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Access to medicines in treating bronchial asthma within the State

Guarantee Benefit Programme

N.N.Brimkulov,

Lung health, Bishkek, Kyrgyz Republic

October 2009 – February 2010

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Introduction

• Currently in KG the number of patients with bronchial asthma is approximately 10,000.

• Within the framework of National Health Reform Program Manas Taalimi the following has been achieved:

– Clinical protocols on asthma– Essential Drugs List– State Guarantee Benefit Programme (since 2006)– Outpatient Drug Benefit Package for insured

citizens (since 2000)

However, do all patients have access to medicines?

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Survey Objective

Availability and transparency survey of benefit medicine

provision for the patients with bronchial asthma in the regions

of KG

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Coverage geography and survey materials and methods

Survey of 100 patients and 203 health workers including:89 – in FMC89 – in hospitals25 -pharmacists 151 medical сheck-lists were examined

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Outcomes (1)• There are benefit medicine provision programs for patients with asthma in KG

But at the same time:

• 16,3% of all interviewed health workers unaware of which diseases are included into SGP

• 22,2% health workers in hospitals, 32% pharmacists and 5,7% policlinic health workers have no awareness of SGBP

• 84% interviewed patients with asthma are informed of their

privileges for medicines by their family physicians• 57,6% patients in oblasts haven’t seen the SGBP

information at FMC stands

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Outcomes (2)• 26% of interviewed patients don’t get refunded for

prescriptions on SGBP as well as the physicians don’t offer, patients have no awareness

• 48% of interviewed patients don’t purchase medicines by refunded prescriptions: pharmacies are out of stock, patients consider medicines expensive

• Beclomethasone is available in pharmacies, patients almost don’t pay according to SGBP

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Availability of inhalation glucocorticosteroids in oblasts

Oblast/pharmacy

Beclomethasone, 250 mcg, available(reimbursement sum)

Price in pharmacy in soms(beclametasone, 250 mcg)

Patient pays the rest of according to SGP (som)

Batken + (1876 soms) 1338 soms 0

Jalalabat + (1750 soms) 1200 soms 0

Naryn + (1876 soms) 1876 soms 0

Osh + (1624 soms) 1700 soms 76 soms

Talas + (-) (1876 soms) 900 soms 0

Chui + (1624 soms) 1200 soms 0

Issykkul + (-) (1750 soms)(often only low dosage of 100 mcg)

Only beclomethasone 100 mcg is available costing 620soms(reimbursement sum is 384 soms)

236 soms

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CONCLUSIONS and PROPOSALS (1)

• 22,2% of hospital workers and 32% of pharmacists are not informed of SGBP

• Because of patients unawareness: - 16% don’t know about their SGBP privileges, - 26% don’t get refunded prescriptions, - 48% don’t purchase medicines in pharmacy even

having refunded prescription

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CONCLUSIONS and PROPOSALS 2)

• Training and study materials are required for patients

• Joint trainings are required with participation of three parties:

1. Health Facility (state) 2. NGO (population) 3. Pharmacists

• To include the issues of benefit medicines provision into continuous medical education program

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• Control and accountability are needed: - norms of writing out refunded prescriptions

Requires committment of physician and pharmacist

- medicine realization on refunded prescriptions in pharmacies

pharmacy get payment from Mandatory Health Insurance Fund for refunded prescriptions, but not for realized refunding medicines

Control is needed over appropriate discloser of the information by pharmaceutical companies about medicines, alternatives in refunded programs (for instance, a share “yellow card” to Ceretid «Glaxo Smith Kline»)

CONCLUSIONS and PROPOSALS (3)

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Pilot trainings held on the basis of taken results

• Training for patients, health workers and pharmacists• Developing brochure “Does the government support

patients with bronchial asthma?• Round Table after Survey was

held with Stakeholders

“Does the government support patients with bronchial asthma?”

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Thank you• Nurlan Brimkulov • CSC coalition • Email: brimkulov@jet.kg • Mobile number: +996 559 957 777• Skype:• Website: