Translated material
Treatment blind
Doctors refuse to prescribe medications that are not available in pharmacies
Over the past few months, the Ministry of Health and Social Development has been regularly reporting on the improvement of the situation in the field of preferential drug coverage . The list of federal subjects where there are interruptions in the supply of drugs is noticeably reduced from one conference call to another, as is the number of prescriptions on deferred service (that is, actually unfilled). According to the ministry, in mid-August such prescriptions accounted for no more than 2% of the total number issued. It is logical to assume that since there are no unsold prescriptions, this means that there is no problem with subsidized medications - everyone who suffers can get them. But over the two and a half years of the existence of the Supplementary Drug Supply (ADS) program in Russia, it has become clear more than once that the formal logic in the description of this project does not work .According to representatives of several associations that protect patients' rights, today it is as difficult to obtain subsidized medications in many regions as it was at the beginning of spring. The only difference is that back then drugs from the DLO list were prescribed, but not dispensed due to the lack of them in pharmacies (which resulted in thousands of delayed prescriptions), but now they are simply not prescribed. “Doctors now write into prescriptions only those drugs that are currently available in the pharmacy. Every month they receive lists of what is planned for delivery. But it doesn’t happen that all the medications needed by beneficiaries are immediately available for sale,” a doctor at a polyclinic in the city of Pushchino told Vremya Novostey. In many towns near Moscow, local doctors immediately warn patients who in a given month can count on drug therapy - kidney patients, heart patients or, say, citizens suffering from respiratory diseases. Everyone else is advised to take care of their health and refrain from going to the clinic.
“There are many such special cases. We have information that doctors, guided by verbal orders from local health officials, refuse to prescribe medications to patients that are not available in the pharmacy. How do they artificially lower the statistics on prescriptions on deferred maintenance,” Alexander Saversky, president of the Society for the Protection of Patients’ Rights, told Vremya Novostey. According to him, the order of the Ministry of Health and Social Development, instructing doctors to “use operational information about the availability of medicines in pharmacies,” actually made it possible not to prescribe some drugs approved by the Federal Service for Surveillance in Healthcare and Social Development (Roszdravnadzor). By the way, the Federal Service itself calls this interpretation of the order false. “This is not a ban on prescribing certain drugs, but just a recommendation. The doctor has every right to prescribe any brand listed in the DLO list, but he must also inform the patient about the availability of this medicine in pharmacies,” Roszdravnadzor told Vremya Novostei.
Recently, the prosecutor's office of the Leningrad region took up the interpretation of this order of the Ministry of Health and Social Development. Beneficiaries in the city of Kirov, outraged by the fact that they were not prescribed anything at all, turned to this authority with a request to understand the situation. The submission dated June 20 of this year clearly states that this provision cannot be a basis for not prescribing a particular drug from the federal list of drugs for preferential categories of citizens. But not everyone turns to the prosecutor’s office, and the local interpretation of the ministerial circular is often diametrically opposed to that given by the prosecutor’s office of the Leningrad region.
“As a result, we are now forced to live with our eyes closed,” says Alexander Saversky. - After all, if there are no recipes, there are no statistics, it is impossible to assess the real need of beneficiaries. Namely, on the basis of this data, regional applications for medicines supplied under the federal program should be drawn up.” Considering that the preparation of regional applications, Minister of Health and Social Development Mikhail Zurabov has more than once called the program’s “weakest point,” such a statistical “blackout” could finally destroy it from the inside. The situation is complicated by the fact that this year the responsibility for conducting procurement auctions and selecting authorized suppliers was assigned to regional authorities for the first time. So there will be enough confusion with subsidized drugs in 2008.