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What to expect from the new list of essential drugs
In Russia, for the first time in five years, the list of vital and essential drugs compensated for patients by the state, will be expanded. Will the innovative drugs, which save lives of patients in the developed world, be included in it or not? The Ogonek magazine reports.
In Russia, for the first time in five years, the list of vital and essential drugs compensated for patients by the state, will be expanded. Will the innovative drugs, which save lives of patients in the developed world, be included in it or not? The Ogonek magazine reports.
The news that the Ministry of Health will at last expand the list of essential drugs, which will be used for treatment in hospitals or provided on prescriptions, created a cautious optimism among patients. However, this was followed by doubts: the purchase of necessary drugs may not be really succeeded due to lack of funds under crisis circumstances. The more so because it is not ordinary drugs, but innovative ones; David Melik-Guseinov, head of the Center for Social Economics, explained the Ogonek reporter that an innovative medicine is the one, which active substance is protected by patent, meaning that it is manufactured by only one company. Until now, the lion's share of such medicines was produced abroad. "The innovative drugs usually developed by Russian manufacturers belong to a group of general tonics, mostly immunomodulators," Melik-Guseinov explains.
Their production is usually significantly cheaper than the production of medicines for treatment of serious diseases, and this is why companies develop and manufacture the latter ones, while the scientific base is available in Russia, which could be used to work with a number of more sophisticated drugs. As a rule, the innovative drugs are developed to treat the most hard to treat diseases — cancer and autoimmune conditions. Today, patients can buy innovative drugs on their own, but the cost of such purchases is unaffordable. Often the only hope for the patient is that the drug is included in the list of medicines, which can be obtained free under prescription or in a hospital.
More effective or cheaper?
The list of essential drugs includes the drugs that in our country can be procured by public medical facilities for patients. Now it contains 588 positions, the last time it was updated by the government in 2011 and then it was prolonged every year. Many effective drugs appeared in the market since that time and they were not available to Russians. It is questionable whether they will be included in the new list. This question is related to the mechanism of compilation of the list. The procedure is as follows: first, specialists review the clinical efficacy and safety of the drug, and then they estimate how advantageous it is for the government to buy this or that drug. In fact, the formation of the list is based on non-medical priorities. It creates an insurmountable contradiction. "For the majority of innovative drugs this criterion is extremely difficult to comply with," admits Alla Rudakova, Professor of the Economics Management Department of the St. Petersburg Chemical Pharmaceutical Academy. "Innovative drugs are often quite expensive; the costs of development may reach $ 2 billion. This creates problems for procurements, because in Russia the amount of government spending on health care system is significantly lower than even in the Eastern European countries, where it averages at 5.5 percent of GDP, as compared with 3.8 in Russia.
Cancer and rheumatic patients are most sensitive to the lack of innovative products; this was discussed at the round table "The lists of drugs. Will innovative medicines be available to patients?" Malignant education rank second as the cause of mortality in Russia; the global trend suggests that this figure increases with life expectancy. "That is why it is essential to increase the availability of modern methods of treatment," stressed Nikolay Dronov, Chairman of the Executive Committee of the IPM "Movement Against Cancer".
According to him, there is another problem associated with such lists: some drugs are additionally included in the list, some excluded, sometimes the ones that have proven their effectiveness. For example, Nikolay Dronov reminds, during the last revision of the lists, only one of nineteen anticancer drugs was included, while some of them, including those that are well proven in practice, disappeared for unclear reasons. "Of course, new drugs must be included in the list," the expert said, "We have to include new drugs in the list. Unfortunately, in our opinion, the commission of the Russian Ministry of Health that compiles the list still lacks the ability to balance public and private interests.
Similar views were expressed by other experts. "Infectious diseases are very diverse in terms of their pathogens. For example, pneumonia can be caused by 30-40 types of germs with different biology," explains Sergey Yakovlev, professor of the Department of Hospital Therapy of the I.M. Sechenov First Moscow State Medical University. "Different antibiotics are effective against each of them, so it is important to have a large enough list of such drugs.
Today the list includes 35 such drugs, but we need at least 40 to treat patients effectively. To purchase an antibiotic that is not present in the hospital record, we need a few days; but when a septic shock develops, each hour of treatment delay increases the risk of mortality for a patient by 7.6 percent.
Read more: http://www.kommersant.ru/Doc/2795916
