United onco does not work – Kommersant

Cancer drugs “Abraxane” from the American BMS and “Picray” from the Swiss Novartis, which are not included in the list of vital drugs (VED), included in treatment regimens financed by compulsory medical insurance (CHI) in 2023, will be excluded from next year from this mechanism. Now the regions will have to purchase drugs at their own expense, government purchases of which increased by almost 63% year-on-year in January-September of this year. This will lead to difficulties in obtaining medications for patients, as there is a lack of funding in the regions, experts warn.

Government purchases of oncology drugs based on paclitaxel with albumin (Abraxane from BMS) and alpelisib (Picray from Novartis), used in the treatment of various types of cancer, grew by 62.8% in the three quarters of 2023, to RUB 1.56 billion ., calculated by Headway Company at the request of Kommersant. Although “Abraxan” and “Picray” are not included in the list of vital and essential drugs, this year for the first time since 2020 they were included in the clinical and statistical groups – this means that they are used in hospitals at high rates, paid from the funds of the Compulsory Medical Insurance Fund.

This happened because these drugs were approved in 2022 by a commission of the Ministry of Health for inclusion in the list of vital and essential drugs for 2023, recalls expert of the All-Russian Union of Patients Alexey Fedorov. As a result, these funds were not included in the list, but remained in the grouping of clinical and statistical groups, on the basis of which compulsory medical insurance tariffs are calculated. At the same time, since 2021, cancer drugs not included in the list of vital and essential drugs were paid at an average rate that did not cover their cost (see “Kommersant” dated July 12, 2021).

Tariffs for these two drugs, which were financed from compulsory medical insurance funds, were formed taking into account the maximum prices that manufacturers were obliged to register when including drugs in the list of essential drugs, explains Alexey Fedorov. According to the Ministry of Health, a product based on paclitaxel with albumin should have been included in this list with a maximum cost of 12.9 thousand rubles. per bottle, and alpelisib – 134.9 thousand rubles. per package.

However, from 2024, financing of treatment with Abraxan and Picray will again fall on the shoulders of regional budgets, follows from the response of the Ministry of Health and the Federal Compulsory Medical Insurance Fund to Kommersant’s request. They say that regional authorities can prescribe drugs outside the list of vital and essential drugs in territorial state guarantee programs and allocate funds from the budgets of constituent entities of the Russian Federation to cover the costs of their purchase. Swixx Biopharma (supplies BMS drugs to the Russian Federation) and Novartis declined to comment.

The patient can receive drugs not from the list of vital drugs by decision of the medical commission in case of individual intolerance to other drugs or for other indications, explains Galina Margevich, deputy chairman of the coordination council of the Movement Against Cancer. According to her, regions are reluctant to finance treatment with drugs that are not included in the list of vital and essential drugs. In some cases, patients have to enforce the appointment of a medical commission by going to court, adds Ms. Margevich.

In mid-November of this year, at the Russian Oncology Congress, Deputy Head of the Federal Compulsory Medical Insurance Fund Olga Tsareva stated that treatment regimens that use drugs not included in the list of vital and essential drugs will be excluded from the grouping of clinical and statistical groups in 2024. According to her, in this regard, the fund received about ten letters from different regions.

The burden on the regions will increase, as patients are accustomed to receiving expensive drugs, says Galina Kryuchkova. Such a load, says Nikolay Bespalov, director of development at RNC Pharma, does not allow regions to expand funding for the treatment of diseases and creates inconvenience from the point of view of the lack of uniform rules. At the same time, the federal fund clarifies that over the nine months of 2023, medical care using regimens with drugs not included in the Vital and Essential Drugs was provided in only 0.4% of cases.

Polina Gritsenko