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2023

Why contracts for the supply of Varian equipment for radiation therapy for 1.5 billion rubles fell through in Russia

In early December 2023, it became known that Russian customers could not receive Truebeam equipment of the American Varian for radiation therapy under contracts that were concluded in April-May 2022. We are talking about the breakdown of contracts worth approximately 1.5 billion rubles. Read more here.

The government allocates billions of rubles for the production of medical nutrition for cancer patients

On November 8, 2023, Deputy Prime Minister Tatyana Golikova presented to President Vladimir Putin the results of work on the production of medical nutrition. The corresponding plan was prepared by the Ministry of Industry and Trade, the Ministry of Agriculture and other interested ministries and departments, including the Ministry of Health, the press service of the Cabinet of Ministers clarified.

It is noted that Minpromtorg and the Ministry of Agriculture give support to producers. Among them:

• Biotech Rosva, which is establishing a project to produce 11 of 17 amino acids. By 2025, it is planned to produce 120 thousand tons annually. Biotech Rosva allocated 400 million rubles;
• JSC PromBiT, in partnership with JSC GloboKiT, is implementing a project to produce a wide range of amino acids. By 2026, up to 100 thousand tons will be produced. The volume of investments in the project is estimated at 2 billion rubles;
• CJSC Infaprim, which produces protein hydrolysates. The volume of investments is 2 billion rubles.

The government will support manufacturers of medical nutrition

This direction, as well as all others that were announced today, are under constant control with us, and we monitor both the deadlines and the results of the implementation of these areas, "Tatyana Golikova emphasized.

According to her, in order to identify oncological diseases at earlier stages, it is planned to improve the clinical examination program and the system of payments to health workers for the detection of oncology.

The problem with the availability of specialized nutrition for patients on chemoradiation therapy in November 2023 was raised by the head of the executive committee of the Popular Front, Mikhail Kuznetsov. He noted that if during treatment in a hospital, cancer patients are provided with everything necessary, then those who are treated on an outpatient basis do not have such a guarantee.

Russian specialized nutrition is sorely lacking, and due to the high cost of foreign nutrition, patients are forced to buy analogues: they buy mixtures for athletes who, in terms of medical qualities, do not correspond to special medical ones, "Kuznetsov explained.[1]

2022

Spending 325 billion rubles on medical care for cancer patients under compulsory medical insurance

In 2022, about 325.3 billion rubles were actually spent on paying for oncological medical care in inpatient and day hospital conditions within the framework of territorial and basic compulsory medical insurance programs, which is 10% more than a year ago. This was reported on February 3, 2023 by the Federal Compulsory Health Insurance Fund (FFOMS).

The main part of the funds of about 240 billion rubles (8.3% higher than the level of 2021 - 220.2 billion rubles) was directed to antitumor drug therapy. 16.5 billion rubles were allocated for radiation therapy (23.1% higher than in 2021); for radiation therapy in combination with antitumor drug therapy - 5.3 billion rubles (6% higher than in 2021); for surgical treatment - 45.9 billion rubles (12% higher than in 2021).

325 billion rubles were allocated to pay for cancer care from compulsory medical insurance in 2022

As stated in the FFOMS, the growth of financial support made it possible to improve the quality indicators of medical care, so in the period from 2019 to 2022 there was an increase in the 12.3% level of use of highly effective targeted drugs in a 24-hour hospital, 19.2% in a day hospital, as well as an increase in the 11.9% multiplicity of chemotherapy courses per patient.

Despite the current situation, the availability of chemotherapy for cancer patients, including with the use of highly effective targeted drugs, remains at a high level. The share of cases of medical care is also growing, one of the progressive technologies for the treatment of cancer - conformal radiation therapy, which is more gentle, that is, with a relatively lower risk of radiation damage, - said Ilya Balanin, chairman of the Compulsory Health Insurance Fund.[2]

According to him, in 2019 the share of conformal radiation therapy was 30.3%, in 2020 - 40.7%, in 2021 - 51.2%, and in 2022 - 56% of the total number of cases of radiation therapy

The Ministry of Health approved a single operator for the purchase of cancer drugs for federal medical centers

In September 2022, an order was signed by which the Ministry of Health approved a single operator for the purchase of cancer drugs for federal medical centers. It was the Federal Center for the Planning and Organization of Drug Provision of Citizens (FCPILO). Read more here

2021

Reimbursement to cancer patient 406 thousand rubles spent on medicines, which should be free

As it became known in mid-September 2021, the Supreme Court (Supreme Court) of Russia issued a decision according to which the Health Committee of the Volgograd Region is obliged to compensate for the costs of independent purchase by citizens of drugs, which, according to the law, should be provided to them free of charge. Since the patient died, the money should be returned to his heirs.

A resident of the Volgograd region faced the problem of compensation for the cost of buying free drugs. Her husband suffered from severe oncology and was recognized as disabled by group II. He was supposed to be provided with medicines for free. However, the health committee delayed the purchase of the drug until additional funding was received, so the family bought the drug on their own. When the man died, his widow went to court with a claim for compensation for expenses.

The Supreme Court ordered the Ministry of Health to reimburse the relatives of the deceased cancer patient 406 thousand rubles spent on medicines that should be free

The department refused the woman, saying that the right to reimbursement of treatment costs is not inherited. As a result, the woman turned to the RF Armed Forces. They noted that ensuring the implementation of the rights of citizens in the field of health protection is one of the principles of legislation.

The money forced to spend on the purchase of medicines refers to the losses of the testator in the form of real damage, the court said. Consequently, the Volgograd Region Health Committee is obliged to pay the widow and son of the deceased 203 thousand rubles each.

If a citizen entitled to free provision of a medicinal product was not provided with it and this circumstance led to the need for a citizen to pay the cost of this medicinal product at his own expense, then the funds spent, documented, must be reimbursed at the expense of a state body, who has not fulfilled the tasks properly assigned to him to organize the medicinal provision of the population, on the basis of Article 15 of the Civil Code of the Russian Federation as losses caused to a person whose right was violated, the definition of the Supreme Court says.[3]

Cancer treatment in Russia has become unavailable due to compulsory medical insurance reform

As it became known on July 12, 2021, the decision of the Russian authorities on the residual principle to pay for chemotherapy based on expensive drugs from compulsory medical insurance (compulsory medical insurance) led to a significant decrease in purchases - by 67% in January-June 2021 relative to the same period in 2020 (up to 647.4 million rubles). Expensive treatment has become unavailable for most oncology patients.

Writes about this Kommersant with reference to the Headway Company. The largest - by 75% - fell purchases of torisel (active substance temsirolimus) and javlor (vinflunin), used to treat kidney cancer, and bladder by 70% - abraxan (paclitaxel + albumin), used in pancreatic cancer. In January - June 2020, when treatment with these drugs was covered by the compulsory medical insurance tariff, state order operators spent almost 2 billion rubles on them.

The decision of the authorities to pay for chemotherapy based on expensive drugs that are not included in the list of vital drugs from compulsory medical insurance (compulsory medical insurance) led to a 67% reduction in purchases of such drugs

They completely stopped purchasing expensive anti-cancer drugs in Ivanovo, Murmansk, Oryol, Kirov, Magadan, Novgorod regions  and Chechnya. At the same time,  in Tatarstan, the Khanty-Mansiysk  Autonomous Okrug , the Tyumen Region and in seven more regions, volumes have been preserved.

Of the compulsory medical insurance, a maximum of 14 thousand rubles is compensated for payment for treatment with drugs that are not included in the list of vital, while the average cost of abraxan therapy is 200-250 thousand rubles, and vinflunine - 130 thousand rubles. The only exception is  Moscow, where the full cost of treatment is paid.

Dmitry Kuznetsov, vice president of the All-Russian Union of Insurers, also notes that payment for treatment with drugs that are not part of the classification of the Federal Compulsory Medical Insurance Fund is made as for "other" schemes, respectively, there is a possibility that it may be significantly lower than the cost of the drugs used.^[4]

300 billion rubles are allocated for cancer assistance in compulsory medical insurance

In 2021, more than 300 billion rubles are allocated for the provision of cancer care under compulsory medical insurance, which is almost 12% higher than a year ago. This was reported in the Federal Compulsory Medical Insurance Fund.

According to its chairman, Elena Chernyakova, most of the planned financial support for cancer care for compulsory medical insurance will be for drug antitumor therapy.

In 2021, 300 billion rubles are allocated for cancer assistance under compulsory medical insurance

Within the framework of chemotherapy treatment, the cost of drugs was allocated separately in order to more differentiatively approach payment for medical care, taking into account all the adjustment coefficients of differentiation used, she said at the Gaidar Forum.

It is expected that 135 billion rubles for the provision of cancer assistance under compulsory medical insurance will be allocated from the federal budget - under the program "Fight against cancer." Earlier it was about costs in the amount of 140 billion rubles.

The number of treatment regimens increased from 1069 to 1467, they additionally included 11 drugs, but which ones, Chernyakova did not specify. For 2021, the list of vital drugs was expanded to eight drugs:

• avelumab (Bavencio for German Merck);
• olaparib (Linpraza by AstraZeneca);
• prolgolimab (Forteca by Biocad);
• midostaurin (Myticade by Novartis);
• durvalumab (Imfinzi by AstraZeneca);
• apalutamide (Erleada by J&J);
• abemaciclib (Zenlistic from Eli Lilly);
• cabozantinib (Cabometyx from Ipsen).

In 2020, the list was replenished with such drugs as:

• ramucirumab (Ciramza by Eli Lilly);
• alectinib (Alekzenza by Roche);
• osimertinib (Tagrisso by AstraZeneca);
• bozutinib (Bozulif from Pfizer);
• venetoclax (Venclecta by AbbVie);
• elotuzumab (Emplicity from BMS);
• palbociclib (Itulsi by Pfizer);
• axitinib (Inflita from Pfizer).

Elena Chernyakova noted that the cost of the completed case of treatment increased "by almost a third," the multiplicity of courses per insured reached 5.

2020

Russians spend billions on cancer drugs with the state allocated 200 billion rubles

According to the IQWIA Research Center, in January-September 2020, Russians spent 2.58 billion rubles on the purchase of cancer drugs. The largest expenses fell on the drug "Methotrexat-Ebewe" - 233.94 million rubles. In addition, the list of best-selling medicines for the treatment of cancer includes:

• Buserelin-depot (220.83 million rubles);
• Femara (145.54 billion rubles);
• Zoladex (130.7 million rubles);
• Anastrozol (93.46 million rubles).

According to Kommersant, the national project "Healthcare" includes the cost of providing the population with cancer drugs free of charge. In 2019, this budget amounted to 150 billion rubles for 2019, in 2020 - 200 billion rubles.

Russians spend billions on cancer drugs with the state allocated 200 billion rubles, the largest costs fell on the drug "Methotrexat-Ebewe"

However, Russians still spend a lot of their own money on the purchase of drugs for the treatment of cancer, and for that there are several reasons. One of them is that some drugs are still not included in the program of high-cost nosologies. This, for example, refers to the popular drug "Imbruvika," used in the treatment of blood cancer. The Ministry of Health of the Russian Federation has repeatedly refused to include this tool in the public procurement system, demanding that the manufacturer Janssen reduce the price, which by the beginning of December 2020 is 500 thousand rubles.

Some patients refuse free Russian drugs in favor of foreign ones. So, when choosing oncourological drugs, patients choose originals produced by foreign companies that cannot be obtained under the Campus Management compulsory medical insurance in state medical institutions, said Bahodur Kamolov, Development Director of the Russian Association of Oncologists.

Ravil Niyazov, a specialist in the development and regulation of drugs at the Center for Scientific Consulting LLC, explained the difference between foreign and Russian generics by the fact that bioequivalence tests of many domestic drugs do not meet international scientific standards for planning, conducting and interpreting such studies.^[5]

New procedure for dispensary monitoring of cancer patients

Every year 300,000 thousand Russians die from neoplasms. At the same time, 39% of stage 3-4 cancer patients themselves did not seek medical help. Oncologists and representatives of the insurance community believe that the new procedure for dispensary monitoring of cancer patients, approved by the Ministry of Health in 2020, will significantly change the current situation.

Since 2018, third-level insurance representatives, employees of medical organizations have been accompanying patients with cancer. Third-level insurance representatives are expert doctors of insurance organizations, often doctors and candidates of medical sciences who have the highest qualification category. At all stages of treatment, from the moment of suspicion and diagnosis of malignant neoplasm, insurance representatives provide the patient with individual information support, legal and consulting support for obtaining high-quality medical care within the framework of the Campus Management compulsory medical insurance system.

The effectiveness of the treatment of malignancies depends on the timeliness of the diagnosis of the disease. In the case of oncology, it is dangerous to hesitate. In 2020, the waiting period for medical care for patients with cancer was significantly reduced:

1. The terms of consultations of specialist doctors in case of suspicion of cancer should not exceed 3 working days.

2. The timing of diagnostic instrumental and laboratory tests in case of suspected oncological diseases should not exceed 7 working days from the date of appointment of the studies.

3. The period for establishing a dispensary observation of an oncologist for a patient with an identified cancer should not exceed 3 working days from the moment of diagnosis of cancer.

4. The waiting period for specialized (except for high-tech) medical care, including for persons in inpatient social service organizations, for patients with cancer - 7 working days from the moment of histological verification of the tumor or from the moment of establishing a preliminary diagnosis of the disease (condition).

If the timing of diagnosis and treatment is violated, contact your health insurance organization. Insurance representatives will organize expert events, establish the causes of violations and help get the necessary medical care in order to defend the rights of their insured to timely and high-quality treatment. Filing a complaint with insurance companies in more than 98% of cases leads to the restoration of the patient's rights in the field of protecting his health.

In the first half of 2020 alone, more than 13 thousand patients with cancer turned to insurers. Of these, 12.8 thousand appeals managed to achieve the restoration of patients' rights.

As noted by Alexei Starchenko, professor, member of the Public Council under the Ministry of Health of Russia, member of the working group for the development of compulsory medical insurance of the All-Russian Union of Insurers: "Insurance medical organizations conduct targeted medical and economic examinations in all cases of medical care in the" oncology "profile with the use of anticancer therapy. In the structure of violations identified during targeted medical and economic examinations in some regions, 15% are cases of non-inclusion of the insured in the group of persons of dispensary observation, in 12% of cases there was a discrepancy between the data of the primary medical documentation and the data of the register of accounts, in 9% of cases, medical organizations did not confirm the fact of providing medical care to insured persons, in 4% of cases, violations of the conditions for the provision of medical care were revealed, including violations of the terms of its provision. "

According to the new order of the Ministry of Health, in 2020, dispensary observation is established within 3 working days from the date of diagnosis of cancer and receipt of informed voluntary consent to medical intervention.

In order to obtain individual information support for an oncological patient, it is necessary to give appropriate consent when obtaining a compulsory medical insurance policy or during a visit to the office of an insurance company.

If there is consent, the insurance representative organizes free information in a form convenient for the patient.

Dispensary observation by oncologists turns out to be free to all citizens of the Russian Federation, according to the compulsory medical insurance policy. It is carried out for timely detection or prevention of complications and exacerbations of diseases, their prevention, as well as for effective rehabilitation. According to oncologists, with early detection of a tumor, a favorable outcome can be observed in at least 97% of cases. Dispensary observation can be stopped, in the event of a written refusal of the patient, or in the event of certain legally significant events, such as detention.

Only an oncologist of the primary oncological office, oncological dispensary or other specialized medical institution has the right to conduct observation. According to the new procedure, the doctor was assigned a list of responsibilities, in particular: the establishment of a dispensary observation group, the development of an individual observation plan, the organization of medical events, the provision of information to a single information system in the field of health care in the region. His responsibility also includes conducting consultations through telemedicine technologies and organizing dispensary registration (consultations and examinations) at home if the patient cannot independently visit a medical organization for medical reasons.

If the patient travels outside the region of residence for more than six months, he must inform his doctor about this in advance to ensure the continuity of dispensary observation. This innovation is aimed at ensuring the continuity and effectiveness of dispensary observation of the patient.

An exception was made for patients with basal cell skin cancer who received radical treatment - they were given a follow-up period of 5 years. If during this period the patient has not been diagnosed with a relapse, then the patient is removed from the dispensary record. For the rest of the patients, the period of dispensary registration remained for life.

The new order of the Ministry of Health for each nosology indicates the recommended frequency of dispensary appointments, which allows insurance representatives to easily navigate the schedule for monitoring cancer patients, as well as promptly remind them of upcoming medical events.

"When the patient is aware in advance of what procedures are coming, this allows psychologically prepared, and forms adherence to treatment and compliance with medical recommendations in patients. The representative of the insurance company will also find out why, for example, the patient missed the appointed appointment or procedure, and whether this is a flaw in the oncologist, "notes Alexey Starchenko. "Oncology treatment is often fraught with comorbidities. And with appropriate complaints, the doctor is obliged to send a consultation to narrow specialists, and not to consider that such a course of events is the norm. If an expensive drug is needed to treat concomitant diseases, it is important to understand that all drugs and maintenance therapy are provided free of charge by compulsory medical insurance. There should be no additional payments "for a good drug" if they require additional payments - call the insurance company. "

The tasks of insurance representatives include: · Participation in the resolution of disputes arising between the insured person and the medical organization in the provision of medical care in order to take measures aimed at observing and restoring the rights of the insured; · Advice on obtaining various types of medical care, including specialized highly qualified care; · Information on preventive measures, accounting and control of their passage; · Control over the organization of planned hospitalizations; · Monitoring of medical examination; · Individual support of insured persons with chronic non-communicable diseases, as well as oncological patients placed on dispensary observation after the provision of inpatient medical care; · Informing insured persons about the need for timely passing of dispensary examinations.

Violation of the rights of cancer patients has another important aspect - the unwillingness of the insured themselves to devote time to onco-screening. As an expert of the All-Russian Union of Insurers notes, Sergey Shkitin:

"During the 6 months preceding the time of the diagnosis of cancer at stage 3-4, a third of patients did not seek medical help, the remaining 2/3 received medical assistance, and more than half of them attended a reception with specialized specialists who could identify the neoplasm of the corresponding localization. The effectiveness of therapeutic measures in cancer largely depends on the early detection of this pathology, which in turn depends on the onconference of doctors of various specialties and the patients themselves. "

With any questions about free medical (including oncological) care for compulsory medical insurance, you can contact your insurance organization, which issued a compulsory medical insurance policy at the number indicated on the Internet. You will receive an appeal and answer the questions that have arisen. For this purpose, from 2016 to the present, the Institute of Insurance Representatives has been working.

2019: Expanded Cancer Care Services Regulation

In 2019, the state allocated 198 billion rubles to expand the compulsory medical insurance program, from which it follows that citizens with an insurance policy can count on a significant expansion of the list of medical services in medical institutions. Thanks to the increase in funding, the state guarantee program for 2019 includes innovations that are aimed at developing an oncological profile. Now, according to the basic compulsory medical insurance program, there is a standard for the volume of medical services provided in this area in the conditions of both a day and a round-the-clock hospital. In addition, in connection with the increased funding of the compulsory medical insurance program, medical institutions began to use effective drugs, without replacing them with cheap analogues.

Also in 2019, the government ordered annual subventions to regional funds for the implementation of the compulsory medical insurance program in the amount of 2 trillion 68 billion rubles, which, in turn, is 10.6% higher than in 2018. In this regard, residents of the Moscow region and other regions are advised to pay attention to the possibility of obtaining medical services under the insurance policy in private Moscow clinics, which are believed to be equipped with more modern equipment and where modern methods of treating cancer are used.

How to get on treatment under the compulsory medical insurance policy in a private clinic

To receive free cancer treatment in a private clinic, you must have:

• passport of a citizen of the Russian Federation,
• compulsory medical insurance policy, also issued in the Russian Federation,
• direction in form 057-y,
• SNILS,
• extract from the medical record,
• all other medical documentation for this disease and information about other diseases that the patient has and the treatment that the patient is currently receiving.

What cancer treatment can a patient receive in a private clinic

The patient can conduct diagnostic studies free of charge within the framework of compulsory medical insurance, for example, PET/CT and SPECT, chemotherapy and surgical treatment, and patients registered in Moscow can also receive radiosurgical treatment or radiation therapy, said Olga Yurievna, head of the oncological center of the leading Russian private clinic JSC Medicine, Doctor of Medical Sciences Anikeeva, in May 2019.

Drugs do not need to be purchased. All necessary drugs will be issued in the clinic where the treatment will be carried out.

How will the patient know what treatment is indicated to them and whether it is properly prescribed

This is a very important point, since it is the right course of chemotherapy and drugs that affect the success of treatment. The patient receives a referral in the form of 057-y from the regional oncologist, signs up for a free consultation with the oncologist at the clinic for any time convenient for him. Comes to the reception with all the necessary documentation. The doctor examines the patient, checks the availability and relevance of all documentation provided by the patient. If all documentation is available and relevant (the statute of limitations of some studies should not exceed 2-3 weeks), the patient is assigned a consultation at which the treatment tactics will be determined. The council consists of doctors of several specialties: oncologist, chemotherapist and radiotherapist. If necessary, doctors of surgical and other specialties of the relevant profile are involved in the consultation. At the consultation, a treatment protocol will be selected in accordance with the accepted standards, the number of cycles of chemotherapy and the timing of each cycle will be determined, a decision will be made on the relationship of chemotherapy with other methods of antitumor treatment (surgical, radiation therapy).

That is, the decision on the treatment method is made at a multidisciplinary consultation, all nuances are taken into account and all risks for the patient are calculated. In some cases, treatment may involve not only chemotherapy, but also radiation therapy or surgical treatment. You need to choose the correct order of its conduct.

Upon approval of the treatment protocol, the patient is invited for chemotherapy treatment in the chemotherapy department. All the time, while treatment is underway, constant monitoring of the patient's condition is carried out, including an assessment of complaints and well-being, an assessment of laboratory tests, an objective examination by a doctor and the issuance of referrals for repeated studies as part of therapeutic control.

A certified pharmacist should be involved in the dilution of chemotherapy drugs. If desired, the patient can look through a special window and control which drugs are divorced. Therapy may not work due to errors in setting the drug delivery rate, in the compatibility of drugs with each other. Therefore, the pharmacist who is engaged in the preparation of drugs also conducts an expert pharmacological assessment of what the doctor prescribed, including concomitant therapy, which should prevent complications, compatibility of drugs, the correctness of the calculation for the height and weight of the patient, etc.

Thus, the full clarity of not only the purpose, but also the preparation of all solutions and cytostatics should be guaranteed. Moreover, artificial intelligence technologies can be used to check the correctness of the doctor's prescription sheet. After all, any errors in the prescription sheet, including those related to the human factor, during chemotherapy can be fatal. No doctor is able to keep information about the interaction of drugs with each other in his head. A computer program that can be used in the clinic, checks all doctor's appointments and, if necessary, adjusts dosages depending on the function of the patient's liver, kidneys, checks for cross-allergy, compares with those drugs that the patient receives for other diseases. After all, oncologists do not always know how their protocols are combined with medicines for diabetes, for arthrosis, for hypertension. And if the doctor made a mistake and did not take into account these combinations, the program will not even allow you to print the appointment sheet until the doctor corrects the errors. The program issues a variety of warnings to the doctor: for example, when prescribing some drugs, the risk of falls increases, and when taking other drugs, grapefruit juice cannot be consumed.

Can relatives stay with the patient during a chemotherapy session

This is welcome in some private clinics. In the department where chemotherapy is carried out, sometimes there is Wi-Fi, you can go online, watch a film together. In order to conduct infusions not through the veins, which during chemotherapy very quickly "fail," at the request of the patient, infusion ports can be installed under the skin in the upper part of the shoulder girdle. Thus, in private clinics they try to ensure that the patient does not fall out of normal life.

See also

• High-tech medical care for compulsory medical insurance
• How to choose or change a clinic for compulsory medical insurance
• Compulsory medical insurance policy on vacation in Russia

Notes