Continuity of supply, and sufficiency of drugs for all citizens, including in situations of exponentially growing demand, are key to a country’s drug security. In turn, drug security depends on how effective the government drug procurement system is. Various mechanisms are used both in Russia and worldwide to lower procurement costs. These include long-term contracts, direct negotiations with manufacturers, and risk-sharing. All these can be considered as potential instruments for modernizing the current government procurement and drug supply system. Today, not all regions of the Russian Federation can solve the problem of drug deficits. One important strategy for ensuring adequate supplies may be a transition to a centralized procurement system. This would encourage planning and interregional distribution of drugs according to needs, improve the government’s negotiating position with regard to cost reduction, and increase patient coverage by the government. What factors dictate the need to modernize the current government procurement system? What international practices could be applied to optimize the current government procurement system from the point of view of preventing drug deficits in all regions of the Russian Federation? What impact might the establishment of a federal centre on planning and organizing drug supply have on citizen support, and on implementing the Healthcare National Project and other federal projects and programmes? What risks might centralizing drug supply carry, and will switching to a centralized procurement system help improve the country’s drug security? What supporting decisions in healthcare and related areas need to be made in order to successfully modernize the procurement system?