It is prescribed to save

Roszdravnadzor is trying to reduce debt to pharmaceutical suppliers

The list of drugs that Russians will be able to receive as part of the additional drug provision program, which was so pompously advertised by the leaders of the Ministry of Health and Social Development after the start of monetization of benefits, will once again be adjusted downwards. The previous six “cuts” - three major and three minor ones - were not enough to fit into the budget allocated by the State Duma for the DLO program. Overspending under this program for three quarters of 2006 has already exceeded 50% and literally every day increases debts to suppliers. Therefore, Roszdravnadzor officials intend to remove the cheapest pills from the list (it is believed that low-income people can afford them if they wish), as well as some drugs in ampoules.

Without two months, two years of experience in implementing the DLO program showed that the needs of the population entitled to free medicines do not fit into the allocated budgets. Thus, by October of this year, according to the Pharmexpert company, Russians received medicines worth more than $2 billion, although the entire annual budget provided for only $1.3 billion.

Experts believe that, firstly, the program was initially poorly calculated, and secondly, doctors are abusing preferential prescribing of drugs. It was really difficult to calculate, since before monetization many beneficiaries simply did not buy the necessary medicines - their income did not allow it. The opportunity to receive at least some medications for free brought a significant number of such people to pharmacies. But there is another side to the problem - doctors began to write prescriptions without regard to the cost of the drug or even its purpose. Quite regularly, clinics prescribe drugs for treatment in hospitals, which by law must be paid for under the compulsory health insurance program from completely different sources. As a result, the average cost of one prescription under the DLO program is now 525 rubles. “Five-year-old children are given a prescription for three packages of a strong painkiller at once. This happens all the time,” say Roszdravnadzor employees who conduct random checks and claim that this is precisely what explains the accumulated debt of the state to pharmaceutical manufacturers working under the DLO program. In monetary terms, this is approximately $1 billion. Although pharmaceutical companies initially agreed to work on the terms of a trade loan with a deferred repayment of 180 days, suppliers are already beginning to grumble.

However, there will not be a full-fledged protest yet, and this was clearly demonstrated by the informal meeting of market participants with the leaders of Roszdravnadzor that took place on Tuesday evening. Despite the fact that the organizers of this meeting gave suppliers the opportunity to ask questions to officials anonymously, no one demanded an explanation of where the “extra-budget” money would come from, much less urgent repayment of debts. On the eve of the next competition for the supply of medicines under the DLO program and in the midst of the “Famacologist” operation carried out by law enforcement agencies, pharmaceutical market participants demonstrated understandable loyalty.

For their part, officials made it clear that savings will begin with doctors. “Control over the issuance of prescriptions for DLO will be improved,” assured Deputy Head of Roszdravnadzor Elena Telnova. Back in the summer, this department, by a special resolution, obliged doctors to prescribe medicines only in Latin, and the prescription can only mention the active substance of the medicine - the international nonproprietary name (INN), and not the name of the manufacturer or trademark. In the future, Roszdravnadzor plans that the issuance of each prescription - both paid and subsidized - will be done only using a computer and all data will be entered into a single database. But the widespread computerization of doctors is still very far away. Therefore, special commissions from local branches of Roszdravnadzor will control the costs of DLO, and, of course, only selectively.

The extent to which administrative methods will help reduce costs will be seen at the end of the first quarter of 2007. But even if this turns out to be effective, the list will still not stop changing. “To begin with, we should expect that inexpensive and non-vital drugs and the so-called hospital forms, that is, ampoules, will be removed,” say marketers from the Pharmexpert company. In addition, it is planned that next year up to 30% of the list will be made up of Russian-made drugs, which, as the Ministry of Health and Social Development assumes, will be cheaper than foreign analogues. And expensive and innovative medicines will now be allocated to four separate lists.

Alexander BARABANOV