Since April of last year in Ukraine began to operate the program of the Cabinet “Affordable drugs”. Three months before the end of 2018 in many regions has mastered all public expenditure, while only a third of the pharmacies of the claimed 8000 are actually working in this project. About why such a situation has arisen, and how to measure the effectiveness of government initiatives in an interview, ГолосUA told the Vice-President of the Association of employers of medical and microbiological industry of Ukraine Viktor Chumak.
– Victor T., recently in the Cabinet reported that the program “Affordable medicine” decreased mortality in Ukraine. Furthermore, it was stated that a decreased number of calls to emergency conditions. Who in Ukraine is a similar records?
– There are such statistics, if among hypertensive patients (leaders in disability prevalence and mortality) and 30% of systemically treated automatically by 30% indicators on the main indicators: mortality, disability, and, as a consequence, the increase in the life expectancy of the population. To date, the program “Affordable medicine” covered a fairly wide number of hypertensive patients. Let drugs are not the most modern, but proven.
But the main problem here is different: how the government learned that the number of recipes corresponds to the number of people? Even the program for hypertension, which was implemented by the previous government, the indicators only worked in 6 regions. In all other cities, including Kiev, was writing prescriptions for nonexistent patients, thus quickly mastered the money. And this despite the fact that then I had 10% to pay for the drug. Now, if the list of drugs that do not need to pay extra, it is easy to agree with the doctor, he will prescribe you with 50 recipes, you’ll go to the drug store and merchandised them, and these 50 packs will be distributed in the form of advertising of his company “in need” or re-send. It is in the best case, worse – if drugs are thrown out. But a mark that you learn tools and participate in the program — you bet.
Of course, if there are once electronic prescriptions, then it will be possible to track where drugs go and how they effectively influence the indicators. To date, no indicators, and no electronic prescriptions.
– And the number of prescriptions per patient per month somehow limited?
– People with chronic diseases prescribe recipes for the next few months.
– That is, no electronic prescription — the soil for a manipulation?
– Here we have such statistics. The consumption of drugs falls in the summer. And if you look at the number of paid sick over the summer period on the contrary, at this time the maximum amount of sick leave. Just patients negotiate with doctors and go on vacation. The same with drugs.
In General, regions believe medication prescriptions so much, hence the same drugs took patients. And how that data can be used to understand what is the impact on reducing the number of calls the ambulance?
– According to the latest Cabinet, announced in late August, the program “Affordable medicine” attended by 8,000 pharmacies. Is this true? And how do pharmacies today perceive this program, because we know that during startup, many refused to participate because they had outstanding debts of the state after the program on hypertension.
– The same sentiment as they were. And then there are contradictions. Pharmacy earns on the margin — the higher the price of the drug, the greater the pharmacy will work on a fixed margin, or the higher the margin, the greater the pharmacy will work at the same price medications. Now let’s deal in fact. Pharmacies that do not participate in the program “Affordable medicine” have the right to put their products on a margin above 25%. Pharmacies participating in the program allowed margin above 15%. Moreover, in the list of “Affordable drugs” just get cheap drugs, so pharmacies participating in the program lose twice: first, profitability, and because the medications that they are forced to sell themselves cheaper, respectively, than the earnings on them less.
Another aspect of this problem is the fact that the pharmacy is participating in the program by selling you the drugs at the price that is set for it, in fact, lends to you, because she is after you have sold the drug within one month runs and asks to repay this, in fact, a loan. Ie is the diversion of working capital, and this is a direct loss. Consequently, all this leads to the fact that of all the announced its participation in this program, pharmacies, actually it involved about a third.
It should be noted here. New year still three months. And in many areas the money allocated for this program has ended, despite the fact that for the second half of this program is not included in the declared additional drugs based on the 4 molecules, i.e. remained the same 21 molecule, but increased the number of brands for the same products. Because the Treasury releases the money in accordance with the statistical data provided by the state statistic Committee, in relation to the population, its structure, etc. But the trouble is that these statistics do not stand up to scrutiny, they do not correspond to the real situation, since, for example, in Kiev, taking into account all immigrants, lives approximately two times more people than indicated in the statistics. You can go to the doctor and without registration.
Thus, the money runs out faster.
This leads to the following problem. What to do now and how to treat people? To release the medications at the expense of prescriptions and allocations next year, i.e. to lend to patients for six months? But if we do that, we would still arise the question of what to do with recipes that will be discharged in the first quarter of next year. A lot of practice, that the duty of the State “forgives pharmacies,” i.e., does not return. Of course, with the introduction of an electronic registry and a prescription this problem can be solved, but now she has no solutions, because it is a cycle of papers in nature.
– Local authorities now contribute to this program? After all, last year the health Ministry complained that the officials are sabotaging its implementation?
Implementation on the ground is complicated by the fact that local authorities were more willing to allocate subsidized from the budget money for this program of so-called utilities, pharmaceutical companies or others. And private pharmacies participating in the program were not funded properly. At the same time, doctors have the right to write a prescription for the patient’s medication in any pharmacy from the list, regardless of the form of ownership. And how and when to return the money, they do not care. Consequently, the numbers of actual participants of the project named Prime Minister are not the same.
– The list of the program “Accessible medicines” includes 261 medications, 57 positions free. How do you rate the list?
– You see, these drugs are taken not just from the ceiling — and from the national list, and in it are the drugs recommended by who. Another thing is that some groups of diseases should now treat the so-called combined drug. But who these drugs is not recommended. Although in General, it should be recognized that the list of preparations of the program “Affordable medicine” given years of proven medications.
As for the prices of these medicines, all of them are formed due to the marketing policies of pharmaceutical companies. And a direct parallel between the combination of price-quality are possible. The same company profitably to raise the price to lay a large margin for themselves, and with small volumes of sales to get their profit. Another company sees the benefit in making a profit, turnover, accordingly, the more it sells, the more profit. So the arguments like what if the drug is cheap — that means he is bad, is unfounded.
– Are all drugs available to patients? What does it depend?
– All there is — the issues are complex. The fact that in a normal retail pharmacy market should be — the cheaper the drug is, the more it margin. Because of existing fixed costs for the product of any one pharmacy can not live — it will be ruined. Our politicians did the opposite — the cheaper the drug, the margin on it is less. And so pharmacies, in order to survive, the following scheme is used: they are willing to take the cheapest product, if the manufacturer of this drug will pay to pharmacies — earlier 20, and now 40% of the turnover, in fact, a “rollback”. All of this is made in the so-called marketing agreement under which the owner of the pharmacy network “at the request” of the manufacturer is studying for a demand for a certain drug, and in fact, is to survive the pharmacy. However, these marketing agreements and criticize it — only lazy does not. But at the same time to offer the pharmacy way to survive, i.e. to introduce regressive scale of the trade margin for sale of cheap drugs, the government is not, i.e., trying to solve the social problems of the country through socially oriented business – the prospect of such a policy is understandable. It should be noted that this “kickback” is due to higher prices for drugs that are not included in the program “Affordable medicine” – miracles do not happen, i.e. all of this at the expense of patients who are not affected by this program.
In 2019 the program “Affordable medicine” will be in charge of the National service of health. In practice, what happens?
– As of 2018, the competence of Dazzleby health went pay doctors, and from April 2019 it is planned that the pharmacy will not sign contracts with local authorities, as it is now, but just with the National health service, which will compensate them for their expenses. And from 2020, the National need to pay for the drugs within Nezperce, and the thousands of drugs on the basis of the 420 molecules, and from April 2019 only on the basis of current 22. Therefore, this step is necessary, but good or bad — we will see over time.
When the program first started, the government was loudly reported the number of prescriptions. Lately the impression that everything quieted down. What is actually happening?
– Number of drugs in the program “Affordable medicine” account for only 1% of the total number of all drugs used in our country sick. In accordance with this program, every hundredth the drug is released for free or for a fee. Is it good? Of course. But another question: today, this program is positioned as a charity by the Government. And the goal was to run the reform is to establish a mechanism by which to track the impact of this program on patients, and how spending of allocated funds and all what we talked about. In addition, there was too much unnecessary noise at the beginning. To solve the problem can only be pursuing some specific goal. For example, solving the problem of diabetes as it is decided now to include three drugs, we will not solve it in General. The same applies to hypertension. And these two diseases – the leading influence on the previously mentioned indicators of the performance of the health system – 52% mortality rate! Thus, our actions are piecemeal — a bit here and a bit there, but in the end we neither not developed nor issue any particular at a deep level not decided.