensing shops


• In 1913 The Pharmaceutical Society of India (PSI) was formed with G.T.

Grice as its President

• PSI endeavored to raise the standard of pharmacist & promote the interest of

Pharmaceutical chemists. It had 40 members

• 1920, 30th November, The Calcutta Chemists & Druggists association was

formed to raise the general state of chemists and druggists• 1923 a society was started in the name of The Pharmaceutical Association


• 1928, The Chemist and Druggist association was formed in Madras

Drug enquiry committee 1930-31 recommended that there should be a central legislation to control drugs &

pharmaceuticals.

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Most significant event for pharmacy practice


• 1937- The government of Madras sanctioned the post of pharmacist at

Government General hospital in Madras

• S.K.Patni was the first pharmacy graduate . He chose community pharmacy as

his life long career

• Shantilal Hiralal Mehta possibly was the first pharmacy degree holder Indian

hospital pharmacist when he joined KEM hospital in 1941


• According to the health survey 1943-45 there were only 75 pharmacists in India

Ratio of 1:4 million


• 1939- The first quarterly journal The Pharmacist published

• 1940- MMC changed the name of the Chemists & Druggists course to Diploma in

Pharmacy which was of 2 ½ Years duration


• In 1947 there were 27000 compounders in India .6000 in Bengal alone

• Indian Pharmacy Congress -IPC formed in 1948

• Calcutta was the capital of pharmacy trade


• It took 9 years to process the drug act 1949

• 29th October 1972 Indian Organization of Chemists & Druggists ( IOCD) formed


• 11th May 1975 AIOCD was formed

• Karnataka state pharmacy council is the first to establish the drug

information Center

• Shimla was known as the Mecca of pharmacists

Our Glorious past - Grand Pharmacies


Some Facts…Grand Pharmacies

• All were run by British pharmacists

• Some had chain of stores in many states like Dadha & Co, Bill & Co etc.

• Stocked photographic apparatus, Surgical instruments, Hospital furnishings,

Toilet requisites, Wines & liquors, Stationery & newspapers, Auction mart,

crockery, sporting requisites, Jewelery & even ammunitions

• Belief : More varied the stocks, more would be the returns from their pharmacy

Department


• Important pharmacy shops were dispensaries & each had a doctor attached

Accolades…Grand Pharmacies

• Bathgate and Co. was known as the ‘Prettiest Pharmacy in India’

• Kemp & Co. Ltd. was known as the ‘Best Chemist of the East’

• Thompson & Taylor was known as ‘One of the Handsomest & most Charmingly

placed Pharmacies’


• B.K.Paul & Co. was known as the ‘Biggest drug store in Asia’

Comparison between an English pharmacy in India and ordinary pharmacy in England brought to mind contrast as

between a mansion & villa


1884 Bengal Municipal Act , Section 252

No person were to compound ,mix, prepare, dispense or sell any drug recognized by British Pharmacopoeia unless he was

duly certified to do so.


???

The Pharmacy Act 1948 requires that a prescription be dispensed by a registered pharmacist only

Whereas

The Drugs & Cosmetics Act 1940 requires that this activity be carried out under the supervision of a registered pharmacist


1947 Vs 2007

• There were 100 pharmacists in 1947. There are 559408+ now.

The ratio of pharmacists per 1000 population is 0.56 ( 2003 data )

• There were 3 pharmacy degree awarding and two diploma awarding institutions

Now we have 358 diploma institutions with an intake of 21200 & 212 degree

institutes with a intake of 11670. 142 PG courses with an intake of 1459• Most of the drugs were imported. Now majority are made locally in India

• Most of the Pharmacies were run by British pharmacists. We only have Indian

Pharmacists running our pharmacies.



Paradigm shift in Pharmacy Practice


Pharmacist’s Insignia approved by PCI -1978-9

Pharmacies Today ….

• 500,000+ chemists are listed with AIOCD. Of this , 2/3rd of the

pharmacies are in urban sector, only a third in rural areas. Over 70 % of the

pharmacies are in 5 states ,which account for 30 % of India i.e. Tamilnadu

Maharashtra, West Bengal , Karnataka & Punjab.• Shop size ranges from 110-300 sq.feet with no air conditioning .

• Shortage of regulatory staff leads to blatant violations of the FDA rules


• Pharmacist may or may not be present

Pharmacies Today ….

• Pharmacies stock everything under the sun. Milk , shoe polish………..

• No concept of patient counseling

• Substitution of the products rampant in ‘B’ class towns

• The current day chemist is not prepared for the expensive patented drugs


• Pharmaceutical industry in itself is undergoing a paradigm change and a change

in the retail scenario is the need of the hour

Pharmacies Today ….Changing slowly….

• Chains made an appearance on the retail landscape some 8 years back

• There are 20+ retail pharmacy chains operating in India

• Size of the pharmacies of the chain stores varies between 200- 5000 sq. feet.

• Retail chains follow the GPP’s


• AIOCD is also attempting to corporatise their standalone retail chemist shops

Organised retail – Pharmacy chains

• Main big size players are Medicine Shoppe and Apollo pharmacies

• Medium & small size players include, Reliance retail , 98.4, Guardian, Med Plus,

Pantaloon, Health & Glow, Dial for Health, Lifeken, Pills & Powder, Trust,Seven

Hills, Dabur , Florence, Fortis, Max, Manipal Care & Cure, Medybiz, Subhiksha….• In all, these pharmacy chains add upto around 3000 pharmacies

• Account for less then 2 % of the retail pharma trade


• Mostly limited to metro & class 1 towns

Challenges……

• Sudden growth leads to shortage and mobility of trained manpower

• Retail real estate is pretty expensive

• Without any national level distribution, retail chains cannot succeed in the long

run

• Margins are decreasing and costs are increasing . Indian market is price

conscious


• India is still 50 years behind the world in organised pharmacy retail

Why will consolidation happen ???

• There are 500,000+ chemists & the retail pharma market is USD 5 Bn.

• It means the sale per chemist per year is USD 10,000 i.e. Rs. 4 Lac per year or

Rs.33000.00 per month

• To follow GPP’s a chemists needs a sale of Rs.20,000.00 per day

• This translates into a yearly sales of Rs.72,00000.00


Why will consolidation happen ???

• Effectively, in a market of USD 5 billion, it translates into the fact that we can’t

sustain more than 28000 good pharmacies in India.

• India has approx. 5 lac pharmacists and < 75 % work in pharmacies


• TPA’s / HMO’s will play a major role

• Customer awareness / generics

What will consolidation do ???

• The statistics proves a few things

• Not all 500,000 chemists will be able to sustain the business in the times ahead

• Big players will create a tough market scenario

• Consumer awareness will drive in efficiencies and GPP’s & would be merciless to

inefficient and stagnant people in the profession


• Those who don’t adapt to change will perish

Pharmacy wanting to change…..must note

• 1 Billion of the total population is below 35 years in age

• 66 % of the population is still not diagnosed

• Life style diseases like obesity, diabetes & CV diseases are on the rise

• According to WHO , 50 % of the medicines prescribed are not taken at all


• A study by The Tribune in NCR region revealed of all the patients who are

prescribed medicines , 1/3rd do not take the medicines at all, 1/3rd take till the

symptomatic relief happens and only 1/3rd comply totallyThe best option is to progress from Community Pharmacy to Family Pharmacy

The Future of Pharmacy

Gateway of all Healthcare needs..


I strongly believe..

Pharmacy is not about sale but service ,because the sale has already been affected by the doctor by writing the

prescription. Pharmacy is all about servicing the prescription.


Pharmacies must realise that……

• The practice of pharmacy is an art & science & not just a trade – a

Calling and not a business

• Pharmacy is the only segment of Healthcare that is present everywhere &

accessed by everyone

• The entire pharmacy set up needs to be more service based then trade based

• The approach has to be patient & family centric


• The role of the pharmacist has to change from a dispenser to Advisor. One who

creates health awareness & provides health related information – IEC

2020 patient will be……

• Demanding …..will not accept things as they are

• Knowledgeable ……will ask for more information …if the pharmacist is not

updated with all the product information …………its going to be tough

• Will be short of time …

• May want to have a complete medical plan which includes medicines + follow up

+ monitoring at home + refill+ checking with the physician + follow up reminder


• The role of the pharmacist has to change from a dispenser to Advisor to a

complete wellness solution provider – More of a chief family wellness officer

Pharmacist..

Doctor is next to God, Nurse is next to the doctor . Only Pharmacist is the closest to the patient


Pharmacies must ……

• Act as a single information touch point for all healthcare needs

• This calls for a close networking with the physicians , nurses , phlebotomist ,

physiotherapist , Dieticians , Chronic care councilors , insurance , ambulatory

services & other care givers in the area. The user must get all these through the

‘Family Pharmacy’.• Use technology to send alerts to chronic patients for taking pills & Dr. visits


• Maintain the family history along with vaccination charts

Pharmacy must provide……

• Health checks like Body mass index, Weight measurement , BP ,

Sugar check up , PFT & ECG. Remote patient monitoring is available today

• Printed detailed information on Do’s & Don’ts to chronic patients on their first

visit

• Encourage , form & support ‘Patient Groups’ for chronic patients . This helps to

change patient behavior and ensures better medication compliance thus leading

to better outcomes from the treatment


• Run a campaign on a quarterly basis to weed out medicines from the first aid

boxes of the family it serves.Technology & automation is the key


Future formats ….

Format Size Product Mix Target audience

Mall / Supermarket pharmacy 150-250 Sq.ft Pure pharmacy .Focus on chronic care.

Monthly shoppers

Pharmacy marts – Large formats

500 -5000 Sq.ft

OTC / Pharma/ Nutraceuticals / Health supplements /Fitness

Health conscious Family

Neighbourhood Pharmacy 350 Sq. ft. Pharma / OTC / Daily use items

Family

Semi Urban / Rural pharmacy 150 Sq. ft Pharma / OTC / fast moving household items

Family

Specialty pharmacy 250Sq. ft Diabetes, CVD, Cancer, Arthiritis.

Patients

Be prepared ……by 2020 ..

• System specific drugs / Genetic drugs

• Nano drugs


• E- Prescription

• Geriatric / Diabetic / Cardiac / Net pharmacy

• Mobile clinics / pharmacies

Three phases ………

• Till 2012- The trial & error phase. New players enter & try new formats

• 2012-2016- Shake up phase . FDI allowed. Mergers , acquisitions & closures.

• Post 2016. Consolidation & stabilization phase.


We are Changing …

But we are still 50 years behind …



50 years back - Europe


India Today

Even if your life is in danger you should not betray or neglect the interest of your patient.


Charaka..


Thanks

Rajendra Pratap GuptaEmail: [email protected] : + 91 9867300045 + 91 9323109456

mailto:[email protected]

The Future of Pharmacy -2020 Rajendra Pratap Gupta Vice-Chairman Heartline Telemedical Services...

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