Scarcity at the cost of a lifetime: why medicines are becoming less and less available

Irina Mishina

"We have no Amoxiclave, and it is not expected in the nearest future". Such a sign can be seen recently in some Moscow pharmacies. The commission of the Ministry of Health of the Russian Federation has added about 86 more names to the list of potentially scarce medicines for 2023, including drugs against cancer, Parkinson's disease, HIV, vaccines for the prevention of whooping cough, diphtheria, tetanus, flu vaccine, some antipyretics, activated charcoal and even iodine! Paramedics are in a panic: getting Prednisone on the list of potentially scarce drugs can turn into a tragedy, because it is this drug that is used for heart attacks to save people.

Does Russia have its own medicines?

The topic of the shortage of medicines reached the president and became the topic of a meeting with his participation. "60% of our domestic medicines are already on the market. Nevertheless, a shortage has formed for some drugs, and prices have increased," the president said.

And what is included in this 60% in general? Didn't it happen that we provided ourselves with bandages, greenery and arbidol for 2/3, and everything else turned out to be in short supply due to imports that became problematic?

"Own Russian pharmaceutical production is a conditional concept", - says Alexander Saversky, head of the League for the Protection of Patients' Rights. - The President says that there are 60% of domestic medicines in Russia. Who gives him these numbers? After all, the secret is known: the fact is that our officials have invented a formula for "domestic medicine", in which if an imported medicine is made in Russia by a foreign company and only packaging is produced in the Russian Federation, it is considered domestic. Hence these inflated 60% of domestic medicines. In reality, they are no more than 20-30%.".

Substances for medicines and raw materials are also imported in most cases. "After February 24, almost no foreign pharmaceutical company has left the market, pharmacists continue to work on imported raw materials", - Yelena Nevolina, Executive Director of the National Pharmaceutical Chamber, confirmed to NI.

Today, many foreign companies have localized production facilities in Russia. These are giants - Sanofi, Bayer, Novartis, AstraZeneca and others. Their factories located in Russia continue production on their own raw materials. But they can also leave. And then what?

We decided to ask the doctors if it is even possible today to be cured exclusively with Russian drugs. For example, to defeat the flu in this way.

"The entire production cycle of one drug is divided in many cases between multinational corporations. Some produce powder, others capsules. The antibiotic Azithromycin, for example, is produced by 20 different companies, including from Russia. So it is fundamentally wrong to talk about whether it is possible to cure some disease, for example, the flu, only with Russian drugs. For information: not a single antibiotic is produced in the USA, and nothing, people live", - explained "NI" Doctor of Medical Sciences, Professor Pavel Vorobyov.

From flu patients to cancer patients: the list of victims of drug shortages is growing

But even in conditions when Western pharmaceutical giants continue to work in Russia, the shortage of medicines has "covered" many. First of all, patients for whom the absence of a drug is tantamount to death were under attack. These are, for example, cancer patients. Patients with oncological diseases experienced a shortage of about a dozen and a half drugs at once at the end of 2022. There are reports that patients diagnosed with breast cancer cannot buy the drug Tamoxifen.

Yelena Khvostikova, head of the Genom Patient Care Center, informed NI about the lack of a drug for patients with adrenal insufficiency "Solo-kartef" from Pfizer.

"This medicine, which used to cost 140 rubles at most, pharmacy chains are now offering to buy for 4,500 rubles", - says Yelena Khvostikova. – Polfa has stopped supplying the drug Cortinef. This drug, which cost 500 rubles at most, is bought at a price of 2500 rubles: it is transported from Turkey through Kazakhstan. Also, according to data from St. Petersburg, a drug that is used for endocrine diseases of the thyroid gland - Rocaltrol - disappeared there. There are patients who have been transferred to analog drugs, but they are different and not suitable, people may simply not survive."

The president of the All-Russian organization of patients with multiple sclerosis, a member of the HRC under the President Yan Vlasov also informed us about the shortage of medicines. According to him, in 2022, the drug against multiple sclerosis was included by the Ministry of Health in the program of high-cost nosologies, but ultimately did not appear in the government decree.

Many may object: they say, these are drugs for people who do not have such common diseases. But there is also a problem with marketable medicines. As follows from the survey data among pharmacists and pharmacists conducted on the platform of the professional community of pharmacy workers Smartpharma, about 99% of representatives of pharmacy organizations in 2022 faced a shortage of medicines. Most often, a deficiency of antipyretics and antibiotics was recorded. So, among the drugs, temporary interruptions in the supply of which were noticed most often, were antibiotics "Amoxiclav", "Augmentin" and "Panclav". From antipyretics, representatives of pharmacies pointed out problems with Nurofen in children's form. In general, the shortage affected both drugs for adults and medicines for children: candles, suspensions, syrups.

Price increases cannot be avoided

Roszdravnadzor assured us that there is no cause for concern. At least, the General Director of the Association of Russian Pharmaceutical Manufacturers, Chairman of the Public Council at Roszdravnadzor Viktor Dmitriev is full of optimism.

"The list of the commission of the Ministry of Health was created in order to place appropriate accents and draw attention to possible risks. Most of the problems arose due to logistics. Problems arise when transporting medicines and their components by land from EU countries. For example, in Poland and Lithuania, the customs clearance time has significantly increased. Previously, the procedure took 30-90 minutes, now it takes from 1.5 to 6 hours. The airspace is closed, transportation by sea is also limited. When the sky and roads open, everything will be faster and, accordingly, cheaper", - Viktor Dmitriev, General Director of the Association of Russian Pharmaceutical Manufacturers, told NI.

There are also reasons for the shortage of medicines related to the coronavirus pandemic: it led to the fact that stocks of medicines, including antibiotics, were spent to the maximum.

"In addition, there are problems related to the production of medicines from the list of vital ones, their prices are limited by the state. But the cost of production is growing, and the manufacturer cannot work at a loss. Suppose he produces drugs from the list of VED at a fixed price, but accordingly raises them for other drugs", - says Yelena Nevolina, Executive director of the National Pharmaceutical Chamber.

As logistics becomes more complicated and the cost of production increases, the rise in drug prices, apparently, cannot be avoided.

"This year we expect an increase in the cost of production of medicinal products by about 34% compared to March last year. An increase in the cost price will inevitably lead to an increase in selling prices. Therefore, we will decide with the regulator: either increase prices or remove unprofitable drugs from production. If we are allowed to raise the prices of medicines from the list of VED, we will keep their production. If prices are not allowed to increase, most likely the production of individual items will be suspended", - Viktor Dmitriev, General Director of the Association of Russian Pharmaceutical Manufacturers, Chairman of the Public Council at Roszdravnadzor, gave such a sad forecast to NI.

It turns out that by setting a ceiling on the prices of medicines from the list of vital ones, the state took care of our pocket, but deprived us of the availability of treatment…

Will the government contract save the pharmaceutical industry?

Instead of building a system to provide patients with medicines, the state adopted a law on the circulation of medicines. That is, the state is engaged in circulation, not provision. That is why there is uncertainty in the question of what exactly patients need here and now.

"In Russia, there is not even a form of statistical reporting to the Ministry of Health on the state of drug provision in the subjects of the Russian Federation. Therefore, when the president says "eliminate the deficit", I am at a loss: how do we know what it is? And at what price will non–scarce medicines be sold - at the cost of a lifetime?", - says Alexander Saversky, head of the Patient Protection League.

Experts agree that it is necessary to rely on Russian laws, which state that assistance is provided and paid for from the CHI according to standards. And these standards include medicines. But it doesn't work today.

"We need not just a reserve of medicines, which the President is talking about. We need a planning system based on the population's need for medicines. This need must be covered by a state order, and this state order must be provided with contracts from 3 years. Disruptions of these contracts should have such sanctions under them that the money from the fines is enough to cover all the costs of emergency purchase or even production of medicines. That's when the manufacturer will no longer be able to quietly withdraw another cheap medicine from the market", - says Alexander Saversky, head of the League for the Protection of Patients' Rights.

In addition, the state order will give a guaranteed profit, and the pharmaceutical industry will not have to fork out for marketing, expensive advertising, and insure risks.

Denis Manturov, the head of the Ministry of Industry and Trade, assures that the production of medicines in Russia has increased by more than 15% over the year compared to 2021. Clinical trials have increased by a third, pharmaceutical companies in Russia have registered more than 130 new drugs. They can be quickly brought to the market if the supply of certain imported drugs stops, the minister explained.

The news is good, but the question remains: how much will these new drugs be available?