40% of Russians have encountered the lack of a required subsidized drug in pharmacies

In 2023, patients with cardiovascular diseases (CVD) experience fewer problems with access to medical care and therapy than in 2022, but rates have not yet returned to 2021 levels. These are the results of a study by the All-Russian Patients’ Union. According to the organization, 35.8% of beneficiaries did not receive the free medicines they were entitled to; in 2022 such respondents were 39%, and in 2021 – only 19%. Experts acknowledge that sanctions restrictions have worsened the problem of supplying medicines, but say that “it could have been worse.” Rossdavnadzor told Kommersant that there have been no complaints from “cardiovascular” patients about denial of free medicines recently. The Ministry of Health talks about an increase in the number of patients receiving free drugs as part of the federal project to combat CVD.

The All-Russian Patients’ Union (VSP), together with the Social Mechanics Center for Humanitarian Technologies and Research, studied the availability of CVD therapy in Russia in 2023. From June 19 to July 10, they surveyed 1,014 patients from 78 regions, including 226 people who had suffered a myocardial infarction in the last two years. In addition, the authors conducted 20 expert interviews with cardiologists from eight regions of the Russian Federation with more than two years of experience in the clinic.

According to the World Health Organization, CVDs are the leading cause of death worldwide. This group of diseases remains the main cause of death in Russia, said Health Minister Mikhail Murashko in 2021. The country has a federal project “Combating Cardiovascular Diseases”. Russians who have suffered acute cerebrovascular accident, myocardial infarction, coronary artery bypass surgery and some other conditions should be provided with free medications for two years from the date of diagnosis and (or) surgical intervention. The list includes 23 international names of drugs.

The VSP study showed that two thirds of patients see improvements in the system of care for CVD over the past year. A third of patients did not notice any improvement over the past year. Moreover, in 2023 there are more such citizens than in 2021 (19.6%), but less than in 2022 (45.5%).

In 2023 and 2022, many more patients in benefit categories experienced difficulties obtaining medications compared to 2021. 35.8% of beneficiaries did not receive the medications they were prescribed for reasons beyond their control (in 2022 there were 39% of such respondents, in 2021 – 19%). 42.5% of respondents encountered a lack of subsidized drugs in pharmacies in 2023 – this is less than in 2022 (56.2%), but much more than in 2021 (26.5%). Due to difficulties in obtaining a prescription, in 2023, 53% of beneficiaries bought drugs that were provided to them free of charge (in 2022 – the same 53%, in 2021 – 32.6%). A source from the healthcare sector names one possible reason: the prescription is written based on the active substance, so citizens buy the drug if they want it from a specific manufacturer.

The survey demonstrated the growing scale of violations of the rights of patients with CVD. Waiting more than 14 days to see a cardiologist is still the most common situation: just like a year ago, 60% of respondents say this (versus 39% in 2021). Patients encountered the absence of a cardiologist in the clinic less often than in 2022 (43.5% versus 52.4%), but more often than two years ago (33.3%). Every year more and more Russians complain about the length of the queue for diagnostics (ECG, ECHO, tests): in 2021, 28.4% of respondents faced this problem, in 2022 – 36.4%, in 2023 – 40, 8%. The problem of waiting more than 20 minutes for an ambulance due to symptoms of acute CVD, even amid a pandemic, was less pronounced in 2021 than in 2023: 29.5% versus 36.6%. About a quarter of those surveyed face the impossibility of undergoing routine inpatient treatment every year. And the high level of requests from patients with CVD to paid medicine (45.4%) indicates, according to the authors of the study, problems with patients exercising their right to free medical care. Since 2021, the share of those using the services of private doctors has increased by 10 percentage points.

Co-chairman of the VSP Yuri Zhulev insists that patients’ problems could be solved, for example, by improving the processes of planning and providing preferential medications and expanding the number of pharmacies participating in this program.

RNC Pharma Development Director Nikolai Bespalov points out: if previously the main pool of problems was related to the peculiarities of the government procurement system, then in the last two years they have been joined by sanctions restrictions and the logistics difficulties they caused. However, he does not consider the situation too alarming: “The main range of drugs on the market remains, and the global situation with drug provision, including for beneficiaries, is relatively favorable. It could have been objectively worse, but our healthcare system coped.” Muraz Shambatov, a cardiologist at the Doctis telemedicine service, also says that the problem of a shortage of subsidized cardiological drugs, which arose due to supply disruptions in 2022, is now being resolved. According to him, many of these drugs have already been replaced by analogues.

Recently, there have been no complaints from patients with CVD about the lack of free medicines, Roszdravnadzor told Kommersant. From 2021 to 2023, the Ministry of Health has observed a trend towards an increase in the number of patients receiving drugs free of charge under the federal project. Thus, at the end of 2021, more than 673 thousand patients received the necessary medications free of charge, more than 824 thousand patients – in 2022 and 754 thousand patients – as of September 1, 2023. The Ministry of Health emphasized that the “Combating Cardiovascular Diseases” project has been expanded several times, and these measures will have a positive impact on achieving national goals to reduce mortality from CVD and increase overall life expectancy.

Natalia Kostarnova