How vital drugs disappear from the shelves of Russian pharmacies

In March 2019, an amiodarone ended in Russia - an antiarrhythmic medicine that is used when heart rhythm disorders threaten life. The pharmaceutical companies explained that due to an artificially underestimated state, the prices for the drug to release it were simply unprofitable. The leading cardiologists of Moscow announced a public campaign to save patients - Amiodaron is looking for Avito and taken from Kyrgyzstan and Kazakhstan.

The MBH Media correspondent talked with doctors and medical experts and found out why the attempts of officials to build pharmaceutical socialism are doomed, and what must be done so that ordinary people do not suffer from the concern of the state.

"Your life is more expensive than a ticket to Minsk"

Amiodaron (commercial name is cordarone - approx. “MBH Media”), which doctors call the medicine for sudden death under arrhythmias, disappeared from Russian pharmacies in early March, and the metropolitan doctors were lost by one of the first. “With a tablet amyodarone in Moscow, really, some kind of misfortune happens. Over the past two days, ten of my patients cannot find it. Even in the ubiquitous apteca.ru, he doesn’t, ”wrote the head of the intensive care unit and intensive therapy of the city clinical hospital named after N. E. Bauman, an anesthetist-resuscitator of the highest category, doctor of medical sciences, Alexei Erlich. He explained that many patients of cardiologists need the drug. “Amiodaron is a drug, including preventing sudden death, if anyone does not know in the Ministry of Health of Russia or the Moscow Department of Health,” Erlich reminded officials, yielding departments in the post.

Those did not respond to tags, but colleagues from the Moscow region, Krasnodar Territory, Novosibirsk, Kemerovo, Kislovodsk, Stavropol and other cities responded. They confirmed: there is no amiodarone. On March 13, one of the main suppliers of Amiodarone, the French company Sanofi, responded to Erlich’s request: “There are currently delays in supplies on the drug. The drug will appear at the distributors in April 2019. The pricing policy has changed. ” Doctors in social networks noticed that the medical community about such deferrals in deliveries should be warned in advance.

“As I found out, I called my brother with tears:“ Everything, I probably will die, there is no my drug, ”a resident of Rostov Svetlana Gorbanev-Sidorenova told MBH Media. - I have been accepting amiodarone for eight years, both for prevention and to stop attacks of atrial fibrillation. Then she began to look for a way out. I contacted friends and relatives in other countries. ”

Healthcare officials in the person of the Ministry of Health and Roszdravnadzor publicly began to comment on the problem only on the twentieth of March, when cardiologists launched a flash mob throughout the country with a hashtag #cordaronvza -ease, and Alexei Erlikh announced the campaign of public salvation to help Russian patients accepting Amiodaron. He suggested that everyone who has the remains of a scarce drug at home, or transfer them to the doctor to give the medicine to needing patients, or place ads, on any exchange of exchange.

He also advised to try to search for amiodarone in poorly pharmacies, including in villages.

“If Cordaron is prescribed for life -burning arrhythmias (ventricular tachycardia), look for the drug abroad. Your life is more expensive than, say, a ticket to Minsk, ”advised a cardiologist, candidate of medical sciences, a doctor of the highest category Anton Rodionov.

Alexei Erlich also recommended that the doctors ask their colleagues from Ukraine, Kazakhstan, Georgia, Uzbekistan, Kyrgyzstan to convey "at least some possible amount of the drug to Russia." “I understand that my proposal is on the verge of legality, but, it seems, it can help,” the doctor explained and said “MBH Media”, which is aware of what position the Moscow Department of Health is now.

“Can you imagine what it is on behalf of the state to buy medicine? This means to declare a tender that should be played for a month or some. The officials, no matter how they want to help, it seems to me, are connected by their hands. What should they do in this situation - I do not know. This is a terrible story. Therefore, if suddenly somehow I can bring at least some medicines, I honestly be only glad. Let it be PR on behalf of the state, let it be pushing public opinion into a corner, but let this medicine appear in any way, ”Erlich admits.

All due to the devaluation of the ruble

The official representative of the French company Sanofi in Russia Anastasia Zorina in an interview with the MBH Media correspondent confirmed that there is interruptions in the supply of amiodarone (Cordaron) to our country. “Sanofi is doing everything possible to resume the supply of the drug to the territory of Russia in full in the near future. So, the batch of the drug in sufficient quantities has already entered the company warehouse and shipped to our customers, the schedule of further monthly deliveries was formed by the end of the year, which Sanofi notified the regulatory authorities, ”Zorina assured, but could not answer the question of why there were problems with amyodarone supplies to the pharmacies.

In addition to Sanofi, Amiodaron was supplied to Russia by the Belarusian Borisov Plant of Medical Preparations, the domestic company Organina and Biocon CJSC. “Organics” and “Sanofi” through the metropolitan healthcare department briefly informed Alexei Erlich that the supply of amiodaron in pharmacies will begin no earlier than April. Representatives of Biokon CJSC were more frank and stated that the production and implementation of the tablet amiodarone did not seem possible. “This is due to the increase in the price of an active pharmaceutical substance that arose in 2015 due to the devaluation of the ruble, and the fall in the profitability of this drug. Due to the current legislation, Biocon CJSC does not have the opportunity to re-register the maximum vacation price to the actual level of increase in the price of raw materials, ”said Veniamin Potashnikov, deputy director for commerce. He explained that the legislation implies a government decree on maximum vacation prices for vital and most important drugs (Decree of the Government of the Russian Federation of 09/15/2015 N 979, as amended on 08.10.2018) .

“If the state begins to regartely intervene in pricing, then sooner or later a situation will happen when the product, the price of which is specially adheres, will not be produced. The laws of the market are still stronger than all state influences. And when the state artificially underestimates the price of some drugs, their manufacturers - Russian whether foreign - are forced to refuse to produce these drugs, ”explains Alexei Erlich. He calls the maximum vacation price for vital medicines with a disgustingly realized good idea.

"Replacing the analogue can be dangerous"

The degree of discussion was tried to reduce the head of the “pharmacy guild” Elena Nevolina: “There are a lot of drugs for treating arrhythmias, so to say that the patients faced the threat of cessation of treatment is incorrect,” she said in the commentary of the Russian newspaper. “<...> But since there are enough analogues on the market, the doctor can always choose another suitable medicine if the patient cannot buy the original drug.”

“Do not replace amiodarone. Amiodaron has no analogues. Five main antiarrhythmics are registered in Russia, but they are not direct analogues. Here the question comes down to whether a horse can be called an analogue of a motorcycle. You can formally move from point “A” to point “B” on any vehicle, but far from always the horse will work where a motorcycle is needed, and vice versa. Amiodaron does not have direct analogues in the life -engraving rhythm situation, does not exist, ”Anton Rodionov does not agree. The doctor emphasizes that in some cases, replacing the analogue can be life -threatening.

“There are no analogues! This is the only drug in its group. I somehow tried to appoint etocizin. Did not help! On the contrary, he gave an arrhythmogenic effect, that is, an unpredictable even worst arrhythmia. I thought I would give oak! I do not agree anymore to anything. Afraid! Although Cordaron has many side effects, there is sometimes no choice, ”says Svetlana Gorbaneva-Sidorenova. She insists: not surviving a serious attack of arrhythmia not to understand the sensation of the patient. “And one feeling: it seems that life is over! God forbid anyone! ”The woman worries.

220 signatures for the new law

The head of the Patient Protection League, Alexander Saversky, is confident that Amiodaron disappeared from pharmacies precisely because the maximum vacation price for the drug below the actual cost of its production set by the state. At the same time, the expert believes that the problem itself is much wider and applies not only to the drug life -saving for cores. “In Russia, there is a law“ On the treatment of medicines ”, and there is no law“ On providing medicines ”. Agree, it is very strange - to have a circulation system and not have a support system. As a result, such a regulation arose in the field of circulation, which began to influence the actual security, ”says Saversky.

According to him, the “League for the Protection of Patient Rights” has already collected 220 thousand signatures, and now goes with them for all working inter -fraction groups of the State Duma and the Russian Academy of Sciences with a request to develop a new law, where the central task will be precisely the solution of the problem of drug support.

“Look how many structures have divorced in this area, except for the Ministry of Health: FAS, the Ministry of Industry and Trade, the Ministry of Economic Development, the Ministry of Finance. All sorts of institutes, intra -decreasing supervisory authorities there. Each establishes their own rules of circulation, intervenes somewhere and so on. And everyone has no task to ensure, but there is a task to participate in circulation. And besides these, as it were, state regulators also have their own interests, distributors, pharmacies, doctors, and medical organizations. It’s just horror! ” - says Saversky.

He proposes to build a single and understandable system of drug support and appeals to the concept of “pharmacoeconomics”. “When there is no drug for outpatient intake, a person may have a stroke or heart attack. He will call an ambulance, he will be in a hospital on sick leave, if he survives, he will become a disabled person. And the state will pay him a pension, pay for rehabilitation and so on. But a person will not work. And if he was given that tablet in time, then nothing would have happened, and he would continue to benefit the economy. Healthcare is the center of the global economy, because people themselves want to be healthy and it is economically profitable to make them like that, ”the expert explains.