'We have repeatedly submitted proposals to abolish the law on benefits monetisation'

Social benefits or life: Russians are promised the possibility to choose drugs even for a subsidized prescription

The Ministry of Healthcare of Tatarstan urges Tatarstan beneficiaries not to refuse the subsidized drug provision in ''natural'' terms. The correspondent of Realnoe Vremya attended the Cabinet of Ministers where Minister of Healthcare Marat Sadykov and his Deputy Farida Yarkaeva cited arguments in favour of benefits and told what the choice of monetary compensation in case of a sudden serious illness can turn into.

''Money is not the main thing''

Every year until October 1, the beneficiaries, who, according to the Russian law, have the right to social assistance from the government, can choose between ''natural'' benefits — in particular, the set of free (paid from the budget) drugs prescribed by a doctor in accordance with the disease — and the monetary compensation. To exercise this right, one should apply to the district office of the Pension Fund. It is also possible not to apply — then the benefits will be granted in accordance with the choice that the beneficiary made in the previous years… However, those who once chose not in favour of drugs, but in favour of the ''raise'' to pension, the doctors offer to think over this again and still go to the office of the Pension Fund and to rewrite the statement.

Deputy Minister of Healthcare Farida Yarkaeva listed the reasons why beneficiaries refused medicines in the previous years. They are the limited list of drugs that are provided at the expense of the budget, the desire to receive drugs with usual names (according to the subsidized prescription, they give drugs that are called differently, although the active substance is the same) and… the need to go to a polyclinic for a prescription once a month, spend time in the queue to a doctor.

According to the statistics of the Ministry of Healthcare of the Republic of Tatarstan, the number of beneficiaries who need expensive drugs is increasing every year. Photo: mosreg.ru

''But the material component, as it turned out, is not the most important thing,'' said Yarkaeva. ''That is, pensioners can consider these 800 rubles as a raise to the pension, but I have repeatedly asked questions about this people in the queue in the Pension Fund — I asked whether they can afford to spend this amount as insurance, guaranteeing the receipt of expensive drugs in the event if they get sick. In that light, they agreed with me that insurance was necessary.''

''Why do those who have enough monetary compensation to buy medicines need 'insurance'?'' the correspondent of Realnoe Vremya asked the participants of the briefing. ''It is one thing when an expensive drug is prescribed to a person, and it is quite another if he buys inexpensive drugs monthly, for example, for 500-600 rubles. Having chosen money, he can choose a drugstore – he will find where the medicine is cheaper…''

''Insurance is necessary,'' Farida Yarkaeva protested. ''Medicine is developing, there are more and more effective drugs on the market, as a result of which the life expectancy increases. But there is a downside: the longer the person lives, the more likely he has new diseases. If a person has a disability for some disease, for example, with diabetes, and makes a choice in favour of a set of social benefits, and then he is diagnosed with cancer, he will receive subsidized drugs from the first day and in this profile. If he makes a choice in favour of money, then preferential drugs for cancer he will not be able to receive another year — until he changes his choice. And cancer drugs are not cheap…''

According to the statistics of the Ministry of Healthcare of the Republic of Tatarstan, the number of beneficiaries who need expensive drugs is increasing every year. In particular, at the end of 2017, the number of patients requiring treatment from 50 to 100 thousand rubles per year increased by 10% (up to 2,700 people), and by 50% (up to 37 people) — those who need drugs for an amount exceeding 1 million rubles annually.

According to Farida Yarkaeva, it turned out that up to 70% of those refused do not spend money on medicines. Photo: minzdrav.tatarstan.ru

''It's time to amend the law''

For the first time in many years, the Tatarstan Ministry of Healthcare, arguing for ''natural'' medicinal benefits and social benefits, put in the first place not the principle of solidarity of patients, but the interests of each of them. Earlier it was stated that the state was able to finance from the budget the purchase of expensive drugs for some beneficiaries only as long as those who need cheap drugs do not refuse the social benefits — thanks to savings on them. Today we have started to discuss the fact that the choice in favour of money is dangerous for patients who carelessly treat their health. After all, according to Farida Yarkaeva, it turned out that up to 70% of those refused do not spend money on drugs. And this leads to disastrous results:

''In the first year after the adoption of the law on subsidized drug provision, the mortality curve in oncology sharply crept down. When there appeared the alternative in the form of monetary compensation, this was no longer so. 44 per cent of cancer patients today make a choice in favour of money, but for them such a question should not arise at all! The choice is made in the period of remission. And then comes an exacerbation, and there is a need for second-line drugs, which the patient cannot buy: they cannot afford.''

''Therefore, we have repeatedly turned to higher authorities with proposals to abolish the law on monetization of benefits,'' said Marat Sadykov. ''It requires serious amendments!''

Good news

Marat Sadykov told the reporters two important news. The first concerns patients with orphan diseases, the treatment of whom previously was a heavy burden for the regional budget, and the lack of funds turned out to be actually a death sentence for the patients:

''579 residents of Tatarstan, including 270 children suffering from orphan diseases, will be provided with expensive medicines from the federal budget in 2019. The cost of treatment of one such patient today reaches 47 million rubles a year…''

According to Marat Sadykov, Russian beneficiaries soon will have the right to choose medicines in a pharmacy. Photo: hrav.mz19.ru

The second important news concerns the future changes in the Russian legislation. According to Marat Sadykov, Russian beneficiaries will soon have the right to choose medicines in a pharmacy. If today they cannot choose and take what they are given by a ''free'' prescription, in the future they will have the opportunity to choose between what is given, and drugs with other names, but with the same active substance. However, if the medicine chosen by the beneficiary is more expensive than the medicine from the subsidized list, he will have to pay the difference in price.

By Inna Serova