Cardiology Medication Affordability in Russia Studied in a New Report

Professor Liliya Ziganshina (Head of Cochrane Russia), one of the co-authors of the paper, partook in a study on access to medicines with expert advice and methodology support from the World Health Organization (WHO) and Health Action International (HAI, Amsterdam). Later, in 2014, another co-author, Chinara M. Razzakova, continued this important study for her Ph.D. thesis at Kazan Federal University.

Reliable information on prices and availability of medicines is the main foundation for improving access to medicines through the development of public policy and evidence-based programs. The analysis of medicine price changes in the pharmaceutical market and price components makes it possible for governments of different countries to evaluate the success and consistency of their policies on price regulation and their measures on price containment.

Reliable information on medicine prices makes it possible for governments to compare their health expenditures with those of neighboring countries of the same level of development. Until 2001, there was no single international methodology for access to medicine studies; the research conducted at that time used methodologies that did not allow full assessment or international comparisons. It was difficult to compare the results of different studies among themselves due to the difference in applied methodologies.

In 2001, HAI in association with the WHO created a joint project and developed a comprehensive methodology to measure medicine prices, their availability, and affordability to compare results across countries and at different time periods. To date, the second edition of the results has been published and is in the public domain.

The information collected using WHO/HAI methodology serves as an evidence base for governments. It is also a starting point for developing and changing governmental policies to improve public access to information about medicine pricing.

In this study, the authors looked at the availability and affordability of 95 medicines. These included 30 medicines from the standard list recommended by WHO/HAI methodology, used for international comparisons, and 65 cardiovascular drugs selected and added to the research project based on the importance of the burden of cardiovascular diseases at the national level. 71 of the 95 medicines were included in the Russian Essential Medicines List. For each selected medicine, information was collected on the originator brand and the lowest-priced generic both in public and private pharmacies. The researchers looked at physical availability on the day of study and prices for concrete pre-specified pharmaceutical products.

We compared local prices with reference prices at the Management Sciences for Health website https://www.msh.org/ by calculating median price ratios and determined affordability of medicines by calculating the cost of treatment of acute and chronic diseases following national standards relative to the salary of the lowest-paid worker.

Since 2009-2010, various price containing mechanisms have been implemented in the Russian Federation, such as decreeing of maximum wholesale and retail mark-ups and registration of the maximum selling price of medicines from the list of Essential Medicines. Various projects and strategies have been introduced to support the domestic pharmaceutical industry. The Federal Target Program "Development of the pharmaceutical and medicinal industry of the Russian Federation until 2020 and beyond" (Pharma 2020) was adopted. In this regard, the authors analyzed prices and medicines availability and affordability in 2015 to document the changes since 2011.

There was a marked decrease in prices in 2015 compared to 2011. The prices of the lowest-priced generics, both retail and wholesale, were closer to reference prices in 2015 and even lower, that is, they became acceptable in accordance with the recommendations of WHO/HAI methodology.

So far, two papers have been produced, and a training manual on the WHO/HAI methodology for pharmacology students of Kazan Federal University was created. The team plans to finalize price analysis for 2010-2018 and make the results publicly available.