The topic of outpatient drug care has become one of the key topics at the VIII International Scientific and Practical Conference "Assessment of Health Technologies: Focus on Drug Supply".

Increasing the availability of drug care at the outpatient stage is one of the key tasks of Russian healthcare. Today, only 20% of the country's population receive subsidized medicines (only for certain categories of citizens or for certain diseases), the rest pay for medicines on their own, which poses a threat to the quality of treatment. At the same time, in foreign countries, the share of government spending on pharmaceutical care is 50-85%. Limited coverage of the population with outpatient drug provision programs leads to a decrease in adherence to therapy, a high frequency of hospitalizations with diseases that could be successfully treated in primary health care. The problem of outpatient drug provision is especially acute for socially significant diseases with a high risk of mortality (for example, cardiovascular), and ensuring the continuity of drug care between the hospital and the outpatient link remains a key issue.

As noted by Oksana Drapkina, Director of the National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russia, Professor, Doctor of Medical Sciences, Corresponding Member of the Russian Academy of Sciences, chief freelance specialist in therapy and general medical practice of the Ministry of Health of Russia, special attention from the point view of drug care should be given to patients with comorbid diseases, since it is in such patients that the risk of mortality is extremely high.

According to official statistics, in Russia there are more than 8 million people with coronary heart disease (IHD), and more than 3 million such patients with one or more comorbid (concomitant) diseases (myocardial infarction, acute cerebrovascular accident (ACVI), sugar diabetes, obstructive pulmonary disease (OBL)), more than 17 million patients with arterial hypertension, to which more than 2.9 million patients with comorbid diseases are added. The mortality rate in one and the other group is 8% and 4.2%, respectively. Preferential drug provision and adherence to treatment (motivating patients to take the correct and consistent medication) are two approaches that will significantly - by 20% - reduce the premature mortality of such patients, while drug provision plays a significant role (14%).

The All-Russian Union of Patients highlights several problems of the current system of drug provision in the outpatient department in Russia. “First, the system is focused on treating patients with severe stages of the disease and at the stage of obtaining disability, while drug therapy should begin at the earliest stages of the disease. The second is defragmentation of the system - financing of drug assistance is carried out according to different programs, from different budgets. Third, the provision of preferential drug care does not occur automatically, there is a gap between the patient's declared rights to benefits and reality. Fourth, the procurement system requires modernization, since today it does not take into account the personification of treatment, the appearance of new patients. Fifth, the federal program "14 high-cost nosologies" (program "14 high-cost nosologies") for the first time in many years is facing disruptions in funding. Over the past few years, the funding gap has been growing, and today the issue of increasing funding for this program is extremely acute, ”said Yuri Zhulev, co-chairman of the All-Russian Union of Patients.

The position of the All-Russian Union of Patients on the need to increase funding for the drug supply system is shared by the Association of International Pharmaceutical Manufacturers in the person of its chairman, Oksana Monzh, emphasizing the importance of a systematic approach to solving problems: “Today in Russia government spending on healthcare is about 3% of GDP, while as in other countries, they reach 7-10% of GDP. Patients pay for about 66% of drugs from their own funds, of which 75% are drugs for the treatment of cardiovascular diseases. And this is against the background of the decline in household incomes, which we have seen since 2014. The funding issue becomes even more acute during a pandemic. An integrated approach to drug care in the outpatient and inpatient department and a revision of the amount of its financing is needed, the search for opportunities for drug provision for treatment in the early stages of the disease, before the onset of disability - with a significant expansion of the population of beneficiaries at the expense of people of working age and the introduction of the possibility of co-payments with side of the population. It is extremely important to increase the availability of innovative drugs through a differentiated approach for such drugs in HTZ, the elimination of the zero rule on the budget when they are included in the WZN and the widespread introduction of new contractual models in procurement, a gradual transition from procurement to the system of drug reimbursement, using the possibilities of digital solutions ”.

Nuria Musina, Head of the Development and External Communications Department of the Center for Expertise and Quality Control of Medical Care of the Ministry of Health of the Russian Federation, noted the relevance of changing approaches to the formation of lists of preferential drug provision: treatment of socially significant diseases, so today there is a question of excluding OTC drugs from the list. Moreover, the inclusion and reimbursement of drugs within the VED list should be for certain indications. 14 VZN is a very heterogeneous list of drugs, which includes both drugs that have cheaper analogues and expensive, non-alternative methods of treatment. For these groups of drugs, it is necessary to use different approaches to make decisions on inclusion: to innovative, non-alternative drugs - to apply new approaches that are now used abroad, - negotiation process with manufacturers to reduce prices, agreements with the condition of confidentiality at the price, agreements on controlled access (risk sharing) ".

According to experts, an effective tool for increasing the availability of drug provision, regardless of the region of residence of patients, is drug insurance. According to Larisa Popovich, director of the Institute for Health Economics at the National Research University Higher School of Economics, “today a significant number of countries are implementing a drug supply system through drug insurance or reimbursement. One of the main barriers preventing the introduction of drug insurance in Russia is "the eclectic nature of the drug supply system, which has led to different accounting systems, differences in legal regulation, and different approaches to patient management."

The participants in the discussion note the importance of implementing the initiatives of the Ministry of Health of the Russian Federation aimed at improving the drug supply system and increasing its availability - the formation of a single register of beneficiaries, the planned transition to an electronic prescription system, the development of distance selling of OTC drugs, especially in remote areas, the expansion of the program of preferential drug supply for patients with cardiovascular diseases - including for preparing the system for the transition to drug reimbursement for the entire population of the Russian Federation.