Rakesh Joshi was prescribed a daily medication regimen: a 500 mg tablet for diabetes after breakfast, another one for high blood pressure after three hours, a pill for his heart after lunch and, just before hitting the sack, another dose for diabetes.What seemed like a straightforward course didn't turn out to be quite that. Reason: the 40-year-old techie would inevitably miss out on at least one of the four pills due to his hectic schedule. "I wouldn't even remember which pill I forgot," he recalls. The stress only added to his blood pressure.What came to his rescue was not the friendly-neighbourhood (and cramped) chemist outlet but its online counterpart: Netmeds , an online pharmacy marketplace that boasts over 5 lakh users. Now Joshi gets regular dosage alerts and, for good measure, regular refills.It's the convenience, ease and comfort of placing an order from a mobile — quite akin to ordering a pizza or a burger — which are driving a bunch of pharmacy startups to try their luck in hooking consumers to order medicine online.What is at stake is a huge pie: the Indian pharmaceutical market was valued around Rs 98,000 crore in 2015, and online pharmacies are expected to capture 5-15% of total pharma sales over the next few years, according to industry body Ficci's white paper on epharmacies . No wonder, over 60 epharmacy startups have mushroomed in India in 2014 and 2015, according to Xeler8, a market intelligence platform for VCs and corporates. The tempo continued this year: 11 have been founded in the first eight months, with most of them getting heavily funded at a time when investors have tightened the purse strings.Take, for instance, Netmeds, which was founded in June 2015 and has raised $60 million so far, including the last funding round of $50 million in October 2015. The Chennai-based online pharmacy marketplace claims to have a pan-India reach, eight fulfilment centres in cities such as Delhi and Raipur, 15 pharmacists who vet each prescription before shipping medicines, and an average ticket size of Rs 1,650. Founder Pradeep Dadha stresses that Netmeds does not sell habit-forming drugs even with a prescription.So how does the online pharmacy model work? It's simple, says Dadha. Customers go to the webpage or Netmeds app, and upload their prescriptions through email or WhatsApp. Once the prescriptions are received, they are vetted by pharmacists. These are then digitised, and the orders are encrypted and transmitted electronically to fulfillment centres where they are decoded, packed and shipped. Every order is digitally timestamped and filmed to preserve a record of exactly what went into every package, claims Dadha. Consumers can speak to customer service agents and pharmacists via voice over internet protocol and chat, they get push notifications and text messages on their mobiles, and messages on Facebook and Twitter.Another value addition that startups like Netmeds offer is a prediction based on artificial intelligence: it tells when the drug refill is due and notifies the customer to ensure they never run out of medicine. "We are building our brand as India ki pharmacy," says Dadha.Netmeds may not be the only epharmacy with that ambition. PharmEasy , a Mumbai-based pharmacy aggregator, is also banking on delighting consumers to widen its appeal. Apart from dosage reminders and medicine refill services, the startup provides diagnostic test suggestions depending on the medicines that a consumer orders. For example, a diabetic patient gets a suggestion to have a lipid profile test done every 60 days, says Dharmil Sheth, cofounder, PharmEasy.Started in March 2015, the startup has raised $5 million, is present in 10 cities, claims to have over 1 lakh users booking medicine through its app every 45 days and does an average ticket size of around Rs 1,500. "We want to be a one-stop solution for the healthcare needs of a patient," says Sheth, adding that the startup has also launched a service for aggregating pathology labs for diagnostic tests.What sweetens the deal even more for the consumers, says Sheth, is the discounts offered: a flat 20%. And what also adds to the credibility is that no substitute medicines are offered or suggested. "We are now India's leading online pharmacy aggregator in terms of volumes," claims Sheth.Investors have been quick to spot the potential in epharmacies. "It's like a prepaid mobile recharge," says Amit Somani, managing partner at Prime Venture Partners , an earlystage investment fund based out of Bengaluru. You have to recharge it once you run out of balance. Similarly, a consumer with a chronic ailment will have to keep buying medicines as long as she is alive, he says. "So business potential is immense."Take, for instance, cardiovascular diseases. Currently, about 2.7 million people die due to cardiovascular diseases in India and the toll is likely to increase by 1.5 million by 2030, according to the Ficci paper. Estimates also suggest that there are about 30 million coronary heart disease (CHD) patients in the country, with 14 million in rural and 16 million in urban areas. The prevalence of CHD in people above 20 years ranges from 6.6% to 12.7% in urban India and from 2.1% to 4.3% in rural India. During the past few decades, prevalence of CHD has increased almost fourfold in rural areas and sixfold in urban areas.An explosion of another chronic disease, diabetes, makes the online pharmacy model more relevant. While there are an estimated 65 million people with diabetes in India, the numbers are projected to jump to 109 million by 2035. Rising hypertension will also add to business. There are 20-40% adults in urban areas and 12-17% in rural areas who suffering from it and it's projected to go up from 118 million in 2000 to 213 million by 2025.Another factor boosting the prospects of epharmacies is a steady rise of nuclear families. A report by BCG in 2015 estimated that more than 200 million households will have nuclear families by 2020. A rapidly ageing population, which curtails mobility, will also push online ordering. The share of individuals aged above 50 is projected to increase from 16% (roughly 190 million) in 2014 to 31% (approximately 506 million) by 2050. And those above 60 will grow from 8% to 18% of the total population during the same time.It was perhaps this eye-popping opportunity that led Phaneesh Murthy to roll out his online pharma startup Zigy last September. The former CEO of IT services firm IGATE raised Rs 40 crore, started retail operations in five cities, including Bengaluru, and bagged over 1,000 orders on opening day."Zigy started with a bang but it soon faced roadblocks," says Hemant Bhardwaj, cofounder of Zigy, which recently scaled down operations. It now delivers to consumers only in Bengaluru, and services its institutional orders in Bengaluru, Mumbai, Chennai, Hyderabad and Delhi.What went wrong? Bhardwaj says potential investors got sceptical due to the noise level against the online pharma players and lack of clarity on the regulatory front. While in October, Zigy had to pull back its advertising due to stiff opposition from brick-andmortar players, it was dealt a near fatal blow when it faced cancellation of its partner’s licence in Bengaluru in December 2015. "This affected business performance," says Bhardwaj. While the founding team at Zigy thought they would be able to raise the next round of funds without any hiccups, it was not the case. The company was left with no option but to conserve cash to run its operations, he adds. "Zigy is like a powerful vehicle that got stranded due to lack of sufficient fuel," shrugs Bhardwaj.For epharmacies, the going might become tough as they face strong headwinds. Leading the charge against them is All Indian Origin Chemists & Distributors (AIOCD), the country's largest organisation of chemists and distributors with over eight lakh members, which has been seeking a ban on epharmacies. The concerns, says its president JS Shinde, are not just business losses. "Online sale of medicines is hazardous to public health," he says, adding that the tech-savvy young generation may have done irreparable damage.Shinde spells out his apprehensions: illegal trafficking of drugs, counterfeits, drug abuse especially of prescription drugs and a potential monopoly in the long term of epharmacies as they kill offline players by offering heavy discounts.Shinde is battling the online sector armed with a white paper by the Indian Medical Association. It states that while an online pharmacy sounds convenient — no waiting in queues, no rushing to the pharmacy before it shuts, easy placing of order and delivery at doorstep — the ease and comfort come at a price. "Not only could there be financial implications for patients, but their safety may be endangered at times," it states.The paper says that there are no well-defined laws for online pharmacies; pharmacies in India continue to be governed by the Drug and Cosmetics Act 1940, Drugs and Cosmetic Rules 1945, Pharmacy Act 1948 and Indian Medical Council Act 1956. "Online availability of prescription drugs will violate provisions of various acts," it adds. It concluded that the online pharmacy has no public health benefits or implications. "At the same time it is loaded with scope for misuse, drug abuse, dependence and adverse reactions," it pointed out.Mohammed Abubakr, cofounder of Hyderabad-based BookMEDS, rubbishes such allegations. "Online pharmacies make it exceptionally hard for drug abuse," he says, adding that the online business model is such that it tracks all information about customers and doesn’t deliver medicines without prescription.Let's think from a potential drug abuser's point of view, says Abubakr. Why would any drug abuser authenticate his phone number, provide address for delivery and share a fake prescription that can be easily tracked, he wonders. On the contrary, says Abubakr, an abuser will simply go to a pharmacy that doesn't ask for prescription, doesn’t collect information and get his stuff.Abubakr contends that threat of epharmacies is being falsely created by certain pharmacy associations, especially those complicit in selling fake medicines and failing to maintain proper customer records. "They feel threatened that their fraud business will be exposed," he says. In fact, online pharmacies are a solution to tackle the menace of fake medicines in India, he adds.If Abubakr's staunch defence of epharmacies sounds a bit filmi, don't blame him. The 30-year-old wanted to change the narrative of Bollywood scenes with his startup Book-MEDS. Movies are replete with scenes where doctors arrive at home to check on patients, he says. "If doctors can come home, why can't medicines?" he asks. The entrepreneur reckons that online players are not villains out to kill the brick-and-mortar ones. "Local chemists are not our rivals but our partners," he says.While Abubakr might be talking about partnership, Yogesh Agarwal of CareOnGo practises it. India's first mobile chain of cobranded pharmacies provides a full-stack solution to the pharmacy retailer to manage procurement using an app called Instastock; inventory management using technology product Pharmalytics and an enterprise resource management tool called CareSol. "Our target consumers are micro or standalone pharmacy owners who have been running their stores in a traditional way," says Agarwal, adding that there are over 8 lakh pharmacies in India, with more than 95% being unorganised.For Delhi-based BigChemist, which follows a hybrid model of online and offline stores, the real issue is not online versus offline. "There are no defined regulations," says Puneet Kapoor, cofounder of BigChemist. What is required is more clarity on the framework under which the epharmacies should operate, he adds. Kapoor contends that regulatory clarity will help epharmacies in refining and stabilising their business model.The government, for its part, is likely to come up with a set of guidelines for epharmacies by year-end. S Eswara Reddy, joint drugs controller at Central Drugs Standard Control Organisation, recently hinted at government backing epharmacies. "(Epharmacy) has the potential to provide proper digital tracking of medicine sales, prescriptions, prescriber's information...thereby reducing the problems of counterfeit medicines and their abuse," he reportedly said at an event organised by Ficci in July. He pointed out that amendments to the drug laws are in the offing and a "negative list", specifying the drugs that epharmacies can't be allowed to sell, would also be added.Ficci recently came up with a white paper on epharmacies, emphasising that widespread use of the internet will improve accessibility and affordability of medicines. Clearly, a set of regulations is just the booster dose epharmacies in India need.