Experts tell us whether we should be afraid of a shortage of medicines in Russia

Last year, experts expected a serious decline in the Russian pharmaceutical market, but it did not happen. Even a small, but still an increase was recorded. However, the market was in a fever all year – various drugs periodically disappeared, some then reappeared, and others disappeared completely. And just before the new year began, consumers began to face a shortage of important drugs in pharmacies. What is happening with medicines – experts spoke about this during the press conference “Pill price. Results of 2023 and the first changes of 2024 for pharmacy retail.”

As Sergei Shulyak, CEO of the analytical agency DSM Group, said, the average market growth in recent years was about 10%, but in 2023 it grew by 5%: “Of course, one cannot expect negative growth dynamics of the pharmaceutical market in terms of money, because medicines, like food, – goods of forced demand, they are the last to be abandoned. There is some decrease in government procurement, but there is also a closed part of the budget from the security forces, where the number of drug purchases has only increased over the past year.”

If we talk about the dynamics of prices for medicines, then, according to Shulyak, retail inflation did not exceed 7%: “The market for medicines (drugs) in packages is falling, but in rubles is growing. In addition to inflation, we are seeing a redistribution of drug consumption towards more expensive ones “. About 20 years ago, the most popular painkiller was analgin, the top sellers included charcoal and citramon – now these drugs are at the bottom of the sales lists. They have been replaced by more modern drugs. There is no need to see the tragedy in the fall of the packaged market – this is a structural change.”

However, the expert does not deny that prices for some drugs have increased by 50% or more. The reasons for this are changes in the supply chain and problems with payments. Sometimes manufacturers see that the competitive environment has shrunk (because other drugs have left the market) and increase prices.

And yes, they stopped supplying a number of drugs to Russia. Thus, there are serious problems with the popular anticoagulant Effient (prasugrel) from an American company – it has not been supplied for six months. At the same time, the manufacturer did not notify Roszdravnadzor about the termination of supplies. “The remaining supplies will be enough for less than a month,” says Victoria Presnyakova, director of the SRO Association of Independent Pharmacies, head of the alliance of pharmaceutical associations. “Until today, pharmacies sold the remnants of old batches, there have been no new supplies for a long time and, according to the official distributor, no more planned. The reason for the situation could be the manufacturer’s decision to suspend exports to Russia of this drug, which was classified by the company as a non-essential drug. However, given that this drug is the most powerful and effective drug from the group of antiplatelet agents, such a decision raises questions. “As an alternative, doctors can recommend to patients drugs with the active ingredients clopidogrel, ticagrelor and others: these are antiplatelet agents that effectively reduce the risk of recurrent myocardial infarction and thrombotic complications.”

In the fall, a shortage of another drug from the same company, the antidepressant Prozac, appeared in Russia. “In recent years, these are not the first imported drugs that are not available in pharmacies. The reasons are different: someone is leaving the market, someone is re-registering the price or registration dossier because something has changed, and someone is experiencing difficulties with logistics. Any withdrawal of a drug from the market is painful for patients, because when switching from one product to another, some undesirable reactions are possible, and such a replacement is not possible at all for all categories of patients. Domestic manufacturers are working on import substitution, so our patients will not be without drugs will remain. The doctor can always choose an effective replacement,” continues Presnyakova.

Among the latest pharmacy losses, one can note “Bronchomunal” (the domestic generic “Bronchovax” also disappeared); hormone replacement therapy drug for postmenopausal women “Divigel” (there are no analogues in the Russian Federation). The children’s forms of the antibiotics Suprax and Pancef have disappeared (even if they exist somewhere, they cost the price of an airplane wing). As for children’s antibiotics, experts call this a global problem: they are very expensive to produce.

Sergei Shulyak reproaches big pharma for the fact that for it money decides everything: “All the words about humanity, a high mission for the health of patients that sounded from the mouths of various companies turned out to be an empty phrase. This is business, not the health of patients.”

However, the executive director of the National Pharmaceutical Chamber union, Elena Nevolina, advises not to rush to conclusions: “These are isolated cases when companies refuse to supply medicines to the Russian Federation and abandon our patients. The long-term consequences of the pandemic are affecting: for 2 years the pharmaceutical industry could not cope with the volume of production of medicines for patients, the number of which has grown significantly, and all this has caused a shortage of medicines even in those countries where pharmaceutical companies are located. They are leaving Russia not because of the political situation, but because they cannot produce as much. We have set a course for import substitution, and our companies are trying to make products that are in short supply. But we actually do not produce all drugs in a full cycle, and there is a shortage of substances all over the world. For example, the shortage of drugs for nasal congestion is due to the fact that there is not a sufficient number of nozzles, and the properties drops are not the same as sprays.And yet there is no need to worry: most pharmaceutical manufacturers, even from the so-called. unfriendly countries fulfill their obligations.”

And yet, Sergei Shulyak gives an example that the company increased production volumes of the diabetes drug Ozempica, which had disappeared in the Russian Federation, threefold that year, but their priorities for supplies were to other countries. In addition, the company producing the popular hormonal drug Metipred left the Russian market.

And although, according to the Ministry of Health, there are no defects in the country regarding vital and necessary drugs within the molecule, experts note that the situation is always different. And if some medicine disappears even temporarily, it does not make the patient any better. “At the molecular level, you can always find a replacement. Yes, we live in such a world, and we must be prepared for anything. It is important that doctors are interested in what is on the market. Sometimes they continue to prescribe drugs that have not been available for several months, otherwise and years, whereas there are a lot of other available drugs,” says Presnyakova.

According to Shulyak, about 15% of imported drugs registered in the Russian Federation are under patent protection, but if any of them disappear, the Russian Federation is ready to use the compulsory licensing mechanism – that is, to produce them in the country in violation of the rights of the manufacturer. Last year, several dozen licenses for such production were already issued. As Elena Nevolina adds, we also allow the import of drugs in foreign packages if they are out of stock in the Russian Federation. And yet, experts note that it is impossible to fill the market with disappeared domestically produced drugs overnight: therefore, priority is given to the production of drugs for oncology, cardiovascular diseases, and diabetes. Every year, about 250 new brands of drugs enter the market in the country. The problem is not only that the production of substances (raw materials for drugs) in the Russian Federation is just beginning to develop, but also that there is no production of intermediates (components of substances) in the country at all. Therefore, all “domestic” substances in fact consist of imported components.

Another problem is illegally imported drugs that are actively sold on the Internet. They may even be “native”, but there is no guarantee that the conditions of their transportation and storage were observed. “When buying on the marketplace, pay attention to the seller: if it is an LLC, then there are doubts; if a pharmacy is indicated, there is more trust. Buying medicines in offline pharmacies is the safest thing today,” says Elena Nevolina.