“I need at least five pills until tomorrow”: vital drugs disappear from pharmacies in Tatarstan

“This medicine was taken away from someone else!”

Rafael Shakirov, disabled person of the second group from Kazan, received cheap for the current times Metypred (200-230 rubles for 30 pills) only after he distributed a video message to the minister of healthcare of Tatarstan on the Internet. Subordinates of the minister brought packages to Kazan from the far region of the republic. Rafael is unhappy:

“This medicine was taken away from someone else! You can't do that!”

Shakirov says that he would buy cheap pills, without daily intake of which he begins to suffocate in the evening to such an extent that he has to call an ambulance, but they are not on sale. There is a warning on the websites of pharmacies: “The product is in high demand during the pandemic!” — and no address where the pills are available.

But with Rafael's disease (he has COPD, chronic obstructive pulmonary disease), more expensive medications are also required, which he, as a disabled person, should receive free of charge. Foster inhalers, Pulmicort, Berodual, Spiriva cost from 2,000-2,500 rubles, so the purchase of the entire set of necessary medicines costs 10,000-12,000 rubles a month (about $124-149). These are just two pensions for a disabled person of the second group.

“Before the pandemic, I was regularly placed in the hospital, in pulmonology departments, which are now repurposed for the treatment of coronavirus," says Shakirov. “And the patients who were with me also complained about the lack of medication. You won't believe it — periodically, for beneficiaries, there wasn't even aspirin.”

Anait Arakelyan, a resident of Kazan, recently told about the lack of vital Metypred in a social network — the woman burst into tears in front of the camera: “I need at least five pills until tomorrow!” As a result, she got the pills — her fellow sufferers shared with her.

In addition to Metypred, Tavanic (active substance — levofloxacin, with an antibacterial effect), Clexane (used for the prevention of thrombosis) and a number of other drugs that are used, in particular, in the treatment of COVID-19 disappeared from pharmacies.

Realnoe Vremya asked the ministry of healthcare of Tatarstan and the territorial body of Roszdravnadzor in Tatarstan to comment on the absence of the above mentioned medicines in pharmacies and their poor provision for their beneficiaries. After receiving the responses, our publication will publish them.

“The crisis, hype and the introduction of labelling coincided”

According to Mendelevich, the “coronavirus” hype is associated with a sharp increase in drug sales recorded in January-September in Russian pharmacies — by 10,9%:

“Sales have increased, and our pharmaceutical industry, which is highly dependent on imports, cannot cope with such a load.”

The second reason for the shortage, the parliamentarian says, is the introduction of mandatory labelling of medicines. The idea is very useful — labelling gives the opportunity to trace the entire path of each pill from the manufacturer to the counter, control pricing, plan purchases and fight fraud. However, labelling is a time-consuming and expensive process, and despite that many drugs were given a “reprieve” due to the coronavirus, a good law that started to work in the context of the economic crisis and pandemic demand has worsened the shortage of medicines. Pharmacies under the threat of a fine did not dare to put unmarked products on the shelves.

“On this occasion, I and other deputies received a lot of appeals from patients, and I am glad that we were heard in the government and recently introduced the notification nature of labelling," said Boris Mendelevich. “I think the situation will start to improve in the next week. I hope that this procedure will be extended for the duration of the pandemic.”

“It's time to move away from the 44th bill”

As for the problems of beneficiaries, according to Boris Mendelevich, there is an urgent need to change a lot in the system of their drug supply:

“Interruptions are also connected with the coronacrisis, but not only with it.”

According to the interlocutor of Realnoe Vremya, in connection with the pandemic, the main funds are used to fight coronavirus:

“I suggest using part of the funding in such conditions for these purposes — in order to reimburse them later. Officials may not have had time to do this. But there is still a systemic problem — medicines for beneficiaries are purchased on a competitive basis under Federal law No. 44. The federal law requires you to buy from someone who offers cheaper. And the official sets the minimum price so that they don't get accused of overstating it. No one claims this price. The competition did not take place, and it is necessary to announce a new one — it takes months, and there are not many stocks of medicines...”

According to the deputy, the issue of providing beneficiaries would be solved much more faster if purchases were made without a competition — on the basis of simple price negotiations, and medicines would be purchased not from intermediaries, but directly from manufacturers:

“It is necessary to negotiate with 'big pharma', avoiding intermediate markups. It's time to move away from the 44th bill!”

“We need to change the principles”

The initiator of changes in the legislative “base” of preferential provision of medicines is another “our man” in the State Duma — the former minister of healthcare of the Republic of Tatarstan, Ayrat Farrakhov. He reminded Realnoe Vremya also about other weaknesses of the organisation of work with beneficiaries:

Ayrat Farrakhov is aware that changing the principles of preferential drug provision is not an easy task. First of all, because the necessary, in his opinion, changes in the legislation will inevitably “tighten” the rights of beneficiaries — they will be deprived of the opportunity to choose money:

“And the current legislation does not allow this. This creates a conflict that will require a lot of political will and significant financial resources to resolve. However, it is necessary to resolve it: the coronavirus pandemic will end sometime, but the issue of increasing the length and quality of life of people suffering from chronic diseases is necessary, and it cannot be solved by building hospitals. In Russia, an elderly person on average receives four times less drugs than their peers in the West. And they feel themselves, respectively, worse.”

As for the departure from the requirements of FZ-44 with competitive purchases, now, he says, “the savings are formal, so new methods of regulation are needed”. And we are talking not only about direct agreements with “big pharma” on the supply of medicines but also about long-term contracts with manufacturers of innovative drugs, as is done in a number of countries. Now the legislation allows them to conclude for no more than 3 years, but it is necessary for 5-10 years. Only in this case, Farrakhov believes, contracts with manufacturers-holders of registration certificates of drugs will ensure savings and stability of drug supplies.

We have to go to a doctor's appointment every month, stand in queues for prescriptions, at the risk of contracting coronavirus, then go to a certain pharmacy by public transport, if there is no medicine, go there again for it... What for?

“Why do we have to wait in queues every month, risking getting infected with coronavirus?"

Thirty years ago, we already experienced the non-alternative provision of medicines to beneficiaries — when it was impossible to choose between “in kind” and money. And this approach also had a weak point: in the 1990's, “in kind” was always not enough, and recipes were not “purchased” in a timely manner. We will see whether this mechanism will work more effectively in the new conditions.

As for today's beneficiaries, they would like to see changes in the organisation of drug supply not only in the future but right now. And here we are talking about purely technical and, at the current level of development of IT technologies, easily implemented things.

“When during the period of self-isolation it was necessary to track the movement of citizens using SMS, we in the republic developed and launched the appropriate portal in a matter of days and found the funds for this," says Rafael Shakirov. “But with beneficiaries, all the information about whom is already available in the computers of medical institutions, pharmacies, pension funds, and so on, for some reason, they will not solve the issue. We have to go to a doctor's appointment every month, stand in queues for prescriptions, at the risk of contracting coronavirus, then go to a certain pharmacy by public transport, if there is no medicine, go there again for it... What for? Why can't I have my prescription sent electronically from the clinic once a month directly to the pharmacy, and from there, when the medicine arrives, I get a call: 'Come and get it'?"