Government generous on drugs

Government is generous on drugs. It allocates 75 billion rubles on pharmaceuticals provision at discounted rates in 2009

Official information and figures on pharmaceuticals at discounted prices are presented here. The government will generously spend on drugs allocating 75 billion rubles (2.1 billion euro) for discounted pharmaceuticals provision in 2009.

During the telephone conference on October 17 chaired by Minister of Health and Social Development of the Russian Federation (RF) Tatiana Golikova, the dimensions of the financing for programmes to ensure the discounted pharmaceuticals provision for the population for the next year were spoken out. In particular, the 2009 financial provision of the ONLS Programme (providing people with indispensable pharmaceuticals - translator’s note) will exceed the current year expenditures by 1 billion rubles (€28 million) reaching some 28.3 billion rubles (€0.8 billion). About 35 billion rubles (€1 billion) will be funneled to the purchase of pharmaceuticals for the seven nosologies requiring heavy spending and almost 1 billion rubles (€28 million) to spend on ensuring logistic processes. Besides, additional 12.2 billion rubles (€343 million) in the form of intergovernmental transfers will go to regional budgets to implement the ONLS Programme.

The rules of the All-Russian telephone conference procedure, which was to deal with issues of discounted pharmaceuticals provision, was, as ever, split into sections. First, Minister Tatiana Golikova expanded in her speech on important government news. After a while, representatives of the Ministry of Health and Social Development and the Federal Service on Surveillance in Healthcare and Social Development made reports, who were followed by regional representatives. In its essence, the conference agenda was quite rich, since a wide number of issues were discussed in the live session, i.e. preliminary results in implementing the programme of pharmaceutical provision for people qualifying for entitlements in 2008, then, perspectives for the near future, as well as the schemes of further perfection of discounted pharmaceutical provision for residents of the nation.

In her address to colleagues from regions, Tatiana Golikova informed that, next year, within the frames of the state programme implementation the scheme of transferring funds to the RF constituent territories would be modified. In particular, the Minister said that the provision of pharmaceuticals, as far as more powers have been delegated to the RF constituent territories, will be done not through the Federal Fund of the compulsory medical insurance but through the federal budget, while funds will go direct to the budgets of the RF constituent territories. When speaking about funding the “Additional Pharmaceutical Support” (APS) programme in the next year, Tatiana Golikova pointed out that the share of funds per a person, who qualifies for entitlements, will be equivalent to that in 2006 while taking into account the rate of price increase for pharmaceuticals; in doing so, the aggregate turnover of funds that will be transferred to regional budgets as subventions, will exceed the programme budget of 2008 by 1 billion rubles (€28 million). During the telephone conference, Tatiana Golikova did not refer to the exact figure of the financing for the state programme, however, as Diana Mikhailova, Director of the Department for pharmaceutical market development and medical technology market, summed up on the conference that, as preliminary calculations showed, the aggregate amount of the financing for the programme of providing people with essential pharmaceuticals in 2009 will reach 28.3 billion rubles (€795 million).

Regional representatives were optimistic to accept the news about the additional 12.2 billion rubles (€343 million) allocated from the federal budget to implement the programme during the next year. As Tatiana Golikova explained, this money comes from intergovernmental transfers and has nothing to do with subventions set apart for RF constituent territories. The relevant funds will be transferred to regions in early January, 2009.

Tatiana Golikova gave recommendations to RF regions to start formulating documents to conduct competition procedures as due and demanded the supplies of all necessary pharmaceuticals for 2009 should be ensured in December, 2008.

Finances news were not over with that. As it was noted at the conference, according to the Regulation #722 of the RF Government “About providing other intergovernmental transfers, which are provided by the federal budget for the budgets of constituent territories of the RF and for the budget of the city of Baikonur to realize certain powers in the area of pharmaceutical provision” of September 29, 2008, at the end of this year 10 billion (€280 million) rubles have been allocated as intergovernmental transfers to implement the state programme. Besides, as the Minister said, some 500 million rubles (€14 million) will be transferred to regions in the near future. Out of this money, each region will get its certain share in accordance with the changed number of people qualifying for entitlements in the federal list.

At the conference, much prominence was given to the issue of implementation of the programme of pharmaceutical provision with high-priced pharmaceuticals for the seven nosologies requiring heavy spending. As Tatiana Golikova informed, the deliveries of pharmaceuticals for the seven nosologies, needed for the first semester of 2009, will be done during December of this year. Diana Mikhailova presented more detailed information about implementation of the programme of pharmaceutical provision for the seven nosologies. According to her, this year the federal budget allocated 30 billion rubles (€840 million) to finance the programme. Besides, 990 million rubles (€27.5 million) are the means to ensure logistic procedures while implementing the programme. In the year to come, 35 billion rubles (€1 billion) will be factored into the federal budget for these purposes, besides 979 (27 million) million rubles will be assigned for logistic functions.

In the course of the conference, Mrs Mikhailova referred to some representative figures and facts as far as implementation of the pharmaceutical provision programme of the seven nosologies is concerned. According to her words, starting the beginning of this year, pharmaceuticals to the amount of 30.179 billion rubles (€850 million) have been delivered to constituent territories of the RF, meanwhile the dispensed pharmaceuticals amounted to 20.151 billion rubles (€565 million). During the period of these nine and a half months, over 257 thousand prescriptions have been written out in regions of Russia. As of October 13, 2008, the federal register of people who qualify for the pharmaceutical provision in the seven nosologies, has overall included 49,541 people.

At the same time, Diana Mikhailova noted that there is a difficult situation regarding the ending inventory of pharmaceuticals for the seven nosologies in the constituent territories of the RF. In particular, ending inventory exceed the demands for six months in a number of territories. Among those with disreputation of the kind, they named the Vladimir oblast (ending inventory exceeds 7-month demands), the Kaluga oblast (ending inventory for over 5 months), the Smolensk oblast (for more than 7 months), the Arkhangelsk oblast (more than 6 months), the Vologda oblast (8 months), and the republics of Komi (more than 11 months), of Dagestan (more than 6 months), of Kalmykia (over 11 months), of the North Ossetia-Alania (more than 7 months), and others. Besides, the note was made of the fact that the situation is wrong in the Far East Federal District regarding the ending inventory.

In the course of her speech, the Director of the Department told about the results of the preliminary analysis of tenders for pharmaceuticals required by the seven nosologies for the first six months of 2009: “The results of this work revealed a modified figure of patients who require high-priced pharmaceuticals”. In particular, the nosology of mucoviscidosis saw a 13% increase, for Gaucher's disease it increased by 27%. Besides, the number of multiple sclerosis patients had increased, too. At the same time, the number of patients with pituitary nanism qualifying for entitlements had lessened by 13%.

As usual for a telephone conference dealing with issues of provision with pharmaceuticals at discounted prices, there are always speakers who represent the Federal Service on Surveillance in Healthcare and Social Development (ROSZDRAVNADZOR). This meeting was no exception since Elena Telnova, Deputy Head of the ROSZDRAVNADZOR told about the outcomes of control and surveillance activities at this department. In making general evaluation of the “Additional Pharmaceutical Support” (APS) programme implementation in regions of the country, Mrs Telnova considered the situation as ‘stable on the whole’. She said that since the beginning of this year, pharmaceuticals to the amount of 55.6 billion rubles (€1.6 billion (this exceeds the deliveries of the last year’s corresponding period by 64%)) have been delivered to constituent territories of the RF, there have been 46,918 prescriptions for pharmaceuticals at discounted prices written out (this figure is less by 30% compared to that of the last year’s corresponding period).

As Mrs Elena Telnova noted, since this year started there have been 257,151 prescriptions for the seven nosologies written out in general in the RF, i.e. there were six prescriptions per a patient on the average.

“It’s a good figure, because, some time ago, patients who required high-priced therapy did not enjoy this amount of pharmaceuticals”. She also operated with the figures being exponential for the volume of pharmaceuticals already dispensed in regions. In particular, since this year started, patients qualifying for entitlements of the federal budget list have received pharmaceuticals to the amount of 40.7 billion rubles (€1.15 billion (15% less compared to the corresponding period last year)). In correlating the figures of receipts and expenditures of pharmaceuticals, Mrs Telnova drew the conference participants’ attention to the significant amounts of ending inventory of pharmaceuticals in regions on both the seven nosologies requiring heavy spending (the ending inventory of pharmaceuticals to the amount of 10 billion rubles (€280 million)) and the regional part of the programme (the ending inventory to the amount of 4.8 billion rubles (€135 million)).

“The ending inventory balance is especially necessary by the beginning of each coming year, however, we must mind that pharmaceuticals is a special product with an expiration date. That’s exactly the reason why we are concerned indeed about the situation with regard to the ending inventory in regions”, Elena Telnova made a point of this.

During the telephone conference, the Deputy Head of the ROSZDRAVNADZOR also operated with figures being characteristic of the situation that reflected the deferred provision (patients’ waiting list for drugs – translator’s note) of patients qualifying for entitlements of the federal budget list. According to her, by the middle of October this year, there were 112,232 prescriptions on the deferred provision list (4 times as less compared to the corresponding period last year). Currently, the deferred prescriptions generally in the country amount to 0.25% (0.8% for the corresponding period last year). For that matter, the Perm oblast is an area of special concern (27,449 prescriptions on the deferred provision list here), as well as the Moscow oblast (10,798 prescriptions), the Murmansk oblast (over 2 thousand), the Archangelsk oblast (3,517 prescriptions), the Chelyabinsk oblast (7,979 prescriptions), the Republic of Adygeya (11,573 prescriptions) and a number of other territories.

After the Moscow representatives delivered their speeches in the Ministry of Health and Social Development, the representatives of regional agencies took the floor. In particular, the heads of Healthcare departments in 13 constituent territories of the country spoke on how things stood in jurisdictional territories, including speakers from the Republics of Sakha (Yakutia), Komi, North Ossetia, Tyva, from the Kamchatsky territory, the Khanty-Mansi Autonomous Area, the Vladimir oblast, the Murmansk oblast, the Kurgan oblast, the Kaliningrad oblast, the Tomsk oblast and Moscow oblast, as well as from Moscow. The outlines of their reports were in general similar: first, they brought to the audience’s attention statistical data on the implementation of the regional part of the state programme and also on the seven nosologies, then, they revealed the situation with reference to the ending inventory of pharmaceuticals, and, too, the information about pharmaceuticals auctions ready to be held was made heard. The representatives of most regions noted that they did not think it a problem to dispense the ending inventory, meanwhile, in their opinion most of the pharmaceuticals would be used during the current year and a minor share of the ending inventory would pass onto the next year.

It must be said that unlike the previous telephone conference on the issues of additional pharmaceutical support (APS), the regions’ representatives almost did not contribute their suggestions to the further perfection of the state programme scheme. Only, Health Minister of the Republic of Sakha (Yakutia) Vyacheslav Aleksandrov complained about the difficulties of pharmaceutical provision for certain regions and made a suggestion to finally solve the problem by organizing the dispensing of drugs through feldsher-midwife stations.

The representatives of other two regional agencies – Head of the Health Department of the Vladimir oblast Irina Odintsova and Health Minister of the Republic of North Ossetia-Alania Vladimir Legkoyev suggested coming back to the issue of pharmaceutical provision without separating patients qualifying for entitlements into those attributed to the federal budget and those attributed to the regional budget (here, the budget is to cover the patients’s drug costs – translator’s note). No comments were made to the suggestion on the part of the Moscow agency.

Summing up the near three-hour discussion, Tatiana Golikova informed her colleagues that by the end of this year they would conduct two more such telephone conferences with regional representatives’ participation, where the first would tackle auction results for pharmaceuticals for the seven nosologies, while the frameworks of the second would provide the floor for discussing if constituent territories are ready to implement the APS programme next year.