Rational and Constructive Perspectives on Online Prescription Drug Sales Amid the 'Drug-First Diagnosis' Controversy

Author: Jian Tie

Recently, a new term has been coined, called“Indications”, sparking widespread debate and discussion online.

Indeed, since “prescribing medication according to the diagnosis” is common sense for everyone, “fabricating a diagnosis to match the medication” clearly contradicts basic cognition and logic. Anyone encountering this term would naturally question the legitimacy and legality of such a practice.

Investigative reports have revealed that certain online pharmaceutical retail platforms have overly simplified and formalized their verification processes for the sale of prescription drugs. This has led to the easy availability of high-risk prescription medications, including psychotropic and narcotic substances, posing significant societal risks. These reports serve as a wake-up call to both platforms and patients, underscoring the urgent and indispensable need for stricter oversight.

For instance, one particularly egregious detail is that a reporter was even able to purchase a medication intended for local anesthesia using the virtual identity of a minor. If these allegations are substantiated, it is indisputable that the platform not only failed to fulfill its basic oversight responsibilities but should also be subject to appropriate regulatory action and penalties.

However, the author also noted that in the comment sections of several articles with high click-through rates on related topics, a large number of readers left comments, many of whom expressed their own views: the online sale of prescription drugs should not be subject to a one-size-fits-all approach.

Why do some readers offer such suggestions? A careful review of these comments reveals that the primary supporters of online sales of prescription drugs are a specific group: patients with chronic diseases seeking follow-up consultations and prescription renewals.

Among the author’s friends and relatives are patients with chronic diseases who frequently need to visit hospitals for follow-up appointments and prescription refills. Particularly for certain specialized medications, regulations permit only a one- to two-week supply per prescription. As a result, outpatient clinics in such hospitals are often extremely busy. The primary reason is that, due to regulatory limits on the quantity dispensed per visit and the short duration of medication coverage, patients must return frequently for follow-up visits and prescription renewals.

It must be acknowledged that offline hospitals have adopted a relatively patient-centered approach to meeting the needs of these patients, thereby implementing targeted measures—namely, the establishment of specialized outpatient clinics for follow-up visits and medication refills. In this model, one or two consultation rooms are reserved exclusively for chronic disease patients who require long-term medication, have relatively stable medication regimens, possess clear and well-documented medical histories, and have existing treatment records at the hospital. A streamlined process is adopted, whereby prescriptions are issued after a brief inquiry. Such “Follow-up and Prescription Renewal Outpatient Clinics,” which serve as convenient services for the public, have been in place for a considerable time in some Grade 3A hospitals in Beijing. They operate entirely within regulatory compliance and are not part of any gray area; indeed, patients can explicitly select this service through Beijing’s “Jing Yi Tong” convenient healthcare platform.

Therefore, it is not difficult to see that those who “match medications to symptoms” online inevitably include, and are likely predominantly, patients seeking prescription refills for chronic diseases. Most of these patients are middle-aged or elderly individuals (or their children, relatives, and friends acting on their behalf). Their actual circumstances result in clear and precisely targeted demands for specific drug types and brands. Online follow-up consultations, prescribing, and medication purchases are significantly more convenient than repeated hospital visits for prescriptions, saving both time and money. This demonstrates the distinct advantages of online pharmaceutical sales in terms of convenience and accessibility. As China gradually transitions into an aging society, the broad reach of the beneficiary population appears unquestionable.

Given the clear positive social benefits on one hand and the obvious loopholes and risks on the other, how should we make our choice? The author believes that this issue should be examined comprehensively with a rational and constructive perspective.

From a legal perspective, the online sale of prescription drugs is legally grounded. On August 26, 2019, China passed the newly revised Drug Administration Law, which established the core principle of “consistency between online and offline operations” for the online sale of prescription drugs, requiring that entities engaged in online drug sales must be licensed brick-and-mortar enterprises. Furthermore, the Drug Administration Law specifies categories of special drugs prohibited from online sale and explicitly mandates the availability of medications for chronic conditions eligible for long-term prescriptions, thereby providing both legal principles and baseline requirements for online drug sales.

Therefore, the author believes that since the law has established a baseline for the online sale of prescription drugs, in addition to continuing to uphold this baseline, relevant processes should be proactively improved and strengthened to achieve a relatively optimal solution that maximizes social benefits and minimizes social risks.

First, since the law explicitly stipulates that, under current regulations, internet-based medical services are limited to “follow-up consultations for certain common and chronic diseases,” internet health platforms must strictly operate within this scope. They should fully leverage advanced industrial internet technologies—such as patient identity verification, recognition of follow-up consultation behaviors, access to prior prescription records, and medication risk assessment—to harness the power of the internet and big data. This will enable precise targeting of the appropriate patient population and ensure the provision of lawful and compliant services.

Certainly, the comprehensive implementation of this approach requires certain prerequisites. For instance, it is necessary to continue exploring whether there is a contradiction between the sharing of patients’ medical records and privacy protection, and where the boundaries lie.

Undoubtedly, from a developmental perspective, it is essential to strengthen the digital infrastructure, integration, and governance of medical institutions, online pharmacies, and brick-and-mortar pharmacies across society. This will facilitate the electronic and digital circulation and supervision of medical records and prescriptions, while enhancing regulatory compliance in the workflows of online healthcare practitioners. Such measures will ensure that the “precise matching of patients with chronic diseases requiring follow-up consultations and prescription renewals” is effectively implemented not only legally but also technically. The author believes that emerging technologies such as AI and big data will play a significant role in these areas.

Furthermore, to prevent the recurrence of various irregularities uncovered in journalistic investigations, it is essential to strengthen relevant regulatory frameworks and industry self-discipline, and to implement refined, tiered, and categorized management. This approach should ensure the normal operation of internet-based online diagnosis and treatment and pharmaceutical sales that are reasonable, lawful, and yield positive social benefits, while applying varying degrees and methods of oversight tailored to specific diseases, medications, and scenarios.

Specifically, for prescription drugs that are reasonable, lawful, and offer clear universal benefits, processes should be further streamlined to allow online sales channels; for those with significant risks of misuse and abuse, red lines must be established and strict controls enforced—this is beyond doubt.

Therefore, regarding the phenomenon of “matching medications to symptoms,” it is generally advisable to guide patients to seek initial diagnosis at offline medical institutions to accurately assess their condition and prescribe appropriate treatment. Subsequent online follow-up consultations and prescription renewals can then be arranged as needed. For patients with chronic diseases who present clear clinical features and meet established criteria, greater efforts should be made to ensure they fully benefit from the convenience offered by internet-based healthcare services.

In fact, as the “Internet + Healthcare” model is increasingly implemented, several positive variables have become evident. For instance, advanced computing technologies are accelerating drug research and development; online consultations via the internet transcend temporal and spatial constraints, enabling more efficient distribution of medical resources—particularly high-quality ones—thereby amplifying the benefits of healthcare accessibility and making pricing for medical services and pharmaceutical sales more transparent. This also demonstrates that applying the internet to public governance and social services yields significant and irreplaceable incremental value. We should fully safeguard and guide the positive role of this emerging force, ensuring that technology serves society to its fullest potential.