Russians with heart problems are entitled to important benefits

— Yuri Alexandrovich, how has the situation with cardiovascular diseases changed over the past 10 years? What are the main trends?

— If we talk about the medical care system, the situation has changed for the better. The country is implementing a national project to combat cardiovascular diseases, specialized medical centers are opening, and modern treatment methods are being introduced. The development of a system of preferential drug provision also plays an important role. Recently, Resolution No. 1254 was adopted, which allows patients with CVD to receive medications free of charge for two years.

— What categories of patients with CVD can count on free drugs? And what subsidized drugs are we talking about?

— Basically, the system of preferential drug provision is divided into two parts: a regional preferential program and preferential drug provision at the expense of the federal budget. At the expense of the regional budget, disabled people of group I and non-working disabled people of group II, as well as a number of preferential categories of citizens and patients suffering from certain diseases can receive free of charge the medicines they need for medical reasons. Working disabled people of group II and disabled people of group III can receive medicines at a 50% discount. This system is regulated by Decree of the Government of the Russian Federation No. 890. At the expense of the federal budget, free medicines are provided to patients who have disabilities, regardless of their group.

I have already mentioned a separate benefit program aimed directly at patients with cardiovascular diseases. These are patients who have suffered an acute cardiovascular event: myocardial infarction, stroke, as well as surgical interventions such as coronary artery bypass grafting, coronary artery angioplasty with stenting, catheter ablation. The list of preferential drugs currently includes 31 items. It is important that the right to receive free medications does not depend in any way on disability status, that is, any patient who has suffered an acute cardiovascular event can receive free medications. This is a very important step for patients with CVD, since preferential drug coverage can increase life expectancy and maintain its quality. Without taking the necessary medications, the risk of developing recurrent acute cardiovascular events and complications significantly increases.

— How do you assess the level of awareness of patients with CVD about their rights and existing government support programs?

— Here again, two aspects need to be highlighted: providing for patients with disabilities and providing patients with a preferential program to combat CVD.

Patients with disabilities are generally well aware of the benefits they are entitled to, as this program has been in effect for a long time. However, there is another problem. Often, patients with disabilities refuse a social package, which includes medications, in favor of a so-called single cash payment. The amount is not particularly high; now the social package is estimated at approximately 1,500 rubles. This decision deprives patients of the right to receive medications under federal benefits, as a result of which many refuse to take the drugs. Unfortunately, there are a lot of people who refused the social package. In some regions the share reaches 80–90%. Most people prefer money, without thinking that in the event of any complication they may need expensive medications for which they do not have money, because the cost of providing medications for one patient with cardiovascular disease reaches several thousand, and sometimes more , rubles per month.

Regarding the preferential program for patients with CVD, unfortunately, the level of awareness is quite low. This is also due to the fact that doctors do not always tell patients about the benefits they are entitled to. There is another serious problem – low patient adherence to therapy. Thus, according to the results of our survey, it turned out that on average, patients receive preferential medications not for 2 years, as expected, but for about 6 months. That is, they stop taking medications that the doctor is ready to prescribe for them free of charge. The tragedy here is that stopping the medications can lead to recurrent heart attacks and strokes, from which many patients may not survive.

— Why do you think patients do not receive the drugs they are entitled to free of charge?

“Some people do not understand the consequences that may occur if therapy is interrupted, and this, again, is the risk of a recurrent acute cardiovascular event. Another reason is a lack of seriousness about one’s health. By the way, this problem is more common among men. Of course, there are diseases in which the patient is very aware that he may die if he stops treatment. And after acute cardiovascular events and appropriate treatment, patients begin to feel better and immediately decide that they can live as before and continue to lead an unhealthy lifestyle. Unfortunately, patients often do not realize that the disease can return in a much more severe form.

Therefore, it is important to inform patients and reach them in all possible ways: directly, through the media and social networks. Last year, the All-Russian Patients’ Union launched an information campaign aimed at patients with cardiovascular diseases. As part of the campaign, we talk about cardiovascular diseases and their risks, about the possibilities of prevention, diagnosis and treatment, about the rights and responsibilities when receiving medical care and drug supply. The problem of patient awareness must be solved jointly with the state, doctors, and public organizations. Families also play a big role. We believe that the family is no less important than the patient himself. She should be the doctor’s ally in the fight for the patient’s health.

— How often do patients with CVD come to you with a request to resolve the situation with receiving preferential medications?

— I cannot say that cardiovascular diseases are the leader in complaints from patients. Sometimes there are interruptions in the supply of medicines in certain regions. For example, we recently had requests from patients from the Tomsk region, we wrote an appeal to the regional Ministry of Health on this topic. Recently, the head of the region, Vladimir Mazur, announced the allocation of additional funding for the purchase of drugs for preferential categories of citizens. We hope the problem will be resolved.

— Is there a problem with the fact that it is difficult for patients to complete documents? Are these questions addressed?

— The set of documents for applying for benefits is not so large: passport, SNILS, compulsory medical insurance policy and extract. And this is where a problem may arise – getting an appointment with a specialist with whom it is difficult to make an appointment. Not everyone is ready to wait and go to doctors’ offices. Especially when a person feels better after an acute cardiovascular event. He thinks that even without drugs everything will be fine. Unfortunately, this often ends badly.

— What to do if the patient is not given the drugs that are required by law?

— First, contact the administration of the medical institution, where they must issue a prescription. Secondly, write an appeal to Roszdravnadzor, the Federal Service for Surveillance in Healthcare, it has branches in each region. Thirdly, contact the regional Ministry of Health, because it oversees the provision of preferential medicines and the activities of medical institutions in the region. In addition, you can contact the prosecutor’s office if the patient sees serious violations of his rights. If a patient is denied medications while he is in a hospital, then the medical insurance organization must be involved. VSP hotline consultants are ready to advise you on how to competently protect your rights.

— Quite often, patients complain that they are prescribed generics instead of the original drug. What to do in such a situation?

— The issue concerns not only the CVD, it is an issue for the entire healthcare system. The fact is that within the framework of public procurement, auctions are carried out by international non-proprietary name, that is, by the name of the molecules. Of course, price plays a key role here. For obvious reasons, when generics come out, they win these auctions.

Is it possible to do something about this? Formally, everything complies with the law; you cannot just come and say: “I want the original drug.” But if any complications arise after taking a generic drug – for example, allergic reactions or the drug is ineffective – the patient has the right to report this to the attending physician and undergo a special medical commission, by which a decision may be made to purchase the original drug.

— Are existing measures to provide preferential medications to patients with CVD sufficient? What additional measures can be taken?

— Of course, we shouldn’t stop there. First of all, it is necessary to expand the benefit period for patients. It is also necessary to include in the program patients who suffer from chronic cardiovascular diseases, such as coronary heart disease or chronic heart failure. Now subsidized drugs are issued only after an acute event, but if you look at the structure of mortality from CVDs, the leaders here are precisely chronic diseases, not acute ones: they account for two-thirds of all deaths from diseases of the circulatory system. To include these patients in the drug benefit program, of course, additional funding is needed, but this measure could potentially save tens of thousands of lives.

— In August, news appeared in the media that the Russian Ministry of Health postponed indefinitely the meeting of the commission on VED (the list of essential and life-saving drugs). Please explain why this meeting is necessary? Could this affect the availability of drugs in general and drugs for the treatment of CVD?

“We are concerned about the situation surrounding the work of the Ministry of Health commission on the formation of a preferential list, because the meeting has already been postponed several times, and this means that a number of drugs that had a chance to be included in the list of vital drugs for 2024 will no longer be included there.

Why do we need a list of vital drugs? This is a list according to which the maximum price for these drugs is set. That is, the state regulates maximum prices for drugs, which allows them to participate in the public procurement system. The law clearly states that, within the framework of the state guarantee, drugs from the list of vital and essential drugs are purchased first. If a drug is not included on this list, patient access to it is significantly limited. Some hospital may buy it, but this happens in exceptional cases, again most often with the involvement of a medical commission. This is a rather complex bureaucratic process. The suspension of the inclusion of new drugs in the list of vital and essential drugs means a decrease in the availability of modern innovative drugs for patients.

Yes, you can buy it at the pharmacy, but the price for it will be as determined by the pharmacy or the manufacturer. And okay, if it’s a few hundred rubles, but what if it’s thousands, tens or hundreds of thousands of rubles? Thus, expensive drugs, if they are not on the VED list, actually become inaccessible to our citizens.