The Role of Pharmacoeconomic Studies in Governmental Decision Making on Providing Medicines Aid to t

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The Role of Pharmacoeconomic Studies in
Governmental Decision Making on Providing
Medicines Aid to the Population of the Russian
Federation

• Dr. Ramil Khabriev
• Head of the Federal Service on
• Surveillance in Health and Social Development
• Chief Scientific Officer of the Pharmacy Research
  Institute of the I.M. Sechenov Moscow Medical
  Academy

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Healthcare expenditures without private finances
of individuals (billion RUR)
Statement of Mr. Yuri Zurabov at the 20th
All-Russian Pirogov Congress of Doctors
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Structure of funding medicines supply for the
population of the Russian Federation
Budget funding

• Extra-budgetary funding
• Private finances of individuals

• Federal Budget
• Regional Budgets

Departmental Budgets
Compulsory medical insurance
Voluntary medical insurance
Direct expenditures for medicines
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DLO System (Supplementary Medicines Supply)
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Profound change in the structure of provision of
medicines
Former structure
money
medicine
patient
Resource-determined
New structure
money
patient
medicine
Demand-determined
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Changes in average cost of prescription in 2006
Average cost of prescription as of 04 December
Growth by 3.7
Growth by 3.4
Growth by 1.7
Growth by 2.2
Growth by 1.2
Forecast
Growth by 3
Growth by 3.7
Growth by 2.3
Growth by 4.7
Growth by 25
Growth by 9.3
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Comparative analysis of prescribing, dispensing
and paying for medicines under the DLO program in
2005 and 2006
Prescriptions provided in 2005 increased by 3.6
Medicines provided under the prescriptions increa
sed two times in 2005
Payment increased by 20 in 2006
Prescriptions provided
Medicines provided
Medicines are paid
Medicines left un-provided
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Dynamics of providing prescriptions within the
DLO program in 2005 and 2006
1st quarter
2nd quarter
August
25 September
09 October
05 December
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Comparative analysis of prescribing medicines
under the DLO program and regional budgets in
terms of quantity and amount
Medicines prescribed and dispensed under the
DLO are two Times higher as compared with
medicines under the regional social benefits in
2005 increased by 3.6
Number of provided prescriptions
Medicines dispensed, thousand RUR
DLO
Regional social benefits
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Constituent entities of the Russian Federation
with unsatisfactory level of social medicines
supply as of 04 December 2006
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Comparative characteristics of the prices for
assortment list of the DLO medicines
Deviance of average retail price on the
commercial market from the average on the DLO
market (according to the DLO list)
Oct06
Jan05
April05
Aug05
June06
Aug06
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Cases of refusal from the social services basket

• Reasons
• Low living standards of population, especially
  rural population (450RUR is a notable addition to
  budget)
• Recreation resort treatment Medicines supply
  are included together in the social services
  basket (many rural residents do not use
  recreation resort
• treatment)
• Medical and medicines aid is not yet fully
  affordable/accessible to the population
• Insufficient awareness of DLO among the
  population
• Dissatisfaction with the list of medicines among
  the population
• Dissatisfaction of the population with the
  failure to obtain required medicines at the first
  request

2006
2007
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Optimization of the list of medicines In 2006
2007
List of medicines for 2007
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Analysis of violations uncovered during the
evaluation of administering medicines under the
DLO program (according to the inspections of
Roszdravnadzor)
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Meeting the request for medicines supply for the
3rd quarter of 2006 by constituent entities f
the Russian Federation
Requested medicines for the 3rd quarter
Actually dispensed medicines for the 3rd quarter
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Meeting request for medicines supply in the 3rd
quarter
Amount of actually dispensed medicines for the
3rd quarter
Amount of requested medicines for the 3rd quarter
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Analysis of ratio of requested medicines to
actually dispensed medicines in the 3rd quarter
of 2006
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Funding DLO

• 2005 50.8 billions RUR
• 2006 29.2 billions RUR (10 billions RUR)
• 2007 40 billions RUR

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System of supplementary medicines supply
Expenditures
Responsibility
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Measures for optimization of expenditures for
social-service medicines supply

• Optimization of the list of medicines in terms of
  both INN and trade names.
• Pursuing policy aimed at reducing prices for
  medicines
• Efforts towards the quality of application,
  demand identification (defense of request)
• Strengthening control and supervision over
  prescribing and administering medicines
• Implement the results of pharmacoeconomic studies

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Pharmacoeconomic studies

• The magnitude and level of the DLO program bind
  healthcare organizers to practice a
  scientifically substantiated approach to
  developing the list of medicines, with involving
  pharmacoeconomics professionals and employing
  standard pharmacoeconomic analysis methods

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On Organizing Activities for Developing the List
of Medicines Which Must Be Dispensed upon
Prescriptions of Doctor (Paramedic) in the
Instance of Providing Supplementary Free Medical
Aid to Respective Categories of Citizens Who Are
Entitled to State-provided Social Assistance
Order of the Ministry of Health and Social
Development of the Russian Federation of 15
February 2006, No. 93

• The list must be developed in view of proposals
  of the entities of circulation of medicines,
  healthcare administrations of the constituent
  entities of the Russian Federation, healthcare
  scientists and experts, containing information
  about
• The results of pharmacoeconomic studies
• The list must be developed on the basis of
• The results of pharmacoeconomic studies of a
  medicine within the same pharmacotherapeutic
  group in consistence with commonly adopted
  methods/practices of the assessment of economic
  effectiveness of using a medicine

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The role and position of pharmacoeconomics in the
operational structure of medicines supply to the
population of the Russian Federation

• Treatment undertaken by patients on an
  independent basis
• Outpatient polyclinic aid
• Federal and regional categories of population
  that are benefit-recipients
• Inpatient aid
• Emergency medical aid

Pharmacoeconomics
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Primary need

• Making informed decisions
• Establishing an integrated database of
  pharmacoeconomic studies
• Establishing a scientific methodology center on
  to be operating for pharmacoeconomic studies on
  the basis of the Pharmacy Research Institute of
  the I.M. Sechenov Moscow Medical Academy

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Model of governmental decision making on
providing medicines aid to the population
Governmental decision making
Pharmacoeconomic studies
Pharmacoepidemiological studies
Assessment of actual clinical practice