Rational use of medicines: the provision of medicines and healthcare products in the context of the ongoing healthcare transformation in Ukraine

For the first time in many years, the state has significantly improved the mechanisms for the efficient provision of medicines and healthcare products to the citizens of Ukraine. The effective procurement through international organizations allowed covering 100% of the hospitals’ demands for 12 categories of medicines and healthcare products. The "Affordable Medicines" program is being actively implemented and expanded – today, every third pharmacy in Ukraine releases fully or partially reimbursable medicines to millions of Ukrainians. On June 25, 2018 the current achievements and future prospects in the medicine provision were discussed at the extended meeting of the Ministry of Health of Ukraine, chaired by the Prime Minister of Ukraine. The meeting was also attended by representatives of the Ministry of Finance, the Ministry of Economic Development and Trade, the Ministry of Justice, regional health departments, medical community, patient and anti-corruption organizations.

Current mechanisms for efficient provision of medicines and healthcare products to citizens of Ukraine 

There are two main mechanisms for the provision of medicines and healthcare products to the citizens of Ukraine – public procurement through specialized international organizations and the "Affordable Medicines" National Prescription Drug Cost Reimbursement Program.

"Free-of-charge medicines are available in Ukrainian hospitals. The procurement of medicines through international organizations allowed us to eliminate corruption and to negotiate lower prices for Ukraine. We use the savings to buy more additional medicines, which means that the state helps more Ukrainians to receive the treatment they need ", commented Dr. Ulana Suprun, Acting Minister of Health of Ukraine.

Owing to the practice of effective medicine procurement through international organizations, for the first time in 7 years, Ukraine is fully equipped with vaccines – reliable, safe and effective. In addition, for the first time ever Ukraine has covered 100% of the hospitals’ demands for  free-of-charge medicines for 12 programs, including HIV tests, a range of medicines for the treatment of childhood oncology, child dialysis, child nanism (dwarfism) of various origins, cerebral palsy, as well as oncology reagents, blood donation products, post- and pre-transplantation medicines.

"Ukraine needs to continue the practice of  using a transparent system of medicine procurement through international organizations, since it allows not only savong money and buying high-quality medicines, but also saving lives of patients with chronic or terminal illnesses", underlined Volodymyr Groysman, Prime Minister of Ukraine.

The "Affordable Medicines" program was launched in April last year and to date, every third pharmacy in the country releases fully or partially reimbursable prescription drugs to patients with cardiovascular diseases, asthma, or type 2 diabetes. Since the program launch, Ukrainian patients received reimbursable medicines upon more than 21 million prescriptions worth almost 1 billion UAH. Currently, the Program covers 23 active substances (INNs), 239 trade names, 47 of which are released completely free of charge to patients upon a correct prescription.

"It would be much better to have every pharmacy participate in the program. Well, this is the responsibility of the local authorities to really make the "Affordable medicines", guaranteed by the state, more accessible and affordable to patients", added Dr. Ulana Suprun.

Ukraine has also implemented the updated version of the National List of Essential Medicines, having expanded it to 427 international nonproprietary names (INN). The purpose of the updated NLEM is to satisfy 100% of the priority health care needs of the population and to ensure the availability of essential medicines in sufficient amounts at any time in hospitals nationwide. In addition, the Ministry recently presented the Liky Control mobile application for checking whether certain medicines are included in the state-guaranteed NLEM, available in stock at a hospital and provided free-of-charge.

As a rule, the local authorities and regional health departments are responsible for the availability in stock of essential medicines in hospitals within their district or oblast. This is why it is essential that health facilities properly estimate and promptly inform the Ministry of the regional demand for specific medicines. This is the only way for the Ministry of Health of Ukraine to ensure effective procurement planning.

The regions that have sufficient medicines due to  excess supply do not need to consult the Ministry of Health of Ukraine to redistribute medicines and vaccines anymore, which allows for prompt redistribution to areas of need.

Prospects for further improvement of the medicine provision mechanisms in the context of the ongoing healthcare transformation 

The medicines and healthcare products that are currently procured by the Ministry of Health of Ukraine through the centralized procurement system or purchased for the regional budget funds at the oblast level constitute an integral part of the healthcare system of Ukraine. Most of these medicines and healthcare products have been included in state programs over the past 10 years, and should form part of the state guarantees at primary, secondary and tertiary care in the next few years.

In order to improve the provision of medicines and healthcare products to the citizens of Ukraine, the Ministry plans to expand the “Affordable Medicines” National Prescription Drug Cost Reimbursement Program with new nosologies and INNs in 2019, as well as to include the medicines procured for budget funds. The cost of some medicines and healthcare products will be included in the cost of the medical services, set by the National Health Service of Ukraine. In addition, the state Procurement Agency will continue procuring medicines for a number of strategic programs (vaccination, infectious diseases, etc.).

"We are currently developing the mechanisms for ensuring a gradual and logical integration of the 40 public procurement programs into the process of healthcare transformation at all levels of care – primary, secondary and tertiary. The key objectives for reforming the public procurement system are to establish the best practices of public procurement through international organizations and not to return to the old corrupt procurement mechanisms. To accomplish this, the newly established Procurement Agency should be legally entitled to the same advantages as the international procurement agencies", noted Olha Stefanyshyna, Deputy Minister of Health of Ukraine.