Pharmacy orders. Special Purpose Recipe

Since September 22, antibiotics have not been sold without a prescription in Russia. So says the order of the Ministry of Health. But in reality, the sale of such drugs looks different.

Russians are increasingly faced with the fact that they are not sold some drugs if there is no prescription or it is issued incorrectly. Pharmacies refer to new order Ministry of Health, which specifies the procedure for the sale of such medicines.

True, the Business FM experiment showed that it is still possible to buy drugs without a prescription, even if one should be available. Autumn, rain, cold. Nothing new: it repeats year after year. Only today it has become difficult to buy drugs for the treatment of this very cold. Since the beginning of October, there have been reports on social networks that pharmacies require prescriptions for antibiotics.
Business FM columnist Ivan Medvedev also faced this.

Ivan Medvedev Business FM columnist“My wife got sick. She called the doctor to the house. The doctor prescribed antibiotics, in particular, the drug "Amoxiclav". But the doctor wrote it out simply on the letterhead of the hospital, that is, it is not complete recipe which, as I accidentally found out, is now of fundamental importance. I went to the pharmacy, where I was told that since September 22, pharmacies have no right to dispense antibiotics without a doctor’s prescription, that is, they can dispense antibiotics only by changing them to a prescription.”

Another Business FM reviewer was more fortunate. In another pharmacy, they were ready to sell him the same drug just like that, without any prescription.

Mikhail Safonov Business FM columnist"Are you for yourself?" I say yes". She assessed my complexion, said: “500 milligrams for you.” I say: “OK, but do you need a prescription?” She looked at me sternly and said: “Actually, you need a prescription!” I say, "I don't." She says: “How do you buy it? What did your doctor tell you?" And I say: “But the doctor didn’t tell me anything, because the doctor is my friend.” She says, "Well, if your friend takes responsibility, then please buy."

At the pharmacy in the supermarket, next to the Business FM office, there were no problems buying antibiotics either. Why pharmacies do not require a prescription when they should do so, no one could explain. Perhaps they are not afraid of fines, although such violations can even lead to a license suspension for three months. However, the fact remains.

In fact, pharmacies were previously not allowed to sell prescription drugs without an official prescription. And the order of the Ministry of Health, which entered into force on September 22, simply clarifies the rules for their vacation. In particular, the pharmacy now retains the so-called one-time prescription after it has sold the medicine on it. Why this is done, explains the executive director of the Russian Association of Pharmacy Chains Nelli Ignatieva.

Nelly Ignatieva Executive Director of the Russian Association of Pharmacy Chains“If the pharmacy received ten medicines according to all documents, and it has five in the balance, we record this, these are separate accounting documents, therefore, there should be five prescriptions, moreover, correctly written prescriptions. If something is written incorrectly in the prescriptions, again this is a violation. In this system, a doctor, a patient, a pharmacy are involved, and for some reason, responsibility for all violations is currently only assigned to the pharmacy. In fact, the problem is completely different. Our doctors have stopped writing prescriptions and, accordingly, confused all patients, and for some reason patients do not demand their rights to issue a prescription.”

The official prescription must be issued on a standard form, stamped, indicating the international generic name drug in Latin. The use of specific trade names is permissible if the drug has no analogues. Why doctors violate these rules, David Melik-Guseinov, head of the Moscow Healthcare Research Institute, told Business FM.

Director of the State Budgetary Institution Research Institute of Health Organization and Medical Management“Only 10% come with some kind of recommendation, and about half of these 10%, that is, only 5% of the population, come with correctly executed prescriptions. Doctors, of course, strove not to write prescriptions, because any prescription with a seal and signature is official document. A document that can be presented in a court of law, a document that can be presented to the executive branch so that they conduct appropriate checks. So medical workers, doctors very often shied away from the obligation to issue an official prescription.

Pharmacies, by the way, are also self-willed. They are required to return to customers the so-called multi-dose prescriptions valid for up to a year, which prescribe drugs for treatment chronic diseases. In this case, the pharmacy must make a note in such a prescription about the sale of the medicine. But sometimes such recipes are also trying to withdraw. The Ministry of Health wanted to put things in order with the sale of prescription drugs. We wanted the best, but it turned out as always.

Lyudmila Lapa therapist “It can’t lead to anything good, because antibiotics are now - here, for example, I prescribed them today, and the girl says she doesn’t need a prescription. She didn't even ask because she was told she would buy it, no problem. That is, she has some kind of pharmacy nearby, which gives out everything. And now, who is right, who is wrong, it is very difficult to determine. Confusion, in fact, exists. This is an undeniable fact."

To the question of what to do if you have not been sold the medicine, there are two answers so far. Either go to the doctor and demand that he write you an official prescription, or look for a pharmacy where prescriptions are not required. As our experiment showed, they can still be found.

Since mid-February, there has been a stir in pharmacies. Knowing that from this March prescription drugs will be sold only by prescription (), people rushed to buy everything that might be needed in the foreseeable future. And no wonder. After all, a special note that it is prescription drug 70% of drugs sold have it. These include antidepressants, all ampoule substances, antibiotics, some antivirals, and the entire group of gastric drugs.

The list of prescription drugs is published on the website of the Ministry of Health.

Although the department's intention was good: to wean Russians from self-medication, the idea of ​​​​a complete restriction on the sale of medicines without a prescription was not received with enthusiasm by the population. After all, people are engaged in self-treatment not from a good life. There are not enough doctors (according to the same Ministry of Health, the shortage of therapists in the country is 27%), there are huge queues in hospitals.

In addition, chronic patients already know what to take, and not “chronicles”, having seen enough advertising, they also “know” how and with what to be treated for all ailments. Well, the mighty Internet will always tell you. In this sense, statistics puts professional medicine on both shoulder blades: about 40% of Russians are treated on the advice of relatives and friends.

Roszdravnadzor believes that electronic prescriptions and the release of therapists from writing can change the situation. But experts doubt that this will greatly facilitate the work of doctors. After all, there is not much difference in what form to write out a prescription: whether by hand, in a computer - time will still have to be spent.

1 channel Antibiotics by prescription only (youtube video).

Pharmacists are no longer allowed to hide information about the availability of cheaper analogues of drugs. We are talking about medicines with the same international non-proprietary name.

In addition, pharmacists and pharmacists cannot refuse buyers to get acquainted with the accompanying documentation for drugs and medical devices(certificates and declarations of conformity).

Pharmacies that are open to visitors around the clock must have an illuminated sign with information about work at night.

Patient's opinion

Not long ago I got sick. Fever, cough, etc. Called the doctor. Let me tell you, the inspection lasted no more than a couple of minutes. On the go, I listened, waving my hand at the thermometer, did not check its readings, did not wait until I got the medical policy, hastily scribbled the prescription. "And the seal?" already at the door caught up with the physician my question. Having pressed the seal, she rushed off to other patients. It was not possible to leave the hospital on the appointed day. My doctor wasn't there. “In Belgorod, at a meeting on family doctors, - explained in the registry. - all the bosses, therapists are being called for the second Friday. So come close the sick leave another day.”

She came the other day (by the way, now it is not financially profitable to sit on sick leave). Waited 2.5 hours in line. And finally, I got to my doctor. Well, how about yours? In fact, our site is run by another doctor, but she is not there, so this nice woman was “hung” as many as three sites. Almost crying, she admitted that she already had no strength. And shame on the patients. Because we are not talking about any quality help. There is no time to examine the patient6 all at a gallop through Europe. And when the situation will improve, is unknown. Graduates of medical universities do not go into medicine: the workload is Akhovskaya, the salaries are penny. there are no fools to work under such conditions. In the Stary Oskol Medical College, they thought to find a nurse, where is there! The graduate said that the girls go to cosmetology. It is morally not so difficult, and private traders pay more money than the state.

So you can't get angry at doctors. They are only the last chain in the vicious link of domestic free medicine.

TO THIS TOPIC

The Ministry of Health supported the preservation of the sale of medicines via the Internet. Now, according to federal law, on pharmacy sites you can only make a reservation. But in order to pay and get the medicine, you still have to go to the pharmacy yourself. Which is extremely inconvenient for patients who, in fact, take drugs, the elderly and the disabled.

Taking into account these and other factors, the Ministry of Health has prepared rules for the online sale of medicines. Internet pharmacies will even be allowed to dispense prescription drugs.

But will the government approve this project? While it is submitted for public discussion.

We continue to reveal the secrets of the order of the Ministry of Health No. 403n "On approval of the rules for dispensing medicines ...".

Today, the questions of our readers - pharmacists and pharmacists - are answered by Executive Director of the Association of Pharmacy Institutions "SoyuzPharma" Dmitry Tselousov.

I would like to know about the norms for the release of ethyl alcohol in pure form for outdoor use. In what weight units should it be released now?

The Ministry of Health tried to regulate the issue of dispensing alcohol medicines.

Orders of the Ministry of Health No. 47n dated February 8, 2017 and No. 979n dated December 21, 2016, which are designed to limit the volume of containers of alcohol-containing drugs, do not apply to ethanol in its pure form, since these orders indicate drugs in the form of tinctures containing alcohol.

Paragraph 23 of Order No. 403n of the Ministry of Health refers to the dispensing of alcohol specifically for external use, since it is hardly possible for a patient to use pure alcohol otherwise. However, this paragraph does not take into account the possibility of packaging alcohol for external use in industrial pharmacies.

What to do with the maximum allowable norms for dispensing medicines? Sometimes a patient comes with a prescription where they are exceeded...

The prescription should contain a note from the doctor why the patient needs more medicine than prescribed. This applies not only to the extreme allowable rate, but also the recommended number of drugs per prescription.

If there are no such explanations, the pharmacy worker dispenses medicines within the maximum allowable norm or recommended amount. This must be noted in the recipe. It is necessary to warn the patient and the medical organization about exceeding the norm.

There is a subtle point here: according to the order of the Ministry of Health No. 1175n "On approval of the procedure for prescribing and prescribing drugs ...", such a prescription is invalid, and medicine cannot be dispensed according to an invalid prescription - this is indicated by the same order No. 1175n (if the drug is potent, the pharmacist and pharmacist generally subject to criminal liability).

From the point of view that if we are talking about the usual form 107, you can release the drug and it is enough just to record violations of the prescription in the journal, I do not agree. And I would like to warn experts that the inspectors may also disagree with this. However, Order No. 403n still allows medicines to be dispensed if the excess of the maximum allowable norm and the recommended amount in the prescription is not justified.

By order of the Ministry of Health and Social Development No. 785 of December 14, 2005, which has become invalid, the pharmacy has a stamp “The medicine has been dispensed”. In accordance with order No. 403n, there should be a different stamp - “ medicinal product released." Does the stamp need to be redone?

The meaning of the inscriptions "Medicine dispensed" and "Medicine dispensed" is identical, so the stamp should not be changed.

According to paragraph 16 of Order No. 403n, a pharmaceutical worker informs the person purchasing the drug about the interaction with other drugs. How to do this if the patient is already taking some medications prescribed to him earlier (sometimes he cannot even remember their names)?

Of course, the pharmaceutical worker cannot know what the patient is taking. And the patient himself will not always remember the ornate names of his drugs. In this regard, I believe that consultation on drug interaction should be based solely on the instructions for the purchased product.

Patients choose pharmacy organizations for specialists who can competently provide pharmaceutical consulting services. In part, this information is mastered during training within the framework of the course of pharmaceutical chemistry, and in part it is learned at trainings during training from manufacturing companies. In this case, the pharmaceutical specialist is guided solely by the knowledge base that he has managed to accumulate during his work activity.

- What about the release of immunobiological preparations?

In accordance with clause 8.11.5. "Conditions for the transportation and storage of immunobiological medicinal products", approved by the decision of the chief state sanitary doctor of the Russian Federation dated February 17, 2016 No. 19 “On approval of the sanitary and epidemiological rules SP 3.3.2.3332-16” (registered with the Ministry of Justice of Russia on April 28, 2016 No. 41968), the release of immunobiological medicinal products in retail sales is allowed provided that they are delivered to the place of their direct use in a thermal container or thermos in compliance with the requirements of the cold chain. That is, the retail sale of immunobiological preparations is allowed subject to the cold chain - this means that if the pharmacy wanted to sell immunobiological preparations, she was obliged to provide the buyer with a thermal container. The ordinance is still in effect. But now, in accordance with order 403n, the drug is dispensed if the visitor has a thermal container.

Is this condition feasible, because a sick person is not required to understand the categories of medicines? And is it worth interpreting it as the right of a pharmacy to refuse a vacation?

Apparently, the pharmacy organization will seek ways to provide the patient with such a container or at least cold elements. For example, dry ice packs.

- Will the patient have to pay for the thermal container?

Of course, the patient is obliged to pay for the thermal container, because he must have it in stock.

Expired prescription drugs may not be filled unless the prescription expired while the prescription was on deferred maintenance. In such a situation, the release of the drug is carried out without reissuing the prescription. But often, due to procurement and supply problems, medicines arrive at pharmacies already when both the prescription that was on deferred maintenance has expired and the deferred maintenance period (10 or 15 days) has also expired. Is it possible to release the remedy according to such a prescription without reissuing the document?

Indeed, in accordance with paragraph 6 of Order No. 403n of the Ministry of Health, it is prohibited to dispense medicines on expired prescriptions, except for the case when the prescription expired while it was on deferred maintenance.

I would also like to draw attention to an issue that remains unresolved. What to do with the minimum assortment if it has a persistent defect? Order No. 403n retains old norm from order No. 785 - a drug from the minimum assortment must be released within five days. But this period does not save the pharmacy. If the check recorded the absence of a drug, a fine is still issued. Arbitrage practice very extensive…

From March 1, Russian pharmacies will work according to new standards - the rules of good pharmacy practice for medicines and their storage and transportation come into force.

And in the future, pharmacies may be allowed to sell medicines via the Internet and deliver them to the customer by courier. Now, we recall that on the website of a pharmaceutical organization, you can only pre-order the drug, and the buyer has to pick it up himself.

The rules of good pharmacy practice, which come into force today, have been approved by orders of the Russian Ministry of Health. A return to the remote sale of medicines is provided for by a draft government decree developed by the same department.

Good Pharmacy Practices (GBP) go into detail on how pharmacies should be equipped and how they should operate, right down to the requirements for their management and staff. So, for example, it is written that a pharmacy worker must not only be highly qualified, but also be sociable and be able to prevent conflicts. And the manager must implement quality systems and constantly inform the staff about everything that happens - from changes in legislation to the content of customer complaints.

As Nelli Ignatieva, executive director of the Russian Association of Pharmacy Chains (RAAS), explained to RG, the international practice of regulating pharmaceutical activities is also based on the norms enshrined in the standards.

All these standards are being gradually launched in Russia, and the coming into force standard of good pharmacy practice is one of them.

"Essentially this normative act combines all the already existing norms enshrined in a number of Russian documents. These orders are long-awaited,” says Nelly Ignatieva. Their implementation does not imply any radical changes for pharmacy customers, the expert continues. But in the end, they will win in terms of service quality. there are only decent representatives of the professional community on it," Ignatieva added.

However, according to experts, there is a small technical error in the rules, which, in their opinion, should be corrected. “There is a rule in the rules,” Nelly Ignatieva explained, “that there should be a distance of strictly 50 centimeters between the equipment in pharmacies, as well as between it and the walls. This rule is difficult to apply to the current formats of pharmacy equipment in Russia. And it was not earlier in the draft document in public comment, it is inappropriate, and we regard this requirement as a technical error that should be eliminated." The expert added that the RAAS, on behalf of 11 thousand pharmacy organizations sent their proposals to the federal authorities to change this rule.

"We hope that the document will be amended and pharmacies will work without changing their layouts, without reducing the assortment and without problems and claims from the inspectors," Ignatieva said.

Also, the rules prescribe a lot of details for pharmacy premises. Thus, it is indicated that the premises must comply with sanitary and hygienic standards, they must be equipped with heating and air conditioning systems, and designed to provide protection from the penetration of insects, rodents or other animals.

medicine on the internet

The Ministry of Health supported the preservation of remote - via the Internet - the sale of medicines.

Recall that according to the Federal Law "On the Circulation of Medicines", now only a pre-order can be made via the Internet, but you need to pay and receive the medicine at a pharmacy.

However, this procedure is extremely inconvenient for buyers. Firstly, it is much more convenient for the elderly and the disabled to order medicine via the Internet and receive it with home delivery. Secondly, buyers prefer "correspondence" sales in some "intimate" cases - many are simply embarrassed to publicly ask at the pharmacy for a pregnancy test, drugs to increase potency. Finally, thirdly, the spread of prices for the same medicine helps to find a pharmacy with lower prices via the Internet. Taking all this into account, the Ministry of Health prepared rules for the online sale of medicines, and officials tried to preserve the advantages of distance selling and nullify possible risks. Moreover, online pharmacies will be allowed to sell even prescription drugs. Draft government decree, which must approve new order sales, the ministry submitted for public discussion.

"There is nothing wrong with allowing remote sales of not only over-the-counter drugs, but also prescription drugs. The main thing is that pharmacies follow this procedure, and it provides for the mandatory presentation of a prescription or a copy of it," the head of the Pharmacy Guild told RG Elena Nevolina - I don't see any threat of counterfeiting either. We won't have "virtual" pharmacies: all sites, as now, must be linked to specific pharmacy institutions and networks. The rules will simply allow pharmacies to deliver ordered medicines to the right address. this should be done not just by couriers, but by people with the appropriate education - pharmacists, pharmacists. That is, the order will be observed in which the buyer has the right to receive competent specialist advice, as it happens in a pharmacy."

The document also resolved the issue of confirming the purchase: the pharmacy employee is obliged to check the execution of the prescription (if a prescription drug is bought) and conclude a sales and delivery agreement with the buyer.

Pharmacies will be able to sell any drugs online, except for narcotic and psychotropic drugs, which are subject to special accounting. "The sale of alcohol-containing medicines over the Internet, the proportion of alcohol in which exceeds 30%, will also be prohibited," Elena Nevolina specified. "So no one will bring the notorious "Hawthorn" to your home."

Will there be a shipping fee? The rules do not address this issue.

"Pharmacists are not prohibited from asking for extra money for delivery, especially if, for example, we are talking about an urgent or night order, - Elena Nevolina explained. - So, for example, online pharmacies operate in the UK. There even free medicines, provided under insurance, can be brought to the patient directly home, but only for money. In our country, I think, everything will be decided by the market and competition. If there is a demand for distance selling, pharmacies will be able to decide for themselves in what mode and under what conditions it is more profitable for them to work."

To protect the market from counterfeiting and fakes, it is envisaged that pharmacies will be able to have no more than one website. And Roszdravnadzor will maintain a register of such sites and control their "binding" to licensed pharmacies. A website for the sale of medicines can only be opened by an officially registered pharmacy. So negative impact back to market remote sales will not, the expert is sure.

Since the end of September, new rules for dispensing and pharmacy products have become legally effective - established by Order of the Ministry of Health of the Russian Federation dated July 11, 2017 No. 403n “On Approving the Rules for Dispensing Medicines”, which determines the process of issuing these drugs by Russian pharmacies. He did not leave indifferent either consumers or pharmacists, giving rise to a kind of confusion on one or another point of the order. In order to clarify compliance with the new rules for dispensing drugs from a pharmacy (order 2017) and eliminate gossip and discrepancies, we will formulate a number of popular questions about the new law on dispensing drugs (September 2017) and answer them.

New dispensing rules classify all types of drugs as prescription drugs?

Of course not. The rules for dispensing prescription drugs have been partly updated and cover the dispensing of only a well-defined range of drugs. For popular non-prescription drugs, there are no vacation restrictions, as there were before.

And after this order, you can just buy a drug, although it requires a prescription?

As you know, over-the-counter dispensing of medicines requiring a doctor's prescription was prohibited. For violations, pharmacy personnel were subject to a hefty fine, and the pharmacy lost its license. However, to be honest, absolute law-abidingness is not observed by all citizens and institutions, not excluding pharmacies. However, the adoption of a new drug dispensing law is also psychological impact on the unconscious part of our citizens, customers of pharmacies. Moreover, pharmacy workers had to become more attentive and strict to the prohibited non-prescription sale of drugs.

How do I know if I need a prescription for a particular drug?

Firstly, whether a prescription is really required to receive it is reflected in the attached instructions for use of any drug.

Secondly, it is no longer necessary to rack your brains in despair if the instructions are accidentally lost - visit or call the doctor who prescribed this remedy for you. By the way, approximately 70% of all registered Russian drugs have prescription status. Prescriptions are written out on special forms, most often issued in accordance with Form No. 107-1 / y.

Thirdly, you can solve this problem yourself, through the online store of our pharmacy at the address (if you have a computer in the house and you know the name of the medicine). If a the right drug marked on our website with the label "prescription drugs", which means that the problem of the need for a prescription for it has been solved, but a doctor's appointment cannot be avoided. If there is no such mark, then over-the-counter dispensing of medicines is allowed.

How to understand: "The prescription remains in the pharmacy"?

With regard to changes in the rules for dispensing drugs by prescription, the following is noted here. If drugs are included in the list of narcotic or psychotropic drugs that require strict accounting, then prescriptions for them are not returned to the patient and remain in pharmacies to control their sale. Control is carried out by both Roszdravnadzor and the Ministry of Internal Affairs.

According to the new law on dispensing medicines (September 2017), this list has been expanded with a number of medicines:

• antidepressants,
• sleeping pills
• neuroleptics,
• tranquilizers,
• alcohol-containing drugs with an alcohol content of more than 15%.

“Alcohol-containing medicines”?.. It turns out that now you need a prescription for valerian or Corvalol?

No. According to the new order, as mentioned above, not all alcohol-containing drugs require a prescription. or no less popular, like a large number other well-known elixirs and tinctures, given the status of over-the-counter medications. In them, the proportion of alcohol is small, and, accordingly, in the instructions for use there is no note about the need for a prescription.

So, let's say that there is a prescription, but several drugs are prescribed at once, and the name of one of them is marked "remains in the pharmacy." However, at the moment, as a patient, I need only one medicine. Will they take my prescription?

Yes. The only exceptions are annual prescriptions, provided that you do not need all of the drugs listed at once, but only need one package of one of them. The pharmacy in this case is deprived of the right to withdraw this long-term prescription. The seller will only record the quantity purchased remedy, and return the recipe.

Is it possible to receive medicines if the prescription is written for another recipient, and not for the patient?

Yes. Dispensing of medicines by prescription is allowed to any bearer of the prescription. In fact, all drugs are dispensed without problems - whether it be the patient himself, his relatives, friends or acquaintances. All you need to do is present a prescription.

Only narcotic or psychotropic drugs fall under the exception. The prescription for them is written out on a specially designed sheet No. 107 / y-NP color pink. To obtain such drugs in a pharmacy, a power of attorney from the patient is required (including permission in handwritten form, without notarization) with the obligatory indication of the date of its compilation and a passport confirming the identity of the recipient.

What else is new in the distribution of medicines and pharmacy products?

When selling pharmacies, they are now required to stamp “Drug Dispensed” on prescriptions, so their reuse is excluded. Keep in mind that you will need to write a new prescription to get the same medicine again.

Regardless of the fact that the received drug has instructions for use, the pharmacy employee is obliged to inform the buyer:

• about how to properly store the medicine;
• about compatibility with other medicines;
• about methods and doses of reception;
• about the presence in the pharmacy of analogues of this medicine, which are cheaper.

This is important!

1. The new order No. 403n canceled the effect of order No. 785 regarding the dispensing of drugs and psychotropic drugs only by an attached pharmacy. The pharmacy is now obliged to serve prescriptions for such drugs prescribed in a polyclinic in any region of the Russian Federation.
2. According to the new order No. 403n, the dispensing norm (no more than two packages) of over-the-counter drugs has now been canceled.