Hepatitis is included in the state budget – Newspaper Kommersant No. 3 (7448) dated 11.01.

By March 1, 2023, the Ministry of Health of the Russian Federation must develop criteria for the treatment of patients with hepatitis C through compulsory medical insurance (CHI). This order was given by the Deputy Prime Minister of the Russian Federation Tatyana Golikova. Until now, specialized patients in Russia could receive assistance at the expense of regional budgets. At the same time, in some subjects there were no programs for viral hepatitis. Starting this year, the treatment of hepatitis C will be carried out at the expense of compulsory medical insurance allocated from the federal budget. The patient community hopes that help will become more accessible, although they do not understand what criteria they are talking about. The Ministry of Health told Kommersant that they would evaluate the effectiveness and availability of treatment.

Deputy Prime Minister Tatyana Golikova instructed the Ministry of Health of the Russian Federation to approve “clear criteria” for providing medical care to patients with hepatitis C by March 1. Ms. Golikova recalled that on November 5 last year, in accordance with the instructions of President Vladimir Putin, the government approved an action plan to combat this disease. “Relevant provisions are provided in the program for its implementation. In particular, this is the procedure for providing medical care to patients with this disease at the expense of compulsory medical insurance in day and round-the-clock hospitals, the allocation of separate tariffs in the tariff agreements of the regions to pay for such care. In this regard, the Ministry of Health must approve clear criteria for such treatment by March 1, 2023,” Ms. Golikova said at a meeting between Russian Prime Minister Mikhail Mishustin and deputy prime ministers on Monday.

It should be noted that in December, during a meeting of the Council for Strategic Development and National Projects, Vladimir Putin said that it was necessary to increase the volume and coverage of drug therapy for patients with hepatitis C, and instructed the government to work out sources of funding for such a program. The plan, approved in November, assumed that 9.6 billion rubles would be allocated to fight hepatitis in 2023, but hepatitis was not included in the draft federal budget.

“It’s hard for me to say what clear criteria the Ministry of Health plans to approve,” comments Nikita Kovalenko, head of the interregional public organization “Together Against Hepatitis”, Nikita Kovalenko. hepatitis, regardless of the presence of liver damage and concomitant diseases. But, since “it is impossible to cure everyone,” continues Mr. Kovalenko, the recommendations clearly outline the criteria for the urgent appointment of therapy. These are the last stages of fibrosis and cirrhosis, significant extrahepatic manifestations, relapses after transplantation, co-infection with HIV, hepatitis B, diabetes mellitus, transplantation of any organs, high risk of transmission (for example, planned pregnancy). “In theory, such patients should receive therapy at the time of treatment, why be wiser?” — says Nikita Kovalenko.

The Ministry of Health told Kommersant that the regulatory consolidation of state guarantees for the treatment of hepatitis C requires “both assessing its effectiveness by establishing quality criteria, and the availability of appropriate medical care.” The relevant criteria, specified in the department, are being developed with the participation of the expert community, the work will be completed by March 2023.

At the same time, medical care for patients with hepatitis, according to representatives of the patient community, is becoming more accessible. According to the program of state guarantees of free medical care for citizens for 2023 and for the planned period of 2024 and 2025, adopted at the end of December, the treatment of chronic viral hepatitis C will now be carried out “at the expense of compulsory medical insurance within the framework of the basic program of compulsory medical insurance.” Until now, patients with hepatitis have been treated at the expense of regional budgets. According to Nikita Kovalenko, regional programs were accepted only in those subjects whose leaders “understood the importance of treating hepatitis” and where there were “active chief infectious disease specialists.”

Now, each region is obliged to treat hepatitis C and implement measures to prevent this disease within the framework of the territorial program of state guarantees. It should be noted that, according to Together Against Hepatitis, in mid-2022, nine regions had no hepatitis programs at all. And according to the experts of the “Coalition for Treatment Preparedness” project (which monitors public procurement and availability of medicines), in 2021, 28.5 thousand people received treatment at the expense of the state — 1% of the total estimated number of patients with chronic hepatitis C living in Russia.

In addition, in mid-October, the Center for Expertise and Quality Control of Medical Care of the Ministry of Health published changes to the draft clinical and statistical groups (CSG) for 2023, including those for treatment in the day hospital of hepatitis C under compulsory medical insurance (based on the CSG of diseases, the cost of medical care is calculated in under the program of state guarantees). Olga Tsareva, deputy chairman of the FFOMS, explained that in 2022, CSG differentiation was carried out depending on the prescription of drugs: pegylated interferons or direct antiviral drugs. In 2023, depending on the treatment regimen (18 drug therapy regimens). “The cost of one month of treatment for different schemes differs by two and a half times. Unfortunately, while there was only one tariff with normal financial support, sometimes treatment was chosen not according to medical, but according to economic indicators, – says Nikita Kovalenko. – Now the tariffs are set more precisely. This will allow even while maintaining costs at the level of 2022, more patients can be cured only through more rational spending of funds.” Mr. Kovalenko assured that the patient community would “carefully monitor” that the cost of treating hepatitis C “at least does not decrease.”

Natalya Kostarnova