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I inspected online pharmacies located in India that sell to Americans. Here's what I discovered.

Answered by Shivam Patel, PharmD, BSPS, RPh | Posted September 11, 2020

You already know that PharmacyChecker helps you afford prescription medication, but you may not know about our discoveries on the way to becoming the best at inspecting international pharmacies for safety from which Americans order prescription drugs.

The PharmacyChecker Verification Program is unique because we are the only independent American program that accredits international online pharmacies that safely sell medications to Americans. We verify the legitimacy and licensure of only those that meet high pharmacy practice standards. In order to ensure these standards are continuously met, we routinely inspect pharmacies located in Turkey, Mauritius, and India.

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Indian Online Pharmacy Practice Standards

I have inspected varying types of pharmacy operations over my career: retail, hospital, mail-order, and international. I was actually the friendly face in your Boston neighborhood CVS at one point! During a recent PharmacyChecker inspection of Indian pharmacies, I was very pleased at how streamlined and similar the operations are to U.S. mail-order pharmacies.

Walking outside in urban India can be quite chaotic: traffic jams, constant honking by rickshaws, air pollution, and the blistering heat. Upon entering an accredited pharmacy for inspection, it was a completely different environment: a calm, cool and clean facility.

I met licensed pharmacists and technicians that were up to speed and eager to exceed PharmacyChecker standards. The work ethic of the pharmacy staff was remarkable; everyone knew exactly what their job was in fulfilling prescription orders accurately. The Indian pharmacy had neatly organized sections including: a front lobby, accounting, medication stock, order fulfillment, shipping, and staff restrooms. Medication orders are filled in a similar fashion to U.S. pharmacies. Data entry was performed from a patient's valid prescription and a prescription label would be printed. Pharmacy staff would then go gather all the medication they needed to fulfill orders for the day and start preparing them in individual boxes. A pharmacist would perform a final verification of the entire medication order before it was sealed for shipment. The pharmacy maintained logs of orders fulfilled, daily temperature/humidity, and cleaning just like here in the U.S. The pharmacy was properly air conditioned to ensure medication storage was optimal and comfortable compared to the heat outside.

Blister Packaging

The majority of oral medication dispensed from India comes in manufacturer-sealed blister packs. Medication is stored in individual blister cells (pockets) that are easily popped by your fingers to retrieve an accurate dosage.

An example of an Indian manufacturer-sealed blister packaging. Atorlip Image Source

Blister packaging ensures medication is dispensed accurately to patients and not tampered with. U.S. pharmacies typically order large stock bottles that can consist of 1,000 or even 5,000 tablets a bottle. The pills are then counted out into the quantity needed for prescriptions and poured into those orange prescription vials with which you're oh so familiar. Counting out is a perfectly fine method to dispense medication, but it adds risks that the wrong number of pills will be dispensed, or, worse, the pharmacist could end up mislabeling multiple prescriptions in one order (where the medication in the vial does not match the label). This is why blister packaging is awesome! It reduces the risk of a wrong fill drastically. The FDA backs this up here.

See: Do international pharmacies make medication errors like in the U.S.? Blister Packs vs. Loose Pills

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Ordering Online from Accredited Indian Pharmacies

Over the years, PharmacyChecker has monitored many, many international pharmacy operations. With strong policies and standards, pharmacies located across the globe can provide the same quality of care we would find at home. Here is a breakdown of some key observations we made in India compared to U.S. pharmacy standards.

Indian Pharmacy Inspection Observations

Comparable to U.S. Pharmacy Standards?

All medications dispensed are checked by a licensed pharmacist Yes
All pharmacy staff are aware of patient confidentiality rules with an agreement to protect health information Yes
The areas where medications are dispensed have adequate air conditioning, lighting, and ventilation Yes
All medications dispensed by the Pharmacy are manufactured under Good Manufacturing Practices (GMP) and procured from licensed wholesalers Yes
All pharmacy areas are kept clean, tidy, and in hygienic condition with staff practicing a high standard of hygiene Yes
The pharmacy has an infectious disease policy in place that prohibits staff members with active communicable diseases such as the flu or COVID-19 to work in the dispensing area Yes
Pharmacy Standard Operating Procedures require hand washing at the beginning of the day, after using bathrooms, breaks and lunch times. In between, hands are sanitized using alcohol based hand sanitizers Yes
All medication stock is protected from: temperature extremes, direct sunlight, moisture, insects, animal, vermin Yes
All dispensed medications are packaged with an invoice that included details of the order Yes

It’s best if you can get your medication locally - not internationally. But if you need more affordable prescription drugs and decide to order from India, now you can breathe a little easier, as long as the online pharmacy is accredited by PharmacyChecker.

Compare prices at PharmacyChecker-accredited pharmacies to ensure your orders are prepared with the care observed above.

See List of Accredited Online Pharmacies

 
 

Find A Safe Online Pharmacy

See Canadian and international online pharmacies that are licensed and vetted for patient safety

Compare drug prices among reputable online pharmacies

Comments
Excellent article Shivam thank you for your detailed description of how a pharmacy in India is run. I’m curious if other FDA regulations are followed, especially in the case of drugs with REMS such as mifepristone? There have been cases of mail order mifepristone orders mailed in violation of REMS requirements of in person dispensing coming from an Indian pharmacy. These pharmacies are harming patients irresponsibly and need to be identified and shut down. Thank you.
Thank you for your comment! Great question. PharmacyChecker-accredited online pharmacies do not list or dispense mifepristone. Accredited online pharmacies must remain compliant to all PharmacyChecker Standards and Policies including 16-02: Medications Requiring Special Dispensing Considerations policy (https://cdn.pharmacychecker.com/pdf/VP+Policies.pdf). This policy outlines the requirements for accredited pharmacies regarding compliance with PharmacyChecker Verification Program standards related to selling, marketing, processing, and/or dispensing medications requiring special dispensing considerations, as defined by this policy, including but not limited to medications identified by U.S.-FDA Risk Evaluation and Mitigation Strategies (REMS) program (https://www.accessdata.fda.gov/scripts/cder/rems/index.cfm).
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