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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
© Rajendra Pratap Gupta . Email: [email protected]
• 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
© Rajendra Pratap Gupta . Email: [email protected]
• 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
© Rajendra Pratap Gupta . Email: [email protected]
• 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
© Rajendra Pratap Gupta . Email: [email protected]
• Work on Indian Pharmacopoeia started in 1948
• Indian Pharmacopoeia list was published in 1946
Some Facts…Pharmacy Practice
• 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.
© Rajendra Pratap Gupta . Email: [email protected]
• In 1892 there were 756 drug stores in Calcutta including 10 established
European houses . There were another 100 dispensing shops
Some Facts…Pharmacy Practice
• 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
© Rajendra Pratap Gupta . Email: [email protected]
• 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
Some Facts…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
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• According to the health survey 1943-45 there were only 75 pharmacists in India
Ratio of 1:4 million
Some Facts…Pharmacy Practice
• 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
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• 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
Some Facts…Pharmacy Practice
• It took 9 years to process the drug act 1949
• 29th October 1972 Indian Organization of Chemists & Druggists ( IOCD) formed
© Rajendra Pratap Gupta . Email: [email protected]
• 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
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© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
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
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• 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’
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• 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
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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.
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???
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
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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.
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
Paradigm shift in Pharmacy Practice
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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
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• 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
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• 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
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• 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
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• 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
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• 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
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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
© Rajendra Pratap Gupta . Email: [email protected]
• 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
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• 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
© Rajendra Pratap Gupta . Email: [email protected]
• 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..
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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.
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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
© Rajendra Pratap Gupta . Email: [email protected]
• 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
© Rajendra Pratap Gupta . Email: [email protected]
• 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
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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
© Rajendra Pratap Gupta . Email: [email protected]
• 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
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• 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
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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
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• 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.
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We are Changing …
But we are still 50 years behind …
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© Rajendra Pratap Gupta . Email: [email protected]
50 years back - Europe
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India Today
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© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
© Rajendra Pratap Gupta . Email: [email protected]
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© Rajendra Pratap Gupta . Email: [email protected]
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© Rajendra Pratap Gupta . Email: [email protected]
Even if your life is in danger you should not betray or neglect the interest of your patient.
© Rajendra Pratap Gupta . Email: [email protected]
Charaka..
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Thanks
Rajendra Pratap GuptaEmail: [email protected] : + 91 9867300045 + 91 9323109456