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A System of Universal Medicine Provision: Key to Achieving the National Goal
13 February 2019
14:30—16:00
KEY CONCLUSIONS
A development strategy for the pharmaceutical industry is the most important tool to meet the objective of medicine provision in Russia

A development strategy for the pharmaceutical industry is the most important tool to meet the objective of medicine provision in Russia — Sergey Tsyb, Deputy Minister of Industry and Trade of the Russian Federation.

State support of national pharmaceutics producers gets results

A lot has been done recently to make medicines accessible to the population. After the industrial policy legislation that we had been dreaming of passed (it was 10 years in the making), the Ministry of Industry and Trade took the most important step through the Industry Development Fund. We went from pushing paper to financing industries — Aleksandr Petrov, Deputy, Member of the Committee on Health Protection, State Duma of the Federal Assembly of the Russian Federation.

Thanks to the support programme for national producers, 64% of the medical preparations and 84% of life-saving medicines in the national register are made by domestic producers. It’s important to note that from 2005 to 2017, as measured in constant prices, we succeeded in doubling government spending on medicines — Guzel Ulumbekova, President of the Board, Association of Medical Societies for Quality of Medical Care and Medical Education; Head, Higher School of Healthcare Organization and Management.

Projects to increase access to medicines are being implemented on the regional level as well.

Since 2013, we have been implementing a medicine insurance project in Kirov Region. We’ve established that, generally speaking it was used by about 60% of federal and regional beneficiaries and 40% of patients who do not have the right to medicine benefits, but suffer from circulatory diseases. The project has already shown noticeable results. In 13 regions that participated in the project, the circulatory disease mortality rate, including in working-age patients, dropped by 18% — Igor Vasiliev, Governor of Kirov Region.

Implementing universal medicine provision is a crucial factor in extending life expectancy and developing the economy

If we implement universal medicine provision, which is now being openly discussed by the Ministry of Health, when it comes to those diseases that are most common in Russia: cardiovascular, musculoskeletal, and respiratory diseases, when it comes to 10 illnesses that are currently not being covered, in the next 10 years we could expect to see the mortality rate of those diseases drop by 10% and see an annual 0.8% boost to the GDP — Vadim Kukava, Executive Director, Association of Pharmaceutical Companies "Innovative Pharma".

[An average life expectancy of] 74 by 2024, 80 by 2030, we’re falling behind. If we don’t implement universal medicine provision, these targets will be very hard, from my point of view impossible, to achieve — Yury Krestinskiy, Director, Centre for Healthcare Development, Moscow School of Management SKOLKOVO.

ISSUES
Insufficient financing

In 2017, general spending on medicine provision in outpatient and in-patient settings amounted to 1.5 trillion roubles, of which 500 billion was paid for by the government and 1 trillion by the population. If we compare how much is covered by the Russian government and the new countries in the European Union, we see that Russia spends practically three times less than those countries, which, by the way, are economy-wise similar to us when it comes to economic development — Guzel Ulumbekova, President of the Board, Association of Medical Societies for Quality of Medical Care and Medical Education; Head, Higher School of Healthcare Organization and Management.

Problems with access to medicines in rural areas

The main issue, as we can see, as we talked a bit with the Ministers during the break, is access to medicines in rural regions — Konstantin Baranov, Minister of Healthcare of the Kaluga Region.

The risk of low rates of medicine use because individuals receiving benefits choose pay-outs instead of free medicine

Based on the standard expenditures per capita, we pay out over 120 billion roubles monetarily. In other words, with respect to interbudget transfers and the allocation of subventions to federal subjects, we see somewhere around 45–46 billion roubles spent annually, while 120 billion are paid out directly to patients — Elena Maksimkina, Director of the Department of Drug Supply and Regulation of Medical Devices at the Ministry of Health of the Russian Federation.

Violations of intellectual property laws

e’re seeing absolutely unacceptable things in regards to patent law. I believe that right now what we’re seeing with violations of patent laws, no matter if they’re domestic or foreign producers, is unacceptable. In pharmaceutics, intellectual property rights are basic rights that must be protected on all levels — Dmitry Morozov, General Director, BIOCAD.

SOLUTIONS
Increasing investment in science

Without putting serious work into increasing investment in science, we can’t do anything related to the development of new pharmaceutical drugs — Vladimir Chekhonin, Vice President, Russian Academy of Sciences; Head of the Department of Medical Nanobiotechnology of Medical and Biological Faculty, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of the Russian Federation.

Monitoring the effectiveness of spending

An important issue is controlling the effectiveness of funds spent on developing new medicines. There needs to be a system of priorities. Currently, not all government subsidies are being spent on the right things — Vladimir Chekhonin, Vice President, Russian Academy of Sciences; Head of the Department of Medical Nanobiotechnology of Medical and Biological Faculty, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of the Russian Federation.

Developing a labelling system for medicines

Labelling is a key stage in the production of each single package of a medicine. Any progress on that front must be guaranteed by the government, specifically with the participation of this information and surveillance system — Mikhail Murashko, Head, Federal Service on Surveillance in Healthcare.

Improving mechanisms for interactions between producers, the state, and society

e proposed expanding the assortment of tools available to producers, including direct conversations between producers and the government, wholesale agreements, etc. Our last proposal was focused on a specific situation, where we might register a minimal reference price and are ready to lower the price if access is increased — Oksana Monge, General Director, Sanofi Russia.

Risk-sharing agreements definitely exist, there are about 500 of them, and they are particularly popular in certain countries. In some countries, before expensive, innovative medicines are covered, an agreement lasting 4 to 5 years is signed, and the government evaluates the result. If there is an excess of funds spent on this medicine, the company must reimburse this excess — Irina Panarina, General Manager, Russia and Eurasia, AstraZeneca.

Improving regulations

In order to increase access to modern, innovative medicines, we need smart regulations and equally smart enforcement. Unfortunately, we’ve recently been creating regulations that create barriers. We’re not treating regulation as a science — Vladimir Shipkov, Executive Director, Association of International Pharmaceutical Manufacturers (AIPM).

We will not achieve the goals established by the President if we are working from the current position on medicine provision benefits: ‘Become disabled, and then we’ll give you medicine.” There can’t be any talk of 80+ or quality of life in that case. There must be a unified principle differentiating subsidies depending on the illness. The government must get involved in universal medicine provisioning at the earliest possible stage — Yury Zhulev, President, Russian Haemophilia Society.

The material was prepared by the Russian news agency TASS