The research team followed the six-stage scoping review framework originally proposed by Arksey and O’Malley, a method designed to map the breadth of a heterogeneous evidence landscape rather than to produce a single pooled estimate. They systematically searched five major databases, PubMed, Scopus, Embase, Web of Science, and Google Scholar, for studies published between 2015 and June 2026. The search initially surfaced 496 records, which the team screened against explicit eligibility criteria. Thirty-seven studies survived the process and formed the analytical corpus. Because scoping reviews of this kind rely on published literature and involve no human participants or identifiable data, the study did not require ethics approval or informed consent.

To make sense of the 37 included studies, the authors applied the framework analysis approach developed by Ritchie and Spencer, a qualitative technique that allows researchers to chart data against predefined themes while remaining open to emergent categories. The charted findings were then organized according to a SWOT framework, the classic strategic planning matrix that classifies factors as strengths, weaknesses, opportunities, and threats. This two-step method, qualitative synthesis followed by strategic categorization, is what distinguishes the study from earlier narrative reviews of internet-based pharmaceutical services, which often catalogued benefits and risks without translating them into actionable strategy.

On the strengths side of the matrix, the review found that online pharmacies offer several concrete advantages for patients and health systems. They can lower indirect costs, the transportation, time, and productivity losses that patients incur when traveling to physical pharmacies, a burden that falls disproportionately on people with chronic conditions requiring regular medication refills. They improve access to pharmaceutical services for populations in remote or underserved areas, and they enhance medication management through digital tools such as automated refill reminders, electronic prescription records, and medication histories that travel with the patient across providers. Taken together, these strengths suggest that well-implemented online pharmacy services could serve as an important complement to conventional health systems rather than a replacement for them.

The weaknesses column, however, is substantial. The review highlights digital inequalities as a persistent barrier: patients without reliable internet access, digital literacy, or smartphones risk being excluded from services that increasingly function as gateways to care. Logistical constraints, including cold-chain maintenance, last-mile delivery in rural regions, and the operational complexity of verifying prescriptions remotely, further limit where and how online pharmacies can operate safely. Cybersecurity concerns round out the weaknesses, since these platforms handle sensitive health data, payment information, and prescription records that make them attractive targets for attackers. Any national strategy for online pharmacy implementation, the authors argue, must confront these structural deficits directly rather than assuming market forces will resolve them.

The opportunities identified in the review point toward a more integrated digital health ecosystem. The convergence of online pharmacies with telemedicine allows a clinical consultation, prescription, dispensing, and delivery to occur within a single digital pathway, reducing fragmentation of care. Emerging regulatory frameworks in multiple jurisdictions are creating legal space for legitimate internet pharmacies to operate at scale, while the adoption of innovative technologies, most notably artificial intelligence, promises advances in demand forecasting, drug interaction checking, personalized medication counseling, and fraud detection. These technological and regulatory currents, the review suggests, are converging at a moment when health systems worldwide are actively searching for ways to expand pharmaceutical access without proportional increases in physical infrastructure.

The threats column carries the gravest warnings. Regulatory gaps remain the dominant concern: in jurisdictions without robust licensing and verification regimes, illegitimate operators can sell medicines without prescriptions, exposing patients to substandard and falsified products. Counterfeit medicines are a related and well-documented danger, with falsified versions of everything from antibiotics to oncology drugs circulating through unregulated online channels. The review also flags self-medication as a threat amplified by easy online access, since patients may obtain prescription-only drugs without clinical oversight, delaying diagnosis and increasing the risk of adverse drug interactions and antimicrobial resistance. Finally, financial sustainability challenges threaten even well-intentioned platforms, as reimbursement models in many health systems have not adapted to remunerate digital pharmaceutical services on par with in-person dispensing.

From this four-quadrant analysis, the authors identified eleven implementation strategies intended to support the safe and sustainable development of online pharmacy services. While the abstract does not enumerate each strategy individually, the study’s framing makes clear that they span the domains the SWOT matrix exposed: coherent policymaking to close regulatory gaps, investment in digital and logistical infrastructure to overcome weaknesses, deliberate integration with telemedicine and novel technologies such as artificial intelligence to capture opportunities, and safeguards against counterfeit medicines, unsafe self-medication, and unsustainable financing models. The strategies are presented as an operational toolkit for governments, regulators, and health system managers weighing whether and how to authorize or expand internet-based pharmaceutical services.

The study’s conclusions are cautiously optimistic. Online pharmacies, the authors write, have the potential to serve as an important complement to health systems by reducing indirect patient costs, may contribute to improving equity in access to medicines, and can enhance the quality of pharmaceutical services. But the conditional clause matters: realizing this potential requires coherent policymaking, sustained investment in infrastructure, and the adoption of novel technologies. In other words, the benefits documented across the 37 studies are not automatic; they depend on governance choices that most health systems have not yet made. The review’s SWOT-based framework is offered precisely as a decision aid for those choices, giving policymakers a structured way to weigh local strengths and weaknesses against global opportunities and threats.

The research was supported by Baqiyatallah University of Medical Sciences in Tehran, Iran, and the authors declare no competing interests. The team notes that during manuscript preparation they used Google Gemini, ChatGPT, and NotebookLM solely to improve readability, grammatical accuracy, and organization of the English translation, with no role for these tools in data extraction, analysis, interpretation, or the generation of scientific conclusions, and that the authors reviewed, revised, and approved the final manuscript and take full responsibility for its content. Published open access in BMC Health Services Research, a journal in the Springer Nature portfolio, the study arrives as online pharmacy use continues to climb worldwide in the wake of pandemic-era acceleration of digital health services. For regulators, the message is that the window for proactive strategy is open now: the evidence assembled here suggests that the difference between an online pharmacy sector that widens access and one that endangers patients lies less in the technology itself than in the regulatory, infrastructural, and financial architecture built around it.

Subject of Research: Strategic SWOT-based analysis of online pharmacy implementation in health systems

Article Title: Strategic analysis of online pharmacy implementation: a scoping review and SWOT-based framework

Article References: Zaboli, R., Jajarmizadeh, A., & Boojar, M. M. A. (2026). Strategic analysis of online pharmacy implementation: a scoping review and SWOT-based framework. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15835-x

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15835-x

Keywords: online pharmacy, digital health, scoping review, SWOT analysis, health services research, telemedicine, counterfeit medicines, regulatory frameworks, cybersecurity, medication access, artificial intelligence, health policy