E-pharmacies are likely to grow seven times to $3.7 billion by CY22 as they aim to grab a large pie of the highly fragmented Indian market, according to a research note by foreign brokerage, CLSA.
The brick and mortar chemists have been protesting against the business models of online pharmacies and have gone on strike several times.
The Indian pharma market is valued at $20 billion and has been growing at 10-12 per cent. Continuation of current growth trends could propel the market to $35 billion by 2025, the report noted.
However, the distribution channel of the pharmacy market in India is highly unorganised and fragmented with over 80,000 distributors and more than 0.85 million brick and mortar retail outlets allowing room for organised and online pharmacies.
According to CLSA, there are several e-pharmacies operating currently but Netmeds, Pharmeasy, Medlife and 1mg have emerged as the key players with a pan-India reach. Apollo Pharmacy with 3,500 stores is the largest offline pharmacy and is also piloting an e-pharma portal. These companies have cumulatively raised close to $400 million since starting out.
As per Frost and Sullivan, e-pharmacy is a nascent market worth $0.5 billion, but it is expected to grow nearly 7 times at 63 per cent compounded annual growth rate (CAGR) to $3.7 billion by 2022, riding higher internet penetration.
At present, e-pharmacies largely cater to subset of the chronic market (cardiac, diabetes where drugs purchases can be planned) and their penetration of the acute market has been tough.
Deep discounting and large promotional spends have been drivers of customer acquisition and sales growth. Most e-pharmacies are burning close to Rs 70-80 million per month and this is largely being funded by private equity money, the report noted
With draft guidelines for regulation of e-pharmacies issued, formalisation of the space on issue of final guidelines may also be an enabler for growth for these companies.
E-pharmacies currently comprise only 2-3 per cent of the India pharma market and thus have limited bargaining power while sourcing from the manufacturer.
“Once e-pharmacies are able to garner 10-15 per cent share of the market, they are likely to have better bargaining power and could then be able to capture a larger pie of margins. Automatic substitution of doctor prescription to unbranded generics (Gx) could be a game changer for e-pharmacies. This may be possible once India enforces uniform quality standards,” CLSA said in the note. (IANS)
People with severe but stable heart disease from clogged arteries may have less chest pain if they get a procedure to improve blood flow rather than just giving Medicines a chance to help, but it won’t cut their risk of having a heart attack or dying over the following few years, a big federally funded study found.
The results challenge medical dogma and call into question some of the most common practices in heart care. They are the strongest evidence yet that tens of thousands of costly stent procedures and bypass operations each year are unnecessary or premature for people with stable disease.
That’s a different situation than a heart attack, when a procedure is needed right away to restore blood flow.
For nonemergency cases, the study shows “there’s no need to rush” into invasive tests and procedures, said New York University’s Dr. Judith Hochman.
There might even be harm: To doctors’ surprise, study participants who had a procedure were more likely to suffer a heart problem or die over the next year than those treated with medicines alone.
Hochman co-led the study and gave results Saturday at an American Heart Association conference in Philadelphia.
Less testing, invasive treatment
“This study clearly goes against what has been the common wisdom for the last 30, 40 years” and may lead to less testing and invasive treatment for such patients in the future, said Dr. Glenn Levine, a Baylor College of Medicine cardiologist with no role in the research. Some doctors still may quibble with the study, but it was very well done “and I think the results are extremely believable,” he said.
About 17 million Americans have clogged arteries that crimp the heart’s blood supply, which can cause periodic chest pain. Cheap and generic aspirin, cholesterol-lowering drugs and blood pressure medicines are known to cut the risk of a heart attack for these folks, but many doctors also recommend a procedure to improve blood flow.
That’s either a bypass — open-heart surgery to detour around blockages — or angioplasty, in which doctors push a tube through an artery to the clog, inflate a tiny balloon and place a stent, or mesh scaffold, to prop the artery open.
Twelve years ago, a big study found that angioplasty was no better than medicines for preventing heart attacks and deaths in nonemergency heart patients, but many doctors balked at the results and quarreled with the methods.
So the federal government spent $100 million for the new study, which is twice as large, spanned 37 countries and included people with more severe disease — a group most likely to benefit from stents or a bypass.
All 5,179 participants had stress tests, usually done on a treadmill, that suggested blood flow was crimped. All were given lifestyle advice and medicines that improve heart health. Half also were given CT scans to rule out dangerous blockages, then continued on their medicines.
The others were treated as many people with abnormal stress tests are now: They were taken to cardiac catheterization labs for angiograms. The procedure involves placing a tube into a major artery and using special dyes to image the heart’s blood vessels. Blockages were treated right away, with angioplasty in three-fourths of cases and a bypass in the rest.
Doctors then tracked how many in each group suffered a heart attack, heart-related death, cardiac arrest or hospitalization for worsening chest pain or heart failure.
Results are in
After one year, 7% in the invasively treated group had one of those events versus 5% of those on medicines alone. At four years, the trend reversed — 13% of the procedures group and 15% of the medicines group had suffered a problem. Averaged across the entire study period, the rates were similar regardless of treatment.
If stents and bypasses did not carry risks of their own, “I think the results would have shown an overall benefit” from them, said another study leader, Dr. David Maron of Stanford University. “But that’s not what we found. We found an early harm and later benefit, and they canceled each other out.”
Why might medicines have proved just as effective at reducing risks?
Bypasses and stents fix only a small area. Medicines affect all the arteries, including other spots that might be starting to clog, experts said.
Drugs also have improved a lot in recent years.
Having a procedure did prove better at reducing chest pain, though. Of those who had pain daily or weekly when they entered the study, half in the stent-or-bypass group were free of it within a year versus 20% of those on medicines alone. A placebo effect may have swayed these results — people who know they had a procedure tend to credit it with any improvement they perceive in symptoms.
Dr. Alice Jacobs, a Boston University cardiologist who led a treatment-guidelines panel a few years ago, said any placebo effect fades with time, and people with a lot of chest pain that’s unrelieved by medicines still may want a procedure.
“It’s intuitive that if you take the blockage away you’re going to do better, you’re going to feel better,” but the decision is up to the patient and doctor, she said.