According to Igor Narkevich, rector of the Federal State Budgetary Educational Institution of Higher Education of the Saint Petersburg Ministry of Health of the Russian Federation, the pharmaceutical market of St. Petersburg at the end of last year amounted to 138.32 billion rubles, or about 6% of the entire domestic market of the country. At the same time, over the past year a new trend has emerged. In 2022, the volume of the St. Petersburg market increased by 8% in value terms and decreased by 6% in physical terms: there are fewer drugs, but they are rising in price, explained Igor Narkevich.

As the discussion participants noted, there is a disproportion in the structure of the modern pharmaceutical market in Russia in general and St. Petersburg in particular. Most of the market (90 billion rubles in St. Petersburg) accounts for retail sales of medicines. Expenses for hospital purchases and purchases of drugs to provide them to preferential categories of citizens at the expense of the regional and federal budgets are almost 3 times less: in 2022 they amounted to 37 billion rubles.

At the same time, the number of patients entitled to free medicine is growing, and these costs place a severe burden on the regional budget. This is a problem not only for St. Petersburg, Igor Narkevich clarified, but for most Russian regions. “In total, about 700 thousand people in Russia are diagnosed with hepatitis B, and in order to provide them all with medicines, 1.3 trillion rubles are needed. The state doesn’t have that kind of money,” Igor Narkevich gave an example.

Lawyer, member of the National Council of Experts on Rare Diseases, member of the Expert Council of the State Duma of the Russian Federation on health protection on rare (orphan) diseases Natalia Smirnova calculated that in St. Petersburg, 31 patients diagnosed with spinal muscular atrophy are provided with medicines at the expense of the budget, therewith one bottle of medicine costs about 600 thousand rubles, and 30 packages are needed for a year. However, the standard federal budget expenditure per patient in 2022 was about 11 thousand rubles; all other costs for the purchase of medicines are borne by the regional budget. “The burden that falls on the regions is very great,” said Natalia Smirnova.

According to the round table participants, St. Petersburg has opportunities to increase the efficiency of the system for providing the population with medicines while simultaneously saving budget funds. According to Aleksey Yakovlev, Deputy Chairman of the Committee on Industrial Policy, Innovation and Trade of St. Petersburg, one of these tools is offset contracts. “This is a universal way to ensure the drug safety of St. Petersburg in terms of supplying preferential categories of citizens,” the official said confidently.

He described the concept of the offset contract as “a market in exchange for investment”, that is, a pharmaceutical company invests in the modernization or creation of a new full-cycle production of necessary drugs, and the city, in turn, guarantees the purchase of these drugs. The first offset contract in St. Petersburg has already been concluded: within the framework of SPIHF-2023, a relevant agreement was signed between the city administration and the R-Pharm company. The cost of the contract was 8.7 billion rubles, the agreement was concluded for 10 years, and investments in creating production will amount to at least 2.3 billion rubles, explained Aleksandr Bykov, director of healthcare economics at R-Pharm JSC. The new plant will produce drugs under 31 international nonproprietary names (INN), including drugs from diabetes, cancer and cardiovascular diseases. As Aleksandr Bykov noted, if the city had independently purchased the entire volume of drugs included in the offset contract through the public procurement system, it would have spent 29 billion rubles on it (in the prices for December 2022). According to Aleksey Yakovlev, St. Petersburg is also considering other promising areas for offset contracts. “There are 350 INNs on the list of necessary drugs, and we want half of these drugs to be included in the new offsets,” he said.

Another way to reduce the financial burden on the budget system could be co-financing of drug care using funds from the population, says Igor Narkevich. According to head of the department for organizing the work of pharmaceutical institutions and enterprises of the Health Committee of the Government of St. Petersburg, Associate Professor of the Department of Health Organization and Medical Law of St. Petersburg State University Olga Makhova, the population could participate on a parity basis in the purchase of medicines for diseases such as hepatitis B and C, arterial hypertension. 

“These are the necessary tools, and although they are discussed a lot, they are not available,” noted Olga Makhova.

Director of the Union “Medical and Pharmaceutical Projects” Dmitry Chagin reminded the discussion participants about such a phenomenon as a compounding pharmacy. The production of medicines in small volumes in pharmacies was very popular during the Soviet era. At that time, pharmacy preparations accounted for up to 60% of all medications. However, pharmacy production gradually lost its importance and market share: by the 80s of the 20th century, its volume in the total market volume decreased to 15%, now it is 0.04%. At the same time, Dmitry Chagin noted that in the USA pharmacies produce up to 15% of all medicines, in England – 12%. According to the expert, the revival of compounding pharmacies would be relevant for providing medicines to small groups or individual patients.

“Pharmacy production could help with the production of drugs for patients with rare diseases, cancer patients, as well as drugs in “children’s doses,” explained Dmitry Chagin.