In 17th century Europe, apothecaries were the portal to medicines. They were small, local, and indispensable, but limited by the reach of their shelves and the speed of the horse-drawn cart. Three centuries later, India’s health system looks similar: a dense web of physical pharmacies in cities, but a vast expanse of underserved towns and villages beyond, leading to a large divide between urban and rural healthcare.
The imbalance is quite stark. Nearly 75% of Indians live outside urban centres, yet have access to just 31% of hospitals and 16% of hospital beds. This uneven distribution has forced India into a reactive posture: treating illness when it emerges rather than preventing it. The pandemic exposed the fragility of our healthcare systems. Yet, the pandemic opened up new trends like teleconsultations, ordering medicines online and discovered how technology could ease the everyday burdens of care.
Care Without Borders
Today, e-pharmacy and teleconsultation services have the capability of capturing 95% of the existing market, or $5.2 billion. The drivers are clear: a healthcare consumer who demands both price and convenience, investors who have seen the resilience of digital health models since their early-2000s inception, and a government that has recognized technology as the only way to bridge healthcare’s geographical inequities at scale.
India’s domestic pharmaceutical market, valued at $19.8 billion in 2019, remains 90–95% unorganised, with 60% of sales in the acute segment and chronic care underserved, especially in rural areas. Even with over 8.5 lakh retail pharmacists, about 60% of the market is still unreachable. E-pharmacies are uniquely positioned to penetrate and extend reach: digital platforms can ensure stock availability beyond metro warehouses, use AI to optimise supply chains, and integrate prescription verification to reduce quackery and counterfeit drug risks.
Strengthening Safeguards, Preserving Trust
Yet as this sector expands, offline chemists argue that doorstep delivery could bypass safeguards, compromise prescription verification, and even threaten livelihoods. These are real concerns, but they are not arguments to halt progress; rather, these are reasons to design stronger guardrails. Importantly, digital platforms can work with, not against, neighbourhood chemists. By integrating local stores into delivery networks and supply chains, technology can enhance their role, preserve the trust communities place in them, and ensure that patients continue to receive medicines safely, affordably, and on time.
From pill dispensers to health orchestrators
The global trajectory shows where this can lead. The first online pharmacies in the US in the 1990s were little more than virtual counters. Today, they are integrated health platforms offering teleconsultations, diagnostics, and preventive care. In India too, leading e-pharmacies are already expanding beyond pill dispensing. They connect patients to doctors in multiple languages, deliver lab tests at home, and provide monitoring tools for chronic conditions like hypertension or diabetes. For lakhs of people, especially in non-metro India, this means moving from fragmented, episodic care to a continuum of services.
Technology as the great equaliser
Government programmes such as Ayushman Bharat and the Jan Aushadhi scheme have laid important policy foundations. The Ayushman Bharat Digital Mission aims to knit together patient records, doctors, and pharmacies into a unified grid. E-pharmacies align closely with this vision. By extending reach beyond urban centres, they break old barriers: the tedious trip to refill a prescription, the uncertainty of stock and the opacity around drug quality. And by digitising the process, they build accountability into a system where counterfeit or substandard drugs still circulate.
India’s next leap
Ecommerce in healthcare is not a panacea, but as part of an integrated digital health ecosystem, it represents India’s chance to shift from reactive care to a proactive, prevention-first model.
The apothecary of the 17th century could never have imagined a world where a patient 500 kilometres from the nearest hospital could consult a doctor, receive diagnostic results, and have medicines delivered within 48 hours through a mobile phone. That future is within reach. The challenge now is to build trust, craft clear rules, and ensure that both digital platforms and neighbourhood chemists work together in service of patients.
E-pharmacies are not a threat to India’s healthcare system. Done right, they can be its backbone by extending care without borders, lowering costs, and ensuring that no patient is denied treatment because of where they live or how far they can travel. The debate should not be about whether they have a place, but one where neighbourhood pharmacies are connected to digital platforms to ensure both reach and trust.
(Shriram Subramanian, Founder, InGovern Research Services.)
Views are personal, and do not represent the stand of this publication.
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