Local hospitals in sparsely populated rural areas will be allowed to sell medicines

Local hospitals in sparsely populated rural areas will be allowed to sell medicines – this bill was approved by the State Duma in the first reading. Deputies point out that almost half of the constituent entities of the Russian Federation are experiencing difficulties in supplying residents of rural and remote areas with medicines. In the future, the authors of the bill plan to legalize mobile pharmacies.

On Thursday the State Duma approved in the first reading bill, which allows local hospitals to sell medications, but only in those localities where there are no pharmacies. The document was introduced at the end of September 2023 by a number of senators and deputies – members of the United Russia faction.

The explanatory note provides a list of organizations that are currently allowed to sell medicines in settlements where there are no pharmacies.

These are outpatient clinics, paramedics and paramedic-obstetric stations (FAP), as well as centers or departments of general medical (family) practice. Lawmakers say the list does not cover every possible situation. Thus, a medical outpatient clinic is organized in rural areas with a population of 2 thousand to 10 thousand people, and a first aid station is organized in settlements where 2 thousand people or less live.

The recommended size of the population served by a local hospital is from 5 thousand to 20 thousand people. But legislators point out that “due to a decline in the rural population,” district hospitals continue to operate in areas where fewer people live “to maintain a higher level of medical care.” The explanatory note cites the Volgograd region as an example, where 66 settlements have rural district hospitals, but 26 of them do not have pharmacies. The total population of these villages and villages is 24,101 people, write the authors of the initiative, and these people have to travel a distance of 8 to 60 km to buy medicines.

Deputies claim that almost half of the constituent entities of the Russian Federation confirm the existence of such a problem and/or support the bill. In these regions there are a total of 125 settlements without a pharmacy, but with a local hospital.

“It is paradoxical that residents of a settlement with significantly greater medical coverage, which local hospitals are able to provide, are forced to travel to a neighboring village to purchase medicines at a first aid station or outpatient clinic,” the explanatory note says.

“It is difficult for a resident of a metropolis, where there is a pharmacy around every corner, to understand what it is like to travel 50 km for medicine. But this is exactly what many of our compatriots are forced to do,” comments the head of the State Duma Health Committee, Badma Bashankaev (United Russia faction). “If the bill is adopted, we will be one step closer to solving the problem of increasing the average life expectancy of our fellow citizens to 78 years”.

Mr. Bashankaev’s colleague on the committee and faction, Evgeniy Nifantiev, points out that the bill “will help increase the physical availability of medicines” in those settlements where there is currently no opportunity to purchase them.

“And work in this direction continues. Already, my fellow deputies and senators and I are working on the next step – a bill on mobile pharmacies,” he says.

Executive Director of the Association of the Health Products Industry and the National Pharmaceutical Chamber Union, Elena Nevolina, calls the initiative “generally important”, since it will significantly improve the availability of drug care in those localities where there are no first aid stations and pharmacies. These are settlements with a small number of inhabitants and low purchasing power of the population, she notes: “It is not just unprofitable to maintain a pharmacy there on a permanent basis. Not a single private pharmacy can withstand living there: there won’t be enough either for rent or for salaries.” Chairman of the National Association of Healthcare Managers, Muslim Muslimov, adds that hospitals have the necessary infrastructure for storing medications: “In addition, we should not forget about convenience: after seeing a doctor, the patient will be able to purchase the necessary medications almost immediately, without leaving the building.”

According to Ms. Nevolina, there may be only one obstacle to the implementation of this initiative: “It will be necessary to buy medicines from the budget of the medical organization for further resale. Therefore, the question arises how ready the hospital is for this. After all, the return of these funds will be delayed.” The Health Protection Committee clarifies that the principle of operation will be the same as that of the FAP. Now the manufacturing plant transfers a batch of drugs to a distributor company that has a wholesale pharmaceutical license (at the same time, it notes the transfer of drugs in the drug flow monitoring system; MDLP). The distributor supplies medications to medical institutions, and they transfer part of the medications to the subordinate FAP (and must also note information about the transfer of drugs to the MDLP system). Then the FAP sells the medicines to the consumer, making a note in the MDLP system about the removal of the packaging from circulation.

At this stage, difficulties begin, Lyudmila Gubina, manager of the Krasnoyarsk pharmacy chain of JSC Gubernskiye Apteki, told Pharmvestnik.

The main problems are unstable communications in rural areas, insufficient equipment of the FAP with special programs and scanners, as well as the difficulty of transferring data to the MDLP system.

“The process is so labor-intensive and complicated that the sale of drugs to the public is kept to a minimum,” stated Mrs. Gubina. Director of the Sakhalin state network “Pharmacia” Inna Grebeneva added that the population receives many complaints about the meager range of drugs in paramedic and obstetric centers, their operating hours and the long wait for a paramedic, who is often busy receiving patients.

Director of the HSE Institute of Health Economics Larisa Popovich points out: the essence of the initiative is not for hospitals to buy medicines for retail. “We are talking about obtaining a license for pharmacy activities. This has long been practiced for FAPs. Hospitals buy medicines within the compulsory medical insurance system; there is money for this in the tariff structure. The pharmacies at these hospitals will supply products for beneficiaries – for budget money – or medicines for sale from distributors or pharmacy chains,” comments Ms. Popovich. “So here we are talking about expanding the number of participants in pharmaceutical activities. The only problem is licensing it. But this is the concern of the regional authorities.”

The Ministry of Health told Kommersant that the department’s position on the bill “is still being formed, the positions of experts, regions, and industry participants are being studied.”

Natalia Kostarnova