Hepatitis has a plan

The government has approved an action plan to combat hepatitis C until 2030. According to the press service of the government, the country plans to develop a system for providing medical care to patients with this disease and improve the mechanisms for paying for treatment within the compulsory medical insurance system. It should be noted that, according to experts from the Treatment Preparedness Coalition, in 2021, only 1% of the estimated number of Russians living with hepatitis received free therapy. The patient community is pleased with the “formalized” plan to combat hepatitis, but notes that the draft budget for next year, which has already passed the first reading in the State Duma, does not provide for financing these measures. The deputies promise to introduce amendments to the second reading.

Hepatitis C action plan approved by the Russian government was published November 5. The press service of the government clarifies: in this way, “it is planned to develop a system for providing medical care to patients with hepatitis C and improve the mechanisms for paying for such treatment within the framework of compulsory medical insurance (CHI).”

The plan is designed until 2030, but most of the work will begin now, according to the government’s website. By the end of 2022, the Ministry of Health and the Mandatory Medical Insurance Fund should develop recommendations for the regions on how to pay for medical care for patients with hepatitis C at the expense of compulsory medical insurance. And already at the beginning of 2023, federal and regional medical organizations should switch to new differentiated tariffs for paying for such treatment. Also, at the beginning of 2023, a single register will be formed to record patients with hepatitis C. The press service said that this will help to “clearly and quickly” assess the amount of necessary financial resources and medicines.

It should be noted, according to experts of the Treatment Preparedness Coalition project (which monitors public procurement and the availability of medicines), in 2021, 28.5 thousand people received treatment at the expense of the state. This is a maximum of 1% of the total estimated number of patients with chronic hepatitis C living in Russia. About 700 thousand people are registered, but the exact number of patients is unknown. The Reference Center for Viral Hepatitis Monitoring of the Central Research Institute of Epidemiology of Rospotrebnadzor estimates that from 3.5 million to 4.7 million Russians live with the hepatitis C virus. And Vladimir Chulanov, chief freelance specialist in infectious diseases of the Ministry of Health, told a journalist in July 2021: “According to the calculations of many researchers, the population of people who could be infected is estimated at about 5.7 million people.”

Therefore, already in the first quarter of 2023, the Ministry of Health should develop a unified register of patients living with hepatitis C and update it monthly together with the Federal Penitentiary Service, FMBA and regional authorities. In addition, the medical department will have to analyze the best practices for treating patients with hepatitis C in federal and regional medical organizations, so that they can then be used in all clinics in the country. The plan also provides for additional education of health workers who provide care to such patients through advanced training and professional retraining programs. It starts in 2023 and will be held on an ongoing basis. The Ministry of Health and the Ministry of Industry and Trade were also instructed to assist in the development of domestic production of antiviral drugs.

“We can happily state that at least some formalized plans to fight hepatitis have finally appeared in Russia,” comments Nikita Kovalenko, head of the interregional public organization Together Against Hepatitis. We emphasize that since 2011, the patient community has been seeking the creation in Russia of state programs to help patients with chronic viral hepatitis. One of the most “positive” provisions of the plan, Mr. Kovalenko calls the intention of the state to scale up “best practices”. According to him, the country has accumulated a lot of experience in the treatment of hepatitis, which needs to be expanded, not only between regions, but also within. “Now in each region, as a rule, there is one medical institution where treatment of patients with chronic viral hepatitis is organized. Given the size of the country and problems with transport accessibility, there should be a dozen such clinics for each subject. And it is important that these are really the best practices of the regions that have achieved significant success in the fight against hepatitis, and not those that have agreed to launch pilot projects, and earlier in the treatment of hepatitis were among the lagging behind,” says Nikita Kovalenko.

The expert is also pleased that the plan provides for informing the population about this disease and organizing additional medical education for doctors of non-infectious specialties. “Patients will finally stop being told that hepatitis C cannot be treated,” Mr. Kovalenko hopes.

Financial support for the implementation of the plan will be carried out “within the budgetary allocations provided for in the federal budget,” the document says.

Specific amounts are not specified. However, as previously told “Kommersant”, the draft federal budget for 2023, which was adopted by the State Duma in October in the first reading, does not provide for financing additional measures to combat chronic viral hepatitis C. The Together Against Hepatitis Association appealed to the State Duma Committee on Health Protection and the Committee on Budget and Taxes requesting changes to the project. Nikita Kovalenko clarifies: according to the plans of the Ministry of Health, 9.6 billion rubles will be required. for 2023 and 11 billion rubles. for 2024 and 2025.

Commenting on the appeal of patients, Deputy Chairman of the State Duma Health Committee Alexei Kurinny (KPRF) said that the allocation of such an amount is quite realistic. According to him, the deputies intend to introduce appropriate amendments to the bill for the second reading, which will be held on November 22. Income from the excise tax on sugar-sweetened beverages can be a source of funding for hepatitis C activities. A bill on the introduction of such an excise tax is also under consideration in the State Duma. It is assumed that the excise will be 7 rubles. per liter and will be effective from January 1, 2023. Additional income from such payments can reach 35 billion rubles. in year. True, 10 billion of this amount has already been decided to be directed to the implementation of measures to combat diabetes, Deputy Chairman of the State Duma Committee on Health Sergei Leonov (LDPR) told Kommersant.

Natalia Kostarnova