– The European Business Association has reported that the purchase of medicines under the medical guarantee program may be stopped in Ukraine. According to the latest information from them, this situation will be resolved. Could you please tell us what consequences the stoppage of procurement under the Medical Guarantee Program would have for us?
The draft budget for 2021 plans to allocate 123bn hryvnyas for the medical guarantee program. This corresponds to the budget request that was considered from the Ministry of Finance. But I will remind you that the budget request from the Ministry of Health and the NHSU is 225 billion hryvnias. As you can see, the difference is more than UAH 100 billion. The funds will not be enough, it is obvious, including for the purchase of medicines under the program of medical guarantees, and this is taking into account the treatment of patients with COVID-19. The NHSU analyzed the dynamics of the disease incidence growth and said that by the second quarter of 2021 it will be necessary to reduce the cost of treatment of all patients with coronavirus infection tenfold. It can also be predicted that the 123 billion budget will not allow for the introduction of additional payments for primary and secondary care doctors. And the NHS will have to reduce services such as early diagnosis of cancer. One of the policies implemented by our team (Ulyana Suprun’s team – author) was the policy of the National List of Medicines. All countries have such a policy. When a person comes to the doctor or goes to the hospital, he receives the most necessary medicines, which are guaranteed by the state. Everything that was not included in this approved short list could be purchased with the help of charitable organizations, local budgets, and various missions. But the short list of medicines for the treatment of basic diseases would have to be taken over by the state. Based on the financing, which was in our cadence, there was enough money for half of the medicines of the National List. Therefore, the European Business Association is concerned about the tarapia of those patients whose medicines are not included in the National List, as well as about the protection of interests of pharmaceutical companies that produce these medicines, first of all in Europe. Until the state adds real money to provide the population with the most necessary medicines, or openly says that we can cover only half of the need in this short list, the issue will not be solved. We have launched the “Affordable Medicines” program at the primary level, which covers this need for three nosologies at the outpatient level. In the same way, the need for the most essential drugs at the hospital level must be met. That is the short comment on what the EBA is concerned about.
– The Minister of Health Maksym Stepanov announced that the budget request for 2021 envisages an increase in funding for the reimbursement program to UAH 4.7 billion.In your opinion, is this amount enough to cover the demand?
The amount of 4.7 billion is considerably more than what we started with when we introduced the reimbursement program. But it depends on what you compare it to. If, for example, we compare it with the situation in Poland, where medicines and medical devices worth UAH 100 billion are reimbursed. In Poland, reimbursement is carried out by the National Health Fund. This is a state organization, which, like our NHSU, is responsible for the policy of reimbursement of the cost of medicines to the population. There are several reimbursement mechanisms in the world, and they are all different. For example, in France, reimbursement is available only to insured citizens. In Germany, it is based on the principle of compensation for pharmacies. But if we analyze the EU countries as a whole, the reimbursement of the cost of medicines for the population is on average 70-90%. As the author of the idea of the “Affordable Medicines” program, I proposed the option of 100% reimbursement. But this reimbursement works together with the mechanism of external price referral, in which case patients could receive full compensation from the state. Now the Medical Guarantee Program for 2021 is still in the process of formation, but I know that drugs that treat mental disorders, such as epilepsy, anxiety, etc., were to be added there, but it is not so simple. Potent drugs are a separate category of drugs, and not all pharmacies will be able to sell them according to the rules established in the Affordable Drug Program. I know that medicines that prevent repeated heart attacks and strokes were to be added.
– Will the coronavirus vaccine be available to all Ukrainians?
Organizations that are members of the People’s Vaccine Alliance made a general announcement that Ukraine, as a participant in the COVAX program, will receive 8 million doses of vaccine free of charge, which will be used to vaccinate 4 million Ukrainians, since vaccination requires 2 injections. The vaccine will be available to people who are at high risk. This category in Ukraine counts about 2 million people: doctors, education, culture, police, military. For the rest, the vaccine will not be available until the fall of 2021. This is due to its physical unavailability. Naturally, most countries with a high standard of living will provide for their citizens first. For example, Canada has already purchased vaccine for its entire population. And poorer countries will receive the vaccine in a smaller volume. And it is clear that African countries may not receive any vaccine at all, unless WHO finds a mechanism to help them. Vaccination has an effect only when we vaccinate at least 80% of the population, then collective immunity is developed and we are protected. When we vaccinate a small part of the population, even 10%, we are not talking about collective immunity. It’s about protecting those people who are on the front lines who encounter the sick so that the pandemic does not spread exponentially.
– Will the saved doctors save the rest of us?
That’s about as far as it goes. There are other difficulties besides the physical lack of the right amount of vaccine. For example, difficulties with logistics. The condition that the vaccine must be transported at a temperature of minus 70°C is something that many people will not be able to meet.
– Analysts are now talking about the coming crisis, which, even with all the high sales, will also hit the pharmaceutical market. Could you comment on the outlook for 2021?
The past 2020 was a very challenging year for the domestic pharmaceutical industry. In January-February, there was a sharp increase in sales. And in the spring – a 20% drop. Then scheduled surgeries were postponed, visits to doctors decreased and, accordingly, the number of prescriptions and consumption of medicines decreased. To this we must also add the decline in the population’s income. People did not work and did not understand what awaited them tomorrow, so they tried not to spend money. Now we are seeing some revitalization of the market. The use of antibiotics, anticoagulants, analgesics, antiviral drugs is growing. But I believe that Ukrainian pharma has a huge potential, which was formed over a long period of time. Before the pandemic, the industry grew by about 10% per year. According to analysts, by the end of 2020 we will see an average market growth of 5%. This is a good indicator, because the other markets – global and European – are far from being as successful. As for the forecasts for 2021, I assume that the pharmaceutical market will grow by 8-10%, including at the expense of exports. I am sure that today export is the most correct vector for the development of the domestic pharmaceutical market. We have a huge potential for this. It is not easy to enter the international market, but it is always better than manufacturers fighting among themselves in Ukraine.
Shutterstock/FOTODOM UKRAINE photos were used
