Government push to expand delivery to all patients draws mass protest from pharmacists

Patient groups call half-measures inadequate, urge delivery with safeguards

Ministerial divisions and legislative hurdles cloud path forward

Participants hold placards at the National Pharmacists' Rally held in front of the Dongwha Duty-Free store in Jongno-gu, Seoul, on Sunday. [Yonhap]
Participants hold placards at the National Pharmacists' Rally held in front of the Dongwha Duty-Free store in Jongno-gu, Seoul, on Sunday. [Yonhap]

Tensions in the healthcare community over how prescription drugs should be delivered to patients are reaching a boiling point ahead of the Dec. 24 implementation of a revised Medical Act that formally institutionalizes telemedicine.

The government's announcement that it intends to expand home delivery of prescription drugs — following telemedicine consultations — to all patients has set off a three-way collision: pharmacists alarmed by the risk of drug misuse and the commercialization of healthcare, patient and consumer groups demanding broader access to treatment, and platform companies calling for dialogue on safety measures.

A debate that has dragged on for more than 15 years has now moved beyond the question of remote consultations themselves to the final step in the care chain: getting medication into patients' hands. Earlier attempts to introduce telemedicine were beaten back by fierce opposition over fears of healthcare commercialization. The COVID-19 pandemic eventually pushed telemedicine past the legislative threshold, but the question of how patients receive their prescriptions after a remote consultation has now detonated a fresh crisis in the healthcare sector.

Under the revised Medical Act, home delivery of prescription drugs after a telemedicine visit is limited to a narrow set of patients — those living on islands, in mountainous areas or remote regions, recipients of long-term care benefits, registered people with disabilities, patients with infectious diseases, and those with rare conditions. But the conflict intensified in August, when the Office for Government Policy Coordination, the Ministry of Health and Welfare and the Ministry of SMEs and Startups announced through a public-private consultative body that they would review expanding delivery to all patients.

The Korean Pharmaceutical Association rejected participation in the consultative body and launched a street campaign. On Sunday, the association held a national rally at Gwanghwamun in Seoul, drawing an estimated 10,000 people by the organizers' count, and called on the government to scrap the policy. Korean Pharmaceutical Association President Kwon Young-hee said the government was "moving to change a law that has not even taken effect yet, in order to sustain the revenue model of specific platform companies — without proper statistics, assessments, safety measures or systems in place," adding that "the lives and safety of the public are not fodder for private platforms." Kim Baek-geon, chairman of the Korean Association of Pharmacy Students, asked: "If drugs are contaminated or mixed up with someone else's medication inside a profit-driven private delivery network, who will be held responsible?"

Patient and consumer groups pushed back, arguing that telemedicine without drug delivery is meaningless. The Korea Consumer Federation, the Korea Patients' Association, Consumers Korea and the Korea Alliance of Rare Disease Organizations said on Sept. 9 that "telemedicine is only complete when it includes the receipt of medication," and urged the government and the National Assembly to "institutionalize telemedicine and drug delivery together to guarantee consumers' right of access to medical care and medicine." The groups pointed out that people who genuinely need delivery — elderly patients with limited mobility and severely ill patients for whom leaving home is dangerous — are excluded from the law's five designated categories. Even so, the groups also called on the government and the Assembly to "design a safe delivery system and strictly regulate unfair inducement and referral practices by platforms."

The Remote Healthcare Industry Council, representing the industry, proposed dialogue. Co-chair Lee Seul said pharmacists and technology companies should "put all the issues on the table together — misdelivery, drug degradation, medication guidance and identity verification — and find solutions jointly," and asked the pharmaceutical association to join in designing a safe home-delivery system.

The calculations within the government and in political circles are equally tangled. The Office for Government Policy Coordination and the Ministry of SMEs and Startups have taken an active stance in favor of full expansion, while caution is detectable inside the Ministry of Health and Welfare, the ministry with primary jurisdiction. The ministry's position is that expanding delivery to all patients would require additional legislation, making a full rollout simultaneous with the December implementation difficult. Observers inside and outside government say the ministry may move to slow the pace, taking into account the pharmaceutical association's concerns and safety issues.

The National Assembly also appears inclined to prioritize the principle of "limited drug delivery" agreed upon during the institutionalization process. The Assembly recently passed at a plenary session an amendment to the Pharmaceutical Affairs Act restricting telemedicine intermediaries from entering the drug wholesale business — informally known as the "Doctor Now Prevention Act" — signaling that the public interest dimension of drug distribution and the need for safety mechanisms have emerged as the central legislative issues. It is likely to take considerable time before the government's plan to expand drug delivery translates into actual legislation.


silverpaper@heraldcorp.com