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Situation analysis in Kyrgyzstan . Making Opioids Available in Eastern Europe and Central Asia March 5-6, 2013 Vienna . Opioid analgesics are currently registered in the country. WHO List Codeine - Morphine inject form 10 mg + Morphine oral - PowerPoint PPT Presentation
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Situation analysis in Kyrgyzstan
Making Opioids Available in Eastern Europe and Central Asia
March 5-6, 2013 Vienna
Opioid analgesics are currently registered in the country
WHO List Codeine - Morphine inject form 10 mg +Morphine oral immediate and sustained release -
IAHPC List Codeine -Fentanyl -Methadone +Morphine (immediate release) + Morphine (sustained release) - Oxycodone -Tramadol +
List of medicines for cancer patients under
State Guarantee Program on
preferential terms
Code and Brand name of Medicines
Medicine’s form
Code and of
Medicine form Dosage
mg, etc.
number
Cost of reimbursement for 1 piece (in som)
Ministry of Health
Statistics on controlled drug usage annually
Than chief nurse reports to regional Health Department
Doctor reports to Chief Nurse the list of
prescriptions with patient’s name
KG State Agency for Drug Control Annually Estimate For 2013 – April 2012
International Narcotic Control Board
Has access to SADC data base
The system of drug control
Pharmacy Warehouse
Storage
Pharmacy
Medical Practitioner
Prescription
Patient
Health Insurance Fund
Copayment
Pharmaceutical Distribution
Company
Department of Medicines Supply
and Medical Equipment of the Ministry of Health
Registration
State Agency for Drug Control
Get approval and include to the Register List
Customs
Customs Clearance
Hospital (Oncology Center)
Barriers•Special prescription form •Four stamps and two signs •Pharmacy dispense limit time (9:00 am – 4:30 pm)•Limit on q-ty (20 vials of morphine) •Limit time – prescription form works 10 days
National Oncology Center PC Department (25 beds)
Inter oblast Oncology Center PC Department
Family Medicine Center
Family Medicine Center
Family Medicine Center
Pharmacy
1. Morphine in 10 mg injection form 2. Promedolum in 20 mg injection form3. Tramadolum
Opioids are always available in specialized hospitals (oncology centers)
Diploma of a physician or feldsher.
Maximum amount of:Morphine for on prescription form - 20 vials Tramadol - 10 vials
Length of Rx is 10 days
Morphine is allowed to prescribe to patients with cancer on 4th stage only
In other cases, doctors prescribe Tramadol and Promedol
2 hospices for HIV/AIDS patients
Opioid accessibility
Health Insurance Fund covers cost of medicines by two ways:1. Additional Package – for all insured people according to the list of medicines 2. State Guaranty Program (SGP) – for 5 types of monitored diseases, including
cancer on 4th stage only The cost of one vial of Morphine – 25,73 KGS (0.53 USD)
one vial of Promedol – 42,73 KGS (0.91 USD)Reimbursement by Health Insurance Fund – 97%
Limits of SGP for cancer patients:3. Ketoprophen – 36000 mg or 360 vials 4. Promedol – 4800 mg or 240 vials 5. Morphine – 3000 mg or 300 vials
The cost of medications and health insurance coverage
Coverage by State Guarantee program of preference patients (9 months of 2012, number of preference patients , % of coverages)
Эпилепсия Бронхиальнаяастма
Параноиднаяшизофрения
Аффективныерасстройства
Онкологическоезаболевание
4172(56%)
4172(61%)
2360(40%)
497 (21%)1430 (79%)
9311
6806
5905
2348
1804
кол-во бн на учете кол-во пациентов с Rp
Epilepsy Bronchial Asthma
Schizophrenia Affective disorders
Cancer IV stage
All registered patients
Number of patient with Rx
The volume of sold medicines (during 9 months 2012)
0.5 1 1.5 2 2.5 3 3.5 4 4.50
10000
20000
30000
40000
50000
60000
Ketoprophenum 100мg50609 units
1665,9 thousand som
Morphine 10 мg25026 units
603,8 thousand som
Promedolum 20мg15764 units
647,6 thousand
Tramadol 50 и 100мг765 units
12,2 thousand som
Opioid prescription’s forms
Prescribed opioids registration book Patient chart and list of opioids injection chart
1. References for pharmacy registration book for taking opioids 2. Sample of reference form
The registration book of used opioid’s ampoules
1. Registration book of certificates damaging empty ampoules of opioids 2. Sample of certificate
6. What is the projected need for morphine in the country by dosage form (IR, SR, and injectable)
Mortality: Cancer - 3400AIDS - 100TB – 600Need in Palliative Care – 4100 Need in morphine – 24,9 kg