What to do if the pharmacy does not have subsidized medicines or refused to issue them? About free drugs. read to everyone! Sample letter to the head physician about non-receipt of medicines

• 24. 11. 2016

What do doctors and officials do not to give out free medicines to patients?

"You are not sick." "You're not sick of that." "You don't need this medicine." "You need this medicine, but another, cheaper one, will do." "You need this drug, but it's not available, wait." This is how doctors and officials respond to thousands of people who are entitled to preferential medicine by law. They are deceiving. They know that a person is sick, and they know what kind of medicine he needs. But according to rough estimates, the state is already short of 45 billion rubles for drug provision. . In some regions, only 10% of applicants can provide preferential drugs. Officials and doctors refuse patients so that the violation of the law is as difficult as possible to prove. The Ministry of Health and Roszdravnadzor regularly report: the situation with preferential drug provision in the country is stable. The figures underlying these reports have nothing to do with reality. The true scale and cruelty of the war of patients with the state is amazing

“They say every time: “Sorry, there are no drugs! I can't help it!" But they are legal to me. If they are not available today, the state must buy them tomorrow. Is not it so?"

Veronica has repeated this question many times, but her voice still sounds surprised. When she speaks, her hands with long, graceful fingers twitch slightly, as if they too cannot contain their astonishment. She has been taking hormonal inhalers for 15 years and cannot breathe without them. She has asthma, multiple comorbidities, and a disability. She has the right to receive free the dose she needs is in the pharmacy, but for a year and a half they have not been giving out the medicine.

“They were always issued intermittently,” says Veronika. - It was necessary to find out in advance the day when the drug will appear, to run to the clinic by the opening in order to have time to get it. If you don't have time, they will say that it's over, and do what you want. But with the fact that there are no medicines for months, I encountered only last year.

The pharmacy said that it was pointless to ask - there would be no medicines

Then, after six months of waiting, Veronika first contacted the Moscow Health Department. It was enough to leave a request, and the inhaler, which was absent in the pharmacy in the morning, was found in the evening. But the magical effect of the call to the department did not last long. After a couple of months, the medicines were no longer issued. This time, when Veronica called the department, she was told that the situation was difficult. You can leave an application, but no one knows when the drugs will be available. On the same day, she received a call from the pharmacy and was told that it was pointless to ask - there would be no medicines. Now Veronica's inhalers are bought by relatives, the amount is several thousand rubles a month. According to Veronica, for many people waiting in line for a pulmonologist, this amount is too much to bear. The words “no medicines” sound like a sentence to them.

Veronica's case is one of thousands. It is enough to scroll through the regional press for the last month to read a dozen such stories. In Mordovia, pharmacies for beneficiaries do not have not only prednisolone, but even iodine and bandages. In the Oryol region, a woman with lymphoma was only able to get medicine after local media wrote about the case. In Khakassia, due to the huge number of complaints from patients, the situation with subsidized medicines will be investigated by the Chamber of Control and Accounts. The growing number of appeals is constantly reported by organizations involved in the protection of patients' rights. Such growth is recorded, for example, by the Movement Against Cancer society. In September of this year, there were so many cases of refusal of people with cancer that violations of the law in a number of regions were dealt with by the Prosecutor General's Office. According to online monitoring for September 2016, conducted by the head of the League of Patients society Alexander Saversky, more than 80% of respondents experience difficulties in obtaining subsidized medicines. Only 35% of them manage to get a prescription for the drug without problems. Similar figures are given in last year's monitoring of the All-Russian Popular Front: half of the patients who apply for drugs are not given medicines on time.

Illustration: Rita Cherepanova for TD

The 2016 government report states that about 45 billion rubles are not enough for drug provision. This is not surprising: the standard cost per citizen receiving free medicines fell from 849 rubles a month in 2011 to 758 rubles in 2016. At the same time, according to Rosstat, drug prices have increased by 24% this year. In 2015, the government even allocated an additional 16 billion rubles to save the situation - but they suddenly turned out to be unclaimed. The Ministry of Health said that all the necessary medicines have been purchased.Roszdravnadzor regularly monitors drug supply in the country and remains satisfied with its results. According to the reports of these departments, in the Moscow region, for example, about 98% of beneficiaries receive drugsand in other regions the situation is stable. The ability of the Ministry of Health to force health officials to shape reality in accordance with the goals of accountability surprises even the president.

If not good

Do you want us to send the best texts of "Such Affairs" to you by e-mail? Subscribe

Free consultation of our lawyer

Do you need expert advice on benefits, subsidies, payments, pensions? Call, all consultations are absolutely free

Moscow and region

7 499 350-44-07

St. Petersburg and the region

7 812 309-43-30

Free in Russia

Some categories of citizens productively use a vital social measure of support. Free subsidized medicines are prescribed by local therapists (pediatricians) and issued in individual pharmacies according to prescriptions. Hundreds of millions of rubles are allocated annually from the federal budget for the implementation of this project. Unfortunately, not all people know their rights, so they do not use the privileges intended for them.

The state regularly develops and introduces preferences. Each innovation is supported by a legal act. The process of supplying beneficiaries with medicines is controlled by the federal
decision "On state support for the development of medicine and improving the provision of citizens with medicines" dated June 30, 1994

In addition, there is a document that provides a list of approved prescription medications for providing medical care to individual social groups that enjoy privileges.

List of beneficiaries for receiving free drugs

So, not everyone is entitled to state preferences. The list of candidates includes the following:

1. Toddlers up to 3 years old.
2. WWII invalids.
3. Awarded soldiers.
4. Veterans of the Great Patriotic War, Afghanistan, the Chechen war.
5. Home front workers.
6. Participants in the fighting.
7. Liquidators of the consequences of the accident at a nuclear power plant in Chernobyl.
8. Disabled people of all groups.
9. Large families raising children under 6 years old.
10. Low-income people.
11. Family members of a veteran and invalid of the Great Patriotic War.

The list is supplemented by patients who underwent an organ transplant operation, as well as with rare and complex chronic diseases:

• tuberculosis;
• myeloid leukemia;
• oncological diseases;
• multiple sclerosis;
• cystic fibrosis;
• hemophilia.

Unfortunately, it is worth noting that cancer patients, who are primarily entitled to preferences, receive insufficient state support measures. I would like more funding for them and a different quality of medical care. Nevertheless, drugs that reduce the pain threshold as much as possible are prescribed by law.

Each health care institution has an information board that displays information about beneficiaries and a list of medicines, which the attending physician must also have. However, due to some circumstances, the pediatrician or therapist does not want to make the data public and prescribes medicines in the old fashioned way on an advertising notebook. Everything is in the hands of the patient himself. He must demand and defend his rights.

Who writes subsidized prescriptions?

It is worth dwelling in more detail on officials whose powers the federal law included the procedure for issuing free forms for receiving medicines.

The drug is taken from the approved list and prescribed by the attending physician in accordance with the disease and medical history. The prescription form is certified by the head of the therapeutic or specialized department.

Features of registration of a preferential document

The procedure for filling out a prescription is the same, so doctors and pharmacists should regularly check and study innovations in this industry. Only for some reason, patients regularly suffer from these innovations: either the name is written incorrectly, or there is no dot, or instead of the address, they indicated the card number. And each time the patient must go to remake the paper.

The main fields that the beneficiary can check for authenticity are:

• the presence of a prescription number and series;
• age;
• Name of the patient;
• home address at the place of registration (only the number of the outpatient card is allowed);
• Name of the doctor;
• stamps: seal of the clinic, doctor, triangle "for prescriptions";
• doctor's signature;
• prescription expiration date.

It is difficult for an ordinary person without an appropriate education to check the correctness of the spelling in Latin of the name of the drug, so this fact remains on the conscience of the doctor.

A prescription for a drug benefit can be given to anyone. This is very important when it comes to citizens with limited mobility, who find it difficult to independently pick up the form at the clinic and be served on it at the pharmacy.

Free children's medicines

The most unprotected category is small patients. There is a choice of drugs in the pharmacy industry, but not always there are funds for their purchase, since the prices for them are from the world of fantasy. All children up to three years old, as well as up to six years old from large families, are entitled to preferential provision of medicines. In addition to these patients, free drugs are provided for children with rare
diseases.

After the birth of a child, parents should:

• register it at the place of residence;
• issue a birth certificate;
• receive SNILS from the Pension Fund;
• order a CHI policy from Alfastrakhovanie;
• attach it to the clinic.

Based on the latter, the child is entitled to free drugs.

What to do if the pharmacy does not dispense medicines at a reduced price?

First, the patient must request a prescription from the doctor. Then a useless trip to the benefits department awaits him. As a rule, these reasons are the basis for the refusal of average patients from receiving state support. It is not always necessary to blame the pharmacy management - they are just intermediaries between
patients with a preferential prescription and a state machine supplying medicines for the first party.

So, how to get the coveted pill if the drugs are over in the benefit department?

1. In the absence of a medication, it should be replaced with an analogue.
2. If the drug is not available temporarily and it cannot be replaced with a similar one, then the rules of action are as follows:

• the management of the pharmacy must register the prescription form;
• take all possible measures to reduce the delivery time of the funds;
• notify the patient upon receipt from the warehouse of the medicine of interest.

If the patient is denied the provision of medicines, his main task is to report the violation to higher authorities or the departmental head physician.

Feedback has been established in the regions. The beneficiaries will be helped to clarify the availability of a medicine by a free multi-channel number 8-800-100-0122. Also, each pharmacy has an internal contact phone for inquiries.

Names of free drugs

In 2019, the parliamentary sector made adjustments to the list of vital therapeutic agents. It increased by 42 items and amounted to 646 items. It should be noted that 6 pharmaceutical manufacturers operate in Russia, and the list of expensive drugs has increased by one component.

The issuance of preferential medicines is carried out in accordance with the legislative procedure. The price turnover is controlled and approved by the government of the Russian Federation, which aims to reduce the cost of medicines supplied to medical organizations.

Receiving sequence

The beneficiary needs to know the process for submitting a prescription form.

1. None of the medical staff has the right to refuse to issue a coveted leaflet.
2. The prescription is issued by the attending physician or other official specified in the charter of the medical institution.
3. In rural areas, this function is performed by a paramedic.

If a person belongs to one of the social categories, then in order to receive a preferential medicine, he should contact a local therapist and present a document confirming the status.

List of documents

The applicant for receiving benefits will have to prepare a package of official papers:

• passport;
• SNILS;
• outpatient medical card;
• a certificate from social security about the presence of a preferential category;
• other documents confirming the disease and special status.

You can refuse the preference by writing an application to the territorial department of social support for the population, and receive monthly monetary compensation. In some cases, this step is justified, since the suppliers of subsidized medicines do not meet the delivery deadlines and patients are forced to buy expensive drugs with their hard-earned money.

Good afternoon.

1. To obtain preferential medicines at a pharmacy, you must write a prescription for them from a local doctor. The basis for issuing a prescription is a written recommendation (extract) received in a specialized medical institution where the patient is observed for his underlying disease.
2. The local doctor may refuse to issue a prescription due to the lack of this drug in the pharmacy. This refusal is illegal, because even if the drug is not currently in the pharmacy, upon receipt of the prescription, the pharmacy is obliged to purchase the drug specified in the prescription within ten days. If there is no prescription - accordingly, the pharmacy is not obliged to ANYTHING, and you will never see the medicine. Therefore, it is necessary to “remind” the local doctor about this and continue to insist on a prescription. 3. If the doctor continues to refuse to issue a prescription, demand it and write it down on the card: “the prescription was not issued due to the lack of medicine in the pharmacy.” He cannot write such a thing, so he will either write out a prescription or refuse to write it down on the card that he did not write it out. In this case, it is necessary that the doctor MUST make an entry in the card that the patient on such and such a date was at the reception and was examined by a doctor on such and such (he will not be able to refuse this).
4. Immediately upon leaving the doctor’s office, write in 2 copies a complaint addressed to the head physician of the polyclinic with approximately the following content: “To the head physician of such and such from such and such ... Please explain on what basis the therapist such and such refused to write me a prescription for medicine (name) necessary for me according to vital indications. I consider this refusal illegal on the basis of the Order of the Ministry of Health and Social Development of the Russian Federation of February 12, 2007 N 110, the Decree of the Government of the Russian Federation of July 30, 1994 No. 890 ...
5. Give one copy of the letter to the secretary of the head physician, ask the secretary to put a stamp on the second copy.
6. If the secretary refuses to accept the complaint, you need to send it by mail - registered mail with a list of attachments and acknowledgment of receipt. The inventory will be given in two copies, one to be placed in the letter, the second to be pasted to the copy of the complaint kept at your home. There also attach a receipt for payment of a registered letter and a notice of receipt of a complaint with the signature of the secretary of the head physician. 7. In the future, act depending on the reaction of the head physician. He may offer to negotiate verbally, but you must insist on a written answer. After that, a prescription for the medicine is usually given.
8. If replies begin (they prohibit prescribing this medicine in the Department of Health, there is no money in the budget, etc.), then you need to contact the prosecutor's office, the regional Ministry of Health, Roszdravnadzor (you can go to 3 of these places at once). Send there COPIES (not originals) of all documents (your complaint, postal documents - an inventory of attachments, a receipt, delivery of a notification; answers from the head physician). If there was no answer from the head physician, you can safely complain to the prosecutor's office. Usually, after a complaint to the prosecutor's office, doctors themselves call home and ask when it is convenient for you to come for a prescription.

Despite the fact that quite a few citizens have a legal right to receive free medicines, pharmacy pharmacists either refuse to dispense medicines or declare that the necessary medicines are not available. Roszdravnadzor has developed a clear algorithm for the actions of pharmacists in pharmacies that do not have the requested drug, but citizens do not know about it. In this article, we will tell you what to do if the pharmacy does not have discount medicines, how the pharmacy employee should act if the medicine is out of stock, how soon the medicines should be provided, and how and where to file a complaint.

Algorithm of actions of a pharmacy pharmacist in the absence of subsidized medicines

Important! According to the text of the Federal Law of August 22, 2004 No. 122-FZ, if a citizen has completed all the actions prescribed by law to receive free drugs (or drugs at a discount), that is, he has collected the necessary documents, contacted the clinic, received a preferential drug and came with it to the pharmacy on time to the pharmacy, which participates in the state program for providing citizens with preferential medicines, the pharmacy pharmacist is not entitled to refuse to dispense the drug.

If, on the date of the patient’s request, the pharmacy does not have the medicine he needs at a discount, the pharmacist has the right to offer the citizen analogues of this medicine, the effect of which is completely similar to the medicines prescribed by the doctor. But the pharmacist has no right to impose a replacement on the client. In case of refusal of substitute medicines, the pharmacist acts as follows:

• offers to apply to another social pharmacy located in the same locality, and with which this institution has an agreement;
• if the citizen refuses, he accepts a prescription for a preferential medicine from the citizen who applied;
• registers the fact of its receipt in a pharmacy journal, specially established for making records of cases of unsatisfied demand;
• assigns the citizen's appeal the status of "deferred service";
• enters information from the prescription form into the pharmacy computer program;
• sends a request to the supplier for medicines that are not available;
• waiting for a response from the supplier company about the presence or absence of the requested drug;
• if the medicine is brought, the pharmacist waits for the delivery, notifies the patient about the availability of the medicine by phone;
• if the supplier does not have the medicines, the pharmacy purchases them on its own at its own expense (expenses will be reimbursed to it later from the federal budget).

How soon the pharmacy will provide a discounted drug that is not in stock

If a citizen applied with a prescription to a social pharmacy, but it did not have the necessary medicine, Roszdravnadzor allows you to assign the status of “deferred service” to the application, take the patient’s phone number and call him back when the drug appears at the pharmacy. No more than 10 working days are given to resolve this issue (that is, weekend pharmacies are not included in the calculation).

However, if a prescription for a preferential medicine was issued by the medical commission of a medical institution, it is allowed to provide it to a citizen within 15 working days.

What to do if the pharmacy does not have subsidized medicines - where to complain

Unfortunately, it happens that pharmacy pharmacists refuse to accept a prescription from a beneficiary at all or report that the required medicine is not available. For starters, you can complain about the pharmacist to the pharmacy manager. If this does not help, there are many more options to protect your rights:

What to do if the pharmacy does not have subsidized medicines

Here is how they comment on the situation with the refusal to issue preferential medicines lawyers. If a citizen is not provided with what he has the right to, the algorithm of actions should be as follows:

1. It is necessary to record the fact of refusal to provide a medicine for which there is a special, correctly executed prescription. To do this, you first need to submit an application addressed to the head physician of the clinic where the drug was prescribed.
2. If there is no response to the application, and the medicine suddenly appears in the pharmacy, or nothing happens at all for unexplained reasons, you should file a complaint with the regional department of the Ministry of Health or immediately with the Prosecutor's Office.
3. If the pharmacy did not have subsidized medicines of vital necessity, or a refusal to issue them was received, you need to contact Rospotrebnadzor. The most effective way is to write a statement to the prosecutor.

Legislative acts on the topic

Common Mistakes

Mistake: The pharmacy pharmacist called back the citizen, for whom subsidized medicines were not available on the date of the request, a month later.

The Ministry of Justice has registered an order of the Ministry of Health, allowing the issuance of preferential prescriptions for patients with chronic diseases for a three-month course of treatment. Previously, such a rule existed in relation to people who have reached retirement age, disabled people of the 1st group and disabled children, but they were violated everywhere. MedNovosti figured out whether the new order would work, or whether it would also remain a "protocol of intent."

Long awaited changes

The question of the need to make appropriate changes to the Order of the Ministry of Health of the Russian Federation of December 20, 2012 No. 1175n "On the procedure for prescribing and prescribing drugs" was raised by the Council of public organizations for the protection of patients' rights acting under the department. The Ministry of Health supported the initiative and in the spring prepared a draft order No. 254n dated April 21, 2016, introducing these amendments.

On July 18, the document was registered, entered into force, and now it has become possible to prescribe medicines for three months also for chronic patients undergoing long-term course treatment. As stated in the order, “prescriptions for medicines written out on prescription forms of form No. 148-1 / y-04 (l) and form No. , disabled children, as well as citizens suffering from chronic diseases requiring long-term course treatment, are valid for 90 days from the date of issue.

Promised three years waiting

Meanwhile, the ability to prescribe medicines for a three-month period for people who have reached retirement age, disabled people of the 1st group and disabled children has existed for three years, but now this rule is being violated everywhere.

So, in the Moscow region, you can get a preferential prescription only if it is available in attached pharmacies. Otherwise, preferential departments of polyclinics do not issue prescriptions. In addition, the prescription is valid for 1 month. It is also impossible to prescribe the drug for more than 1 month. As a rule, subsidized drugs are imported no more than once a month. And on this day, you need to get to the clinic as early as possible, get and buy a prescription. It doesn't always work out.

Read more:

The main event of the month in the life of Russian diabetics is the delivery of insulin to subsidized pharmacies. On this day, you need to get to the clinic as early as possible, get and buy a prescription. It doesn't always work out. A resident of the Moscow region told MedNovosty how she monthly produces insulin for her diabetic mother.

The procedure consists, firstly, of a visit to the attending physician, who must make an appropriate entry in the card (and since the day the drugs arrive at the pharmacy is not known in advance, it is impossible to make an appointment in advance). And, secondly, from visiting the benefits department, which cannot cope with the wave-like influx of patients - the density of the queue these days is like in the subway during rush hours. The use of electronic technologies in the process is limited to indicating in the prescription the addresses of pharmacies and the number of packages of the drug at the time of issuing the prescription.

Deputy head physician:“Such a claim will never be confirmed to us”

Now the regularity of passing through these ordeals, theoretically, should turn from a monthly into a quarterly one. But there is little hope for this. As the deputy chief physician for EVN (examination of temporary disability) of one of the district hospitals explained to MedNovosti, the real situation does not allow providing all beneficiaries with medicines for 3 months. Planned applications are formed in the district and are accepted by the regional Ministry of Health on a monthly basis, based on the average monthly need of patients.

“The order to prescribe drugs for 3 months for treatment courses for a certain group of beneficiaries has been in place since 2013, but if we work according to this principle with each patient, then we will have to triple the need for essential drugs, and this application will never be confirmed to us , - admitted the deputy. head physician. - Medicines are purchased and supplied not by us, but by the Ministry of Health of the Moscow Region, which proceeds from the financial situation, allocating funds for the year and for the month. Therefore, we work with patients according to this scheme only individually. For example, in connection with departure, hospitalization, sanatorium treatment. In addition, an elderly patient can “change his condition” at any time, so providing him with medicines for 3 months in advance “is also not quite right,” she added.

In her opinion, taking into account the real situation, the current procedure for issuing prescriptions is the most optimal. “We write out prescriptions based on the availability of the drug in the pharmacy,” said the deputy. head physician. - Let's say the pharmacy has 5 packs of vital insulin. And three of them can be taken by one patient, or you can write them out to five. Deliveries don't come every day. The order is good, and it could be used, but we are talking about real benefits when a person goes to a pharmacy with a prescription and receives medicine. Unfortunately, the ability to implement many good regulations in our country depends on the financial situation.”

Expert: "All to court!"

According to experts, the financial difficulties of the region should not be of interest to the patient. The current legislation guarantees him timely medical care, including medicine, but how to provide it is the problem of officials. “Who prevents them from forming an application for 3 months, or for 5? - says the president of the National Agency for Patient Safety and Independent Medical Expertise Alexei Starchenko. - If there is such an internal order in the region, then the regional Ministry of Health does not know how to work. A patient with diabetes mellitus (as well as other chronics) who needs insulin is registered at the dispensary, and it is possible to plan his need for a year or longer. And not to be afraid that the patient will die, and the prescription written out to him will be lost. He would rather die if he can't get the cure."

According to Starchenko, the situation will get off the ground if officials begin to be "punished with the ruble." “If the patient is not given the drug, he can buy it at his own expense and present all checks to the local health department at the end of the year to compensate for the costs,” the expert explained. - Today, the courts automatically make such decisions. Plus, you can claim compensation for non-pecuniary damage. If all patients begin to claim expenses through the courts, then we will get a completely different practice.”

Read more:

In Moscow, shortages of anticancer drugs began again. GBUZ "Center for Drug Supply of the Department of Health of the City of Moscow" ("TsLO DZM"), which includes the network of pharmacies "Pharmacy of the Capital", has not been supplying the long-term drug "Glivec" to the points of the network for the treatment of gastrointestinal stromal tumors (GIST) for more than a month.

At the same time, you must first force the clinic to issue a prescription, and then the pharmacy - to provide it within the time frame established by law (up to 15 days). By law, a preferential prescription must be filled in any case, and it is precisely because of the shortage of drugs that there is an informal rule not to write prescriptions until the drug arrives at the pharmacy.

“The issuance of a prescription should not depend on whether there is a medicine in a pharmacy or not,” Starchenko believes. - This is a document that confirms that the patient needs medicine. And immediately. And if the patient is not given such a prescription and is not put on delayed service, this is a reason to write a complaint to the prosecutor's office. Prosecutors, by the way, are now very actively engaged in the supervision of drug provision.”

According to the President of the League of Patients Alexander Saversky, the order of the Ministry of Health of the Russian Federation is mandatory for execution, and in the regions, in the end, they will be forced to reorganize. “This, among other things, will simplify the work of the officials themselves,” the expert believes. You don't have to do the same work every month. The healthcare facility knows that it has a chronic patient at its site, and while he is alive, he needs to buy medicines for him. Although, perhaps, at first, the activity of the patients themselves will be required. And in case of refusal to issue a prescription for 3 months, it will be necessary to write a complaint addressed to the head physician. When the flow of applications begins, this will be the way to bring the same order to the attention of all leaders and doctors.

Ministry of Health: "Everything will be fine"

However, the regional Ministry of Health promises that none of this will be needed. As reported from the department in response to a request from MedNovosti, “Order of the Ministry of Health of the Russian Federation on 04/21/2016 No. 254n was communicated to all persons whose competence is to control and implement this regulatory document.” And its unconditional execution will be "carried out from January 1, 2017 in accordance with the approved changes."