Online pharmacies have been warned they can no longer prescribe ‘high-risk’ medicines and weight loss drugs based solely on information given by potential customers in website questionnaires.

The updated guidance from the General Pharmaceutical Council has been broadly welcomed by the Royal Pharmaceutical Society and the National Pharmacy Association. Questionnaire-style prescribing should never become the norm, particularly for prescription-only medications and those with additional risk factors, the RPS said. The NPA said it is important to note that the vast majority of pharmacies, including online sellers, already adhere to good practice in this area. 

The GPhC, which published the guidance on February 4 following a consultation on draft proposals that were unveiled last September, told online pharmacies that they must beef up their safeguarding processes following numerous cases involving “unsafe prescribing”.

The announcement comes a day after the publication of a Sussex coroner’s report that found an online questionnaire helped a woman with a history of overdoses access a fatal quantity of prescription medication.

From now on, when a member of the public requests a high risk medicine – which can include those posing a danger of harm or fatality if taken in an overdose as well as weight management drugs – the prescriber must do one of the following:

• Speak to the patient by phone or video call         
•  Access their clinical records         
•  Contact the patient’s GP, usual prescriber or a third-party provider.

In the case of weight loss medicines, this means online prescribers must independently verify a person’s weight and/or BMI before making the decision to prescribe.

The guidance states that in all cases of online prescribing there must be ways for the patient and prescriber to speak with one another to discuss possible treatments and make informed decisions.

Other changes to the guidance include:

• Making superintendent pharmacists jointly responsible (with pharmacy owners) for ensuring online pharmacies meet the guidance
• Emphasising that businesses must follow all relevant laws around the advertising or promotion of medicines
• Providing steps for companies to follow when a patient says they do not have a regular prescriber or GP
• Clearly setting out companies’ responsibilities when working with third-party prescribing services.

The consultation revealed strong support for these steps, with 69 per cent of sector stakeholders and 94 per cent of patients agreeing they would improve patient safety.

The regulator says it is writing to online pharmacy owners, superintendent pharmacists and employed pharmacists and technicians to ask them to review the guidance and ensure they have understood it.

GPhC chief Duncan Rudkin commented: “The message of this updated guidance is clear: online pharmacies should only supply a medicine if the prescriber has had an appropriate consultation with the person and has made sure they have all the necessary information to check if that medicine is safe and suitable for them.

“For high risk medicines, online pharmacies need to put even more safeguards in place, including always verifying the information provided by the person before supplying that medicine.

“We know online pharmacy services can provide a valuable service, but through our inspections and investigations, we’ve seen too many cases of medicines being supplied inappropriately online and putting people at risk. This updated guidance will support online pharmacies to protect their patients, and we expect them to act now to make sure these safeguards are in place.”

Mr Rudkin said GPhC inspectors will continue to visit online pharmacies to assess whether they are meeting the regulator’s standards. 

The Royal Pharmaceutical Society has welcomed the updated guidance. RPS president, Professor Claire Anderson, said: “We fully support these safeguards to ensure safe prescribing practices and reduce risks associated with online supply of medicines. The inclusion of measures to ensure prescribers independently verify information provided by the patient, and weight loss medicines being added to the list of high-risk medicines, is a key step toward protecting patient safety.

“We are pleased that the GPhC has reinforced the importance of a two-way interaction between patients and prescribers. Online consultations should be as thorough and robust as in-person consultations to ensure that patients receive appropriate treatment. 

“Questionnaire-style prescribing should never become the norm, particularly for prescription-only medications and those with additional risk factors.”