[The Future of Telemedicine ③] "Consultation at Home, but No Medication Delivery?"... A 'Half-Finished' System

Consultation Completed in Two Minutes, but Medication Delivery Not Allowed
"Delivery Blind Spots" Created by Amendments to the Medical Service Act

Editor's NoteWe are now in an era where, instead of standing in long lines in hospital waiting rooms, people can consult with a doctor on their smartphone screens. Telemedicine, which was temporarily allowed during the COVID-19 pandemic and during periods of conflict between the medical community and the government, and later implemented as a pilot program, is set for full-scale adoption at the end of this year. While telemedicine offers the convenience of bridging medical gaps for remote areas and vulnerable populations, it also faces limitations due to the prohibition of medication delivery, as well as concerns about misuse of pharmaceuticals. Divergent views persist among the medical community, platform companies, and patient advocacy groups. As the healthcare industry faces this major paradigm shift, we take an in-depth look at how telemedicine is transforming medical practice in Korea and analyze the key challenges that must be addressed for genuine innovation.

#Park Mijeong (alias, age 45), an office worker, did not have time to take her child, who was suffering from a runny nose and sneezing, to a hospital. Instead, she used her lunch break to request a telemedicine consultation. From her office in Yeouido, Seoul, she accessed a telemedicine platform app, checked user reviews, and registered for a consultation at a pediatric clinic in Songdo, Incheon. Within two minutes, she received a phone call. The doctor asked how long the child had been experiencing symptoms, when the runny nose was most severe, and whether there was a sore throat or fever. After a one-minute conversation, the doctor prescribed a five-day supply of allergy medication.

However, picking up the medicine after work proved to be challenging. She submitted the prescription to Pharmacy A near her home, but soon received a message requesting a "pharmacy reselection." She then tried Pharmacy B, but again, the prescription was not accepted. Fortunately, Pharmacy C, her third attempt, informed her that they would fill the prescription with a different brand containing the same active ingredient and accepted the order. When asked why the prescription was not accepted, Pharmacy A said, "We do not have the medication in stock," while Pharmacy B explained, "We had too many customers at that time and could not handle additional prescriptions." Park sighed, saying, "Consultations have become easier, but obtaining medication is still the patient's responsibility."

#Kim Suhee (alias, age 38), who lives in Incheon, consults with a doctor about once a month through the telemedicine platform "Doctor Now." She has a level 2 physical disability (cerebral palsy) and frequently needs painkillers for recurring leg pain. Recently, she also started taking hypertension medication. Since she has difficulty moving without a cane, telemedicine is especially safe for her during cold weather and when roads are slippery, as a fall could result in serious injury. She applies for a consultation via a smartphone app, receives a phone consultation from a doctor, and sends the prescription to a nearby pharmacy, where the medication is delivered to her home by motorcycle courier.

Kim explained, "Although I usually see the same doctor through telemedicine, if the timing does not work or the clinic is not accepting appointments, I check app reviews and select a new internal medicine or orthopedic clinic for my consultation. For medication, I choose a pharmacy that accepts telemedicine prescriptions and is close to my home, and I pay about 8,000 won for delivery." To receive medication delivery services, Kim submitted her disability registration certificate in advance through the platform.

Although telemedicine has now entered the formal healthcare system, there is ongoing criticism that it remains a "half-finished service." While the convenience of consultations has improved, the most requested feature-medication delivery-remains prohibited by law.

Ms. Park Mijeong submitted her child's prescription through a telemedicine platform, but after two pharmacies consecutively refused the prescription, she received a KakaoTalk message requesting a "pharmacy reselection."

Currently, after a telemedicine consultation, patients are required to visit a pharmacy in person to receive their medication. As seen in Park's case, it is common for pharmacies to refuse to fill prescriptions or for patients to be turned away due to a lack of medication. An industry insider commented, "Many people cannot get their medication after receiving consultations at night or on holidays because they cannot find an open pharmacy. From consultation to medication, it is all part of the treatment process, but if delivery is blocked, telemedicine becomes meaningless for users (patients)."

On the other hand, some, like Kim, directly benefit from medication delivery. The amended Medical Service Act allows medication delivery only in areas designated by the Ministry of Health and Welfare for residents of islands and remote areas, long-term care recipients, registered persons with disabilities, patients with infectious diseases, and those with rare diseases. However, most users, such as regular office workers or parents with young children, remain excluded from delivery services.

This is why some argue that the success or failure of telemedicine institutionalization depends on whether medication delivery is fully expanded. The main reason for using telemedicine is physical distance or mobility issues, so if patients still have to visit pharmacies to get their medication, can this truly be considered telemedicine? In a survey released by the Remote Healthcare Industry Council in November last year, 37.7% of respondents cited the approval of medication delivery as an urgent policy task.

However, strong opposition remains from groups such as the Korean Medical Association and the Korean Pharmaceutical Association. The pharmaceutical association argues, "If medication is altered, lost, misused, or causes side effects during delivery, it is unclear who is responsible. If face-to-face medication guidance is omitted, patient safety cannot be guaranteed." In response, the platform industry maintains, "It is technically possible to control these issues," and insists that "regulations should be relaxed with public convenience as the top priority."

However, even for Kim, who has a disability, only in-person consultations are possible when using general hospitals rather than local clinics. This is because her disability requires regular check-ups such as imaging at rehabilitation medicine departments, and opioid painkillers for severe pain can only be prescribed at tertiary hospitals.

The government has indicated that it may establish detailed standards for limited medication delivery, but significant differences among stakeholders suggest ongoing difficulties. For now, it appears that further discussions will take place after the full-scale telemedicine program is launched at the end of this year and the effectiveness and limitations of medication delivery are evaluated.