This is not a panic, this is a disaster

In the Saratov region, patients cannot get free insulin. "Medusa" found out that problems with drugs - throughout Russia

On May 21, a photo of the queue in the clinic at the first city hospital appeared in the VKontakte community in the VKontakte community on May 21. The author of the picture explained that people are sitting for several hours in line for insulin - and that he himself has not been able to get the drug since the beginning of the month. The picture was accompanied by the signature: “Saratov suffers a disaster. How many more diabetics will die? " A year earlier, a non -profit organization that helped people with diabetes was closed in Saratov - after it was recognized as a “foreign agent”. Problems with the receipt of insulin in local patients with diabetes began due to the new rules of the Ministry of Health that regulate the purchase of drugs for beneficiaries. "Medusa" found out that not only Saratov, but also other cities of Russia tolerate disaster.

A photograph of the queue in the city hospital in the Typical Saratov was published by 29-year-old Andrei Konstantinov. Type 1 diabetes in the last 20 years has been diagnosed with his civilian wife, but she cannot stand behind free insulin due to work; Instead, Andrei, who has a free schedule, goes for the drug. However, as much time is required in Saratov to receive insulin, he does not have it.

“Previously, they gave three syringes for a month. The last year they began to give one syringe-hand-it is enough for 10 days. But on May 13 I came - there is no insulin. He returned three days later - not again. He came on Monday, May 21, insulin was - but the line for reception is huge. I asked people who is not for insulin. Two or three raised their hands. The rest sat to write a recipe. "

The difficulties with receiving insulin were also written in the comments on the photograph of Konstantinov. “Today I bought one ampoule for 890 rubles, because I have no opportunity to defend the turn,” the NAS TYA user notes. - This ampoule - for a week ... Grandmother with a pension of eight thousand rubles can buy an ampoule for 890 rubles? This is not a panic, this is a disaster! "

The day after the recording on VKontakte, the regional Ministry of Health sent an audit to the first Saratov city hospital and, according to its results, said that “the line was not connected with insulin,” and declared the photograph “fake”. According to the commission, there was repairs in the building, some specialists were transferred from one wing to another - hence the accumulation of patients. The State Duma deputy from the Saratov region Unicorn Evgeny Primakov (the grandson of the former Prime Minister and Minister of Foreign Affairs of Russia Evgeny Primakov) after a couple of days on his Facebook called “not to be kept on Navalnyatin”: “Then people were bought to receive in the same corridor-but they did not give up insulin.”

On that day, Konstantinov could not receive free insulin; The medicine had to buy in a pharmacy-887 rubles for one syringe. However, soon representatives of the local Ministry of Health and the head physician of the clinic came to him. They explained that the fault for interruptions does not lie at the hospital - the problem is in procurement and deliveries, and suggested that they are jointly "developing a plan for closing the deficit." What does this mean, Konstantinov found it difficult to explain.

“I see how it happens with those who write to the prosecutor’s office,” says Andrei Konstantinov. - Everything is long, dreary and most often to no avail. Between the appeal and the result passes at least six months. Therefore, I did not contact the prosecutor's office. If there is an effect from the post on social networks, it means that this is enough. ”

Interruptions with free insulin in Saratov - since the summer of 2018. There are problems with other drugs that patients with diabetes need

According to many patients surveyed by Medusa from Saratov, interruptions in insulin began in July 2018 - both in the city and in the region.

Daria Ivanova (the surname has been changed at her request) from the city of Marx has recently mined insulin for his 14-year-old son (12 years old he has diabetes) only by call. “Pubertat is the most difficult period for a diabetic,” Daria explains. - Therefore, in February, doctors transferred us to Tresib - a new insulin of extended action. I specifically asked them: is it always real to get it? They said: yes. A few months ago they grabbed - there is no drug. Week, month, another month. It got to the point that insulin was left only for a day. I am writing to all instances - to the Ministry of Health, to the prosecutor's office. I reached the regional government, I ask: where do I take my child to the morgue right away? And then, after the call [of the regional deputy prime minister on the social development of Valentina] Grechushkina, after the call [deputy] Primakov finally sent us the package of “trust”. ”

In May, Daria failed to get Tresiba for free. One packaging of the drug, designed for a month, costs more than six thousand rubles. “Of course, if you start calling again, they will solve this issue,” says Daria. “But it seems to me that this is wrong.” Once a month, I should not overtake the thresholds to get a medicine, it just should be in a pharmacy. ”

28-year-old Olga Bogaeva, a disabled child of the first group, also repeatedly complained to different instances, since she could not get other medicines for people with diabetes, which are purchased by local Ministry of Health according to the same scheme as insulin. Bogaev ceased to receive the medicines she needed since January 2018. Doctors explained to the girl that the Saratov Ministry of Health could not purchase a sufficient amount of medicine - and you need to either wait or buy it yourself. The girl’s health was worsened: she was amputated, the kidney disease developed. In October 2018, Olga Bogaeva died . Based on the results of the prosecutor’s inspection, several criminal cases were instituted (including under the article “The provision of services that do not meet the requirements of the safety of life and health of consumers”). In the same month, the Minister of Health of the Saratov Region Vladimir Shuldyakov resigned .

In 2018, an organization was closed in Saratov to help patients with insulin. On the complaint of the student, heading Putin's headquarters, she was recognized as a “foreign agent”

A year before the death of Olga Bogaeva, in the fall of 2017, the local prosecutor's office began checking the Saratov regional public organization of disabled people with diabetes-this is one of the oldest non-profit organizations of Saratov, it was registered in April 1995. The reason was the complaint of the second -year student of the medical university Nikita Smirnov; He is the leader of the local student headquarters of the support of Vladimir Putin. The young man said that financing of the NGOs from abroad is concerned with him. The organization really received sponsorships, including more than half a million rubles from Russian representative offices of foreign pharmaceutical companies - Novaya Nordisk and Johnson and Johnson, from 2014 to 2016.

The expert opinion on the activities of the NPO was entrusted to write to the teacher of history from the Saratov Law Academy Ivan Konovalov (he isthe author of several articles on countering “color revolutions”). In his conclusion and in a speech in court, Konovalov spoke about the “subversive nature of the activity” of the NPO, which “forms the prerequisites for discrediting authorities” and “transfers information about the so -called pain points of the region to foreign partners”.

The lawyer Nikolai Dronov, speaking in court, suggested that the audit of the prosecutor’s office and the court was “revenge” to the head of the NPO Ekaterina Rogatkina for publicly criticizing officials from the healthcare sector. Rogatkina got a job in organizing assistance to patients with diabetes at the beginning of zero - after her child fell ill with diabetes. Together with her colleagues, she held seminars and conferences, arranged summer camps for children; But the main thing-pressed on the local Ministry of Health, monitoring the purchase and quality of drugs and consumables (needles and test strips).

On May 28, 2018, the Saratov District Court recognized the organization as a “foreign agent” and awarded 300 thousand fines. The head of the Diabetic NPO Ekaterina Rogatkin was fined 50 thousand rubles. After the in the fall of 2018, the prosecutor's office demanded the enforcement of the organization in the register of “foreign agents”, the structure was self-destructed. Ekaterina Rogatkina refused the comments of Medusa.

Saratov region - among the worst regions to organize insulin procurement. Because of the new rules of the Ministry of Health with insulin, it is bad in other areas

Shortly before the death of Olga Bogayeva, in July 2018, Prime Minister Dmitry Medvedev sent an additional 35 million rubles to the Saratov region for the purchase of drugs for patient patients (“in connection with an increase in the number of those in need”). In total, the federal and local budgets spent 1.8 billion rubles in 2018 to provide beneficiaries in this region.

However, judging by the current situation with insulin, the injection of money with a lack of drugs for patients with diabetes, it was not possible to solve. According to experts from pharmaceutical companies and industry experts with whom Medusa spoke, the insulin crisis in the Saratov region is associated with a poorly organized public procurement system - and with the work of local officials of the Ministry of Health, who were unable to overcome the complexity systems created by this system.

How the insulin procurement system works in Russia

Endocrinologists of the polyclinic draw up an application for drugs for their patients on the basis of a register (it indicates how many drugs consume for a certain period the patients of a particular doctor). The application should indicate existing patients who need medicines and new or translated from other groups. Separately, a list for federal beneficiaries is compiled (those who have a disability group), separately for regional (all others). Then the doctor protects the application with the main endocrinologist of the hospital, explaining why it is so much insulin (someone has changed the course of the disease or new patients have appeared). Finally, applications from endocrinologists from clinics are collected by a specialist from the regional Ministry of Health and transfers to his drug support department. Then the regional Ministry of Health decides on the volume of procurement, based on all these data, - and an auction is carried out on the public procurement website.

“The regions can decide for themselves, buy them the entire amount of drugs [who spread among patients for free] for a year - or do it quarterly. As a rule, the regions purchase insulin for a year, less often for six months, even less often for a quarter. In recent years, the Saratov region has been buying medicines in a quarterly, ”said the source of Medusa in one of the insulin manufacturers.

The analytical company Headway Company, which tracks tender purchases in the pharmaceutical industry, at the request of Medusa, the research reservations of insulin procurement. It turned out that problems in this segment are observed not only in the Saratov region, but also in the whole country. Firstly, the percentage of torn auctions increased significantly-due to non-appearance of participants, due to errors in the conduct of tender procedures, etc. According to Headway Company, in 2019, 15% of the total number of insulin tenders in the country did not take place-against 8% in 2017 and 10.1% in 2018. Secondly, in some regions of insulin for 2019, significantly less than half of the average annual procurement of previous years were purchased. The Saratov region is one of these problematic regions.

The purchases of insulin by Russian regions from 2016 to the present. Pink is highlighted problem regions

According to the diabetes sugar register , in the Saratov region, 83 thousand people were diagnosed with diabetes; Of these, 4.1 thousand have type 1 diabetes , the rest of the type 2 diabetes . Mostly, insulin’s daily injections are needed by patients with type 1 diabetes, but sometimes insulin is also prescribed to patients with type 2 diabetes.

Judging by the tenders who had already passed in 2019, the Saratov region by the end of spring purchased 31% of the annual needs of insulin. This is far from the worst result in the country: in the Tyumen region they purchased only 6% of the annual volume, and in the Republic of Tuva almost nothing was bought. But, obviously, real problems do not arise where insulin has remained since 2018. According to Headway estimates, the Amur, Belgorod, Ryazan, Tyumen and Yaroslavl Regions, Krasnoyarsk Territory and the Komi Republic also include the current presence of insulin.

A source in one of the Russian insulin manufacturers told Medusa that in the most popular group of insulins-genetically engineering human insulins-over the past year and a half, the Saratov region has broken about half the tenders.

It is difficult to conduct tenders effectively and on time not only to Saratov officials. In 2018, an order was issued by the Russian Ministry of Health No. 1380 “On the features of the description of the drug ...”, after which officials learned to fill out documents for several months. And since the beginning of 2019, order No. 871 entered into force- “On approval of the procedure for determining the initial maximum price of the contract ...”. This document ordered the organizers of the competition (that is, the regional Ministry of Health) to set the lowest possible price for drugs, which during auctions should have been reduced even more. At the next auction, the average price from this auction should be taken as a reasonable price and, in turn, decline further.

The main players in the Russian insulin market: three foreign companies (each has a plant in the Russian Federation) - Novo Nordisk, Sanofi, Eli Lilly - and three Russian - “Heropharm”, “Medsintez” and “Farmstandart”. Enterprises sell their products mainly through public procurement system. A source in one of these companies complained to Medusa that the prices in the Russian insulin market due to high competition and one of the lowest in the world and companies simply does not make sense to dump further-therefore, everyone carefully looks at the conditions of the competitions that the regions announce, and if the price is underestimated, do not participate.

“A lot depends on the human factor,” explains the source of Medusa. - There are regional officials who, even in the conditions of these orders, manage the Ministry of Health to understand the rules, set real prices on tenders, are not afraid to justify them. And there are officials who do not care. They conduct meaningless tenders one after another, the regions suffer from a lack of medicines - but the prosecutor’s office will not come to them and will not accuse them of overstating prices at auctions. ”

The press secretary of the Saratov Ministry of Health, Alexander Kolokolov, told Medusa that the competitive procedures for the purchase of insulin are “generally normal”. “There is insulin in the region, there is even a small stock,” said Kolokolov. - Not always competitions are held flawlessly, problems arise with the conduct of competitions and with the supply. We solve all the problems that arise in diabetes on an individual basis and in the shortest possible time. ”

Anna Mukhina , correspondent of the agency "Free News"