Targeted drug delivery through Kazpost and other innovations in an exclusive interview with L. Byurabekova

Medicinal coverage of the population, including a preferential category, is one of the main tasks of the Ministry of Healthcare. The whole Committee in the Ministry of Healthcare takes all necessary measures: the improvement of regulatory base, the centralization of drug purchase, the transition to an electronic format are underway. Chairman of the MH RK Pharmacy Committee Lyudmila Byurabekova talks in the interview about these and other innovations of the industry

— Lyudmila Vitalyevna, what was the 2017 like for the pharmaceutical industry? What kind of innovations did you apply? What did you achieve?

— One of the main events I would like to name is the instruction of the Head of the State to introduce price regulation for all medicines. As part of the implementation of this mandate, we drafted a bill on certain issues of medicines and medical products. Last year, we coordinated it in all state bodies and passed to the majilis of the Parliament. And already since January we are starting the work on it in all committees of the Majilis and we are planning that the law will be passed in June. And the regulation for all medicines will be enacted on January 1, 2019.

In addition, for us, one of the significant events was the decision on centralized outpatient drug provision through SK-Pharmacy. Similarly, in implementing this instruction, a law was passed on certain issues of the CHSI and by-laws. So, from January 1, 2018, all medicines for free outpatient drug provision are purchased through SK-Pharmacy.

— What work is carried out to support the domestic producers?

— I want to note that last year there was a big growth of domestic industry – by almost 41%. It comes due to the Ministry of Healthcare. Support of domestic commodity producers occurs by concluding long-term contracts for a period of 10 years through a single distributor. For example, this year, according to the list of a single distributor, our domestic producers provided almost 50% of the nomenclature. Thanks to this, it was possible to start deliveries of domestic drugs from January 1, 2018.

— Procedures for the purchase of medicines and medical products are being transferred to electronic format. What will it give?

— We are already trying to conduct all purchases transparently, that is, we broadcast them online either on the site of SK-Pharmacy, and on their Facebook page. Nevertheless, this will be an even more transparent way of purchasing. The paper workflow will be reduced due to integration with the public procurement portal and other information systems. For entrepreneurs this will be a very simplified procedure, that is, they will not submit these large packages of documents. For us, members of the tender commission, this will also simplify the work, shorten the time for consideration of documents. In the future, it is also the prevention of all possible risks, which were discussed a lot in the past year.

— What is being done to increase the availability of medicines?

— Well, first of all, it's registration of medicines, checking them for quality and safety. Including one of the measures to increase accessibility – the centralization of procurement of outpatient drug provision to bring the drugs to each patient and, plus we have repeatedly said, this is a targeted drug delivery project through Kazpost. The project is now under consideration. As a pilot in the second half of the year, we want to launch it in the Karaganda region.

It is worth noting that the very delivery of medicines on an outpatient level takes place in several stages. The first is the purchase of the medicinal product itself at the request of the medical organization. The second is its delivery to the pharmacy, where the patient must receive it. The patient will choose one of the delivery methods: to go to the pharmacy for a drug, or to his own clinic where he is served, or through Kazpost, the medicines will be brought home as some parcels are brought to Kazpost. In general, Kazpost has already established this service. They also have an SMS alert. The patient himself will choose the method of delivery.

It will not require additional allocation of budgetary funds. We have already conducted all the calculations together with Kazpost.

— What stage are you at with procedures for purchasing free medicines and related services for 2018?

— We really had a problem with the late purchase of medicines, we also talked about this. In general, under the current legislation of medicines, SK-Pharmacy can purchase medicines for the next financial year. Accordingly, it gave the opportunity to begin shipping goods almost immediately from January 1, 2018. But due to the fact that we had passed a law in late June and many by-laws required certain procedures, we went out to buy late. In connection with this, we applied to the Government, the akimats and the health department of Astana informed the situation. Additionally, they allocated funding for outpatient medical support for January-February at a rate of 5.4 billion tenge. A change was made to the current regulation, which enables SK-Pharmacy to purchase a 90-day demand from a single source.

To date, all procedures for purchasing the 90-day demand have been made. Tomorrow we will already have an auction for the main tender for a two-stage tender, for the remaining 9 months. In the list of a single distributor, there are more than 1000 items. Now we have already purchased 488 items. They are shipped to warehouses of SK-Pharmacy and are dispersed in the regions. In eight regions of the country, the dispensary this year takes place in the polyclinic, where the patient is attached. He does not need to go anywhere, he receives a prescription, and then immediately receives his drug. In the remaining eight — the service of accounting and sales will be carried out through the existing pharmacy chains temporarily. Shipment is already in full swing. Eight regions, which through polyclinics, have already received their drugs. Where there are pharmacies in four regions, shipment is already underway. Some regions kept their word: they bought the extra money we gave them for security for January-February and now they do not even need additional medications. For example, in the Kyzylorda region.

— In January, a quadrilateral memorandum was signed on the non-rise in prices for medicines between the akimat of the South Kazakhstan region, the Healthcare Department, the Pharmacy Committee of the region and the Damu association. 30 large drug suppliers will not raise prices for 150 names of medicines most often used by the population by the end of the year. In addition, an agreement was reached on reducing the price of 13 medicines. From whom did this initiative originate? Will it be replicated in other areas?

— This initiative has been introduced for a long time, since 2009. Earlier, a similar memorandum was signed between the Ministry of Healthcare and large associations on a certain list of drugs. In general, domestic producers undertake to contain prices. In general, we support this memorandum. Now four more regions came out with the same proposal. The list of medicines was previously reviewed by us. I want to say that in principle, we have already bought a large part of the drugs for out-patient drug provision by a single distributor, including from domestic producers. Let's hope that this will not entail any economic consequences. These memoranda, of course, are needed for the regions and for the industry as a whole.

— What other work is the Committee of Pharmacy conducting in the digitalization of healthcare?

— We can’t say that it is our Committee only, but together with regional health departments, one of the priority projects is the introduction of medical information systems so that we can monitor the number of patients in the online mode, the number of patients on the dispensary account so that we can know exactly, to whom the drug is laid, whether the drug reached the patient or did not reach. It will be very important for us when planning needs. Because our budget legislation is arranged so that we plan the budget for the year ahead. That is, before April 1, we must form a need for medicines and budget for 2019. Medical information systems that will be integrated with our drug information system and the SK-Pharmacy information system are needed so that we have a complete cycle from the patient to the shipment and then the drug reaches the patient. Integration of our system and a single distributor system will be completed at the end of this week, further it will depend on the digitalization of the regions.

— A number of media reported that due to abnormal frosts, not all medicines were delivered on time. Many citizens, including retired people complain. How is the delivery situation and who is responsible for it?

— The delivery of medicines to the regions is carried out by logisticians who participate in the procedure of purchasing a single distributor and then they already deliver to the regions. Last week, when there were frosts, there really was a problem with the delivery of drugs to the northern regions: this is Kostanay, North Kazakhstan region. We asked the Ministry of Internal Affairs for help, to allow us to send the medicine with escort. Medicines are a specific product, require special storage conditions. Naturally, we couldn’t risk that they get up somewhere, get frozen and come in an unfit image to patients. Yesterday (note – January 30 this year), drugs in all regions where delays were already gone.

— Regarding the availability of drugs. There are complaints that many pharmacies do not have medicines for pressure. Is it really so and why?

— Complaints are coming from those regions that have since this year abandoned the services of vacations through pharmacies, for example, Astana. Hippocrates LLP was engaged here before the release of medicines. Since this year, the health department has refused this service to save money that they spent on vacation and vice versa to expand the number of purchased drugs. All drugs are now released directly through polyclinics. We are now actively working on this. In all regions, explanatory work went on. Our territorial departments, the health department, the center for the rational use of medicines are united in an information group and work with the entire population.

For example, I would just say why the centralization of the medical supply occurred? Because the 25% of the service supply was carried out through pharmacies. That is, the medicine was bought, the services of accounting and sales, dispensing to the patient were included in its price. We lost 25%. When we centralized at the level of SK-Pharmacy, we reduced from 25% to 12%. But on a national scale, 12%, taking into account the sale, is 12 billion tenge. Therefore, many regions felt that they thought it better to buy medicines for this money and to release drugs at their polyclinics.

— What else has changed in the drug supply system?

— Since 2012, the list for outpatient drug provision has been revised for the first time. It was completely optimized, and ineffective drugs which are no longer used anywhere in the world were excluded. New drugs were introduced, coordinated with the protocol of diagnosis and treatment. The prices for many positions were reduced. For example, with viral hepatitis, a new drug has been introduced, which gives the effectiveness of 95% therapy. We are also negotiating with UNDP to purchase it directly from one source. UNDP gives us a price cut in half. That is, this year we will be able to cover twice as many patients with this therapy. That is, they (patients) will take the drug for three months and will be actually healthy. We introduced a lot of such new drugs.

— Lyudmila, thank you for the interview. Good luck to you in the further implementation of the set tasks!

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