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Medicine for the elite

In Russia cancer kills more than 300,000 people every year; 2.5 million people have cancer and need treatment. But the system of financing procurements of drugs is capable to guarantee treatment for only 5 percent of them. The funding in this sphere was declining before the crisis. The money allocated in the federal and regional budgets for the programs for aid to seriously ill patients, are drowning in an ocean of new diagnoses. Russia is only on 130th place in the list of countries by the effectiveness of using budget funds under the "oncology" item. Every year 505,000 new patients are diagnosed with cancer in Russia; almost one-third of patients die within the first 12 months after diagnosis.

In Russia the most funded program for the purchase of expensive drugs is called "Seven Nosologies". The project started in 2008 as a solution to the problem of lack of funds in the "Additional pharmacological support" program (Russian abbreviation: DLO). The "Seven Nosologies" includes diseases with most expensive treatment: haemophilia, cystic fibrosis, pituitary dwarfism, Gaucher disease, myeloid leukaemia, multiple sclerosis and immunosuppressive therapy for organ transplant patients. Today the program covers about 77.000 patients with chronic diseases, which are recipients of about 40 bln roubles allocated in the federal budget for the purchase of expensive drugs. By the year 2013 the list of Nosologies can be expanded and government spendings are expected to reach 54 billion rubles. Meanwhile, with regard to cancer patients this program covers only medicines for patients with haematological malignancies. This is only 2% (55,000) of total 2.5 millions cancer patients in the country, but 45% of all budgetary funds dedicated to anticancer drugs are spent for those patients. Since its launch the program has definitely became a breakthrough in treatment of even such a small fraction of patients. However, it is clearly inadequate and unable to sufficiently reduce cancer mortality in the country.

The "Seven Nosologies" does not include any of the most common cancer pathologies, such as breast, colon, lung and stomach cancer, malignant tumours of the female reproductive system. Thus, drug provision for 95% of patients whose diagnosis is not listed is based on the leftovers principle. Their treatment is the responsibility of regional governments; the rate is 500 rubles per month per a privilegee, who did not monetized his/her right to a benefit. At the same time the cost of treatment using up-to-date highly effective drugs can reach 2–3 mln roubles a year.

According to experts, in Russia the funding of cancer patients pharmacotherapy is only €3.3 a year (per capita), while in Sweden and France it is €17. "As compared with the United States, the level of our cancer patients' provision with vital drugs is almost 9-fold lower. But there are real lives under each statistical figure: in Russia, women with breast cancer die twice more often due to inadequate medication," Anatoly Pechenkin, consultant for NP "Equal Right to Life" explained.

The catastrophic shortage of funds forced doctors to deny patients in prescription of life-saving drugs for free. In some regions, the prescription of expensive drugs is unofficially banned, the so-called waiting list is used, when new patients receive medication only after cease of treatment of patients earlier included in the approved list. Sounds cynical, but patients have to wait for the death of those who share the ward with them to get a chance to recover. There are cases when young women with hormone-dependent tumours of the breast are referred for surgery to remove the ovaries, making it impossible for them to ever have a child. However, the adequate treatment for them is a pharmacotherapy at federal clinics.

The situation could be exacerbated further by a new initiative of the Russian Ministry of Health and Social Development. In July, during the debates on a draft law on health care the ministry headed by Tatiana Golikova proposed to delegate the responsibility for tendering and procurement of drugs within the "Seven Nosologies" program to the regions. Officials have admitted that they have difficulty in administering the program, so they decided to complicate the procurement scheme even more. It was proposed to transfer funds for the purchase of expensive drugs to the regions in the form of subventions; the regions would have to arrange auctions. When bidding is centralized, the starting price of lots in many cases can be reduced by 10–15%. Analysts warned that in case of tenders in the regions the costs of drugs will exceed their wholesale prices; it will made drugs more expensive. When the ministry faced the medical community's criticism on the draft law it decided to hold back its proposal until 2014. If the initiative will somehow be given the go-ahead, then in two years even those 2 percents of cancer patients who today are guaranteed to receive life-saving medications may be deprived of their drugs