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Where disappear the medications

Куда исчезают лекарства

In the regions of failure of tenders for purchase of medicines for beneficiaries and hospitals in the Network write that some drugs were missing from pharmacy shelves.

Russians in social networks and forums say that pharmacy has gone prednisone, included in the list of essential drugs (EDL). Also, the media report on the shortage in the pharmacy networks of vaccines against rabies and tetanus, insulin, immunoglobulin against tick-borne encephalitis and other drugs. However, since the beginning of the year in Russia fell by almost a third of the tenders for the procurement of drugs for clinics and hospitals, as well as for beneficiaries who are prescribed medications receive for free. Some positions noted in the “Газете.Ru” coincided with those that disappeared from pharmacies. In this list, the magazine says that the rabies vaccine, insulin, and prednisolone. In a number of regions was disrupted bidding for the purchase of medicines for cancer patients.

Where does the drugs and in such a situation, do the patients, “Rosbalt” asked the experts. According to the Director General of the Association of Russian pharmaceutical manufacturers (ARPM) Viktor Dmitriev, the fact is that today the prices of medicines regulated by the state. “And they are regulated at such a low level that their production and sale are not just not profitable, and unprofitable. Respectively, of the company or suspend the release, or not release drugs in the pharmacy network, because the losses no carry not want it,” he said.

“With regard to public procurement, the reason for their failure has become the current Ministry of health order No. 781 — about the so-called initial maximum price contract. When the price of the contract at 80% below cost, for tender no go. I call it non-initial maximum, and sad maximum price. While the situation does not change, the tenders will be broken, because there is a threshold of profitability and there is a loss. Debts due to the state policy to get no one wants. We wrote about it and talked. The Ministry of health was a meeting which proposed an alternative order which would establish not a minimum, as the reference price, which is average within the same international nonproprietary names,” — said Dmitriev.

In fairness I should add that about possible problems with medicines, “Rosbalt” wrote back in April of this year, and even then the head of the ARPM raised the issue of price regulation and warned of possible disruptions.

But despite the fact that the problem was known in advance, avoid them failed. Regions announced tenders for the purchase of medicines, manufacturers they did not. According to the Director of the Institute of health Economics HSE Larisa Popovich, in this case, health officials should announce another tender, slightly raising the initial price. But the pharmaceutical companies again refused to participate in the bidding, procurement went into a new cycle. And since the tenders in the procedure is not fast, the whole story started to become dangerous.

“Unfortunately, some management decisions at the Federal level has led to the fact that the initial maximum contract price may not satisfy the interests of producers. Objectively, it turns out that the more they sell, the more they loss. Those prices which are declared on the auctions of organizers of trading, not satisfied with manufacturers. They often do not reflect even the cost of production, logistics and distribution. But we still need to understand that all manufacturers and suppliers are still a commercial organisation, not a charity funds. They can’t operate at a loss. Unfortunately, we now fix problems, even in prosperous regions. For example, in Moscow there is one of the most common drugs for the treatment of breast cancer, although the drug produced a huge number of companies, including domestic ones. There are a number of regions where there took place the purchase of more expensive drugs, which are also already available in Russia. The result undermined the efforts of the Ministry of industry on the revival and reconstruction anew of the pharmaceutical industry. Invested huge funds in the framework of the “Strategy 2020″, and not only the public but also means owners of pharmaceutical companies. But they can’t afford to produce drugs at a loss. And it turns out that doctors prescribe medications, but patients are unable to outfit their preferential recipes in pharmacies because the health authorities of drugs are not purchased”, — said the Chairman of the Executive Committee of public organization “Movement against cancer”, member of the public Council under the Russian Ministry of health Nikolay Dronov.

Individual health organizations — health clinics and hospitals — are also deprived of the opportunity to organize the purchase, because they also have to follow the order of the Ministry of health on determining the initial maximum contract price, and for these purchases, no one is, the expert added.

According to him, recently, the government has allocated an additional 70 billion rubles for the purchase of anticancer drugs in hospitals and day care. “The amount is comparable to the volume of the market of anticancer drugs three years ago. And this money is already being used. But doing this is difficult — again due to the fact that the auctions are broken,” — said the expert.

“As for the disappearance of drugs in pharmacies, it has long paid attention manufacturers: there are drugs, production of which is unprofitable. Here, too, need some decisions at the state level, to allow pharmacies to have a minimum range of medicines,” — said the drones.

According to Popovic, the minimum required range that must be in every pharmacy, established by the legislation. This is a medication from the list of vital and essential drugs (VED). This list also applies, for example, insulin. But, first, the insulins of the state purchases and issues to citizens free of charge. Second, there are at least 20 different types of drug. “People want modern insulins, which are effective and are very expensive, but the state cannot always afford to buy them. In addition, not all patients these insulin needed. But patients demand them, and they say that these insulins have disappeared if not get,” said Popovich.

Of course, if the doctor prescribed is expensive and imported, but the state does not buy, the patient turning to healthcare can achieve the individual purchase of these drugs. In addition, the patient (if available prescribed by a doctor prescription) may acquire away the drug for their money, and then to present material claims to the health authorities. “It does not have to worry about the problems of the health authorities and their inept management decisions that disrupted the purchase of medicines. Health insurance organizations that give us insurance policies, have a responsibility to protect our rights, they do it more actively. We have experience of successful court decisions in patients ‘interests”, — said the drones.

According to him, if subsidized medicines is lame, of course people run out and buy the drugs in pharmacies. Perhaps this was the reason for the disappearance of a number of drugs of free sale. “What if the drug is nowhere? Where would you get it? The correct answer is: nowhere. Unfortunately, it is a great misfortune of our patients. It is simply unacceptable that this has brought. You have to beat all the bells and demand from the government system and immediate measures,” — said the drones.

The situation with prednisone, which began with a discussion of the disappearance of the drugs, officials explained the re-registration of the drug. And then, according to Popovich, prednisolone also come in all shapes and produces them not one company. “Perhaps we are talking about a specific form, which could not be ordered in pharmacies. It happens. The pharmacy is not obliged to have the whole range from 26 thousand items. It should be understood that the drugs did not disappear in all pharmacies and over. Just one place is in another. But nobody comes into everything,” — says Popovich.

As for the rabies vaccine, according to her, she now urgently made, and soon it will deliver. “These vaccines free, then they must be procured by the state. Why a tender was not held, whether this is due to price — I don’t know,” said the expert.

In other words, with the disappearance of each drug is its own story. But each, according to Popovich, there is a lot of peers that do not disappear. “Any catastrophic situation that the people are deprived of medicines, no,” she said.

“What the state purchases, to a very small extent intersects with what without a prescription buys population — in pharmacies. Intersect, they can only in a very slight degree, and disappear at the same time, if only the drug will be illicit trafficking. Such situations also happen when some painkillers with side effects were withdrawn from the market. Then people translated into other drugs. There is always a therapeutic substitution if we are talking about a complicated prescription schemes. But now such a situation does not arise. It’s artificially pumped fears,” — says Popovich.

According to her, the Ministry of health and the state Duma is now actively engaged in the issue of tenders. “As far as I know, they’re going to adjust the law on tenders, so it does not look so difficult in relation to drugs. Document is only valid on 1 January. Practice accumulated, and now it clearly will improve. I believe that will simplify and change the system calculation of initial maximum price of the contract,” she said.

Drones also believes that in the near future the Ministry of health will make appropriate adjustments in the tendering process. “Reason to think so there. The Ministry of health is aware of the problem, and government officials, whatever they are abused, trying to respond. Yes, they have certain faults, but to say that they are not doing anything in this direction, I can’t,” he concluded.

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