As early as the beginning of March, Russia started having problems with foreign-made drugs. Some of them disappeared from sale altogether, and the prices for some of them went up drastically. Cancer patients, diabetics, and people with thyroid disease found themselves in a vulnerable position - they had to switch to analogues of dubious quality and gather in groups to look for drugs together and help each other. Experts with whom The Insider spoke believe the problems are logistics-related: transport companies were simply not ready for such an increase in demand, and warehouse stocks keep failing to arrive at pharmacies on time.
«A few days after the war began, the drug was nowhere to be found.»
Double price, not for everyone
«A few days after the war began, the drug was nowhere to be found.»
Alla was diagnosed with cancer in 2018. She underwent comprehensive treatment. To reduce the risks of recurrence, she needs to take an aromatase inhibitor drug on a daily basis. The active ingredient in this medication is anastrozole, which is designed to completely stop the production of estrogen (female sex hormone) in the tissues, since the tumor was dependent on female sex hormones.
«My doctor recommended the drug Arimidex, which is produced by AstraZeneca, it was on sale in all our pharmacies. It was more expensive than the Russian analogues, but it was better because it had fewer impurities. We could have received medicines under the Obligatory Medical Insurance policy, but the doctor said that if I could buy them, I would be better off buying them. The foreign drug will not have strong side effects such as body aches, pain in the bones and joints, of intense leaching of calcium from the bones. So, I have been buying Arimidex since 2019,» she says.
Without the drug, Alla will not feel any immediate negative effect. But the longer the patient goes without the drug, the higher the risks of cancer recurrence, because the level of hormones in the body will return to its previous state.
«After the war began, I understood there would be a shortage of medicines, but I just didn't have the money to buy a supply of Arimidex for any length of time. I waited a few days for my paycheck, it came, I ran to the pharmacy where I usually buy it, but it was already gone. I rushed to another one, but it had run out there too. It turned out that it was nowhere to be found. I did not take anything for a week and only recently decided to buy the Russian drug. By the way, it is also very expensive, and the side effects can be stronger. I am still testing it and see what happens. The most striking effect of the Russian analogue is bone pain. I can't even walk normally because my legs hurt».
According to Alla, the mood in the oncology community is anxious. Many patients find it difficult to buy drugs specifically for hormonal therapy. Previously, when foreign drugs were available (although each of them cost around 9,000 rubles), many preferred to pay extra in order not to feel the side effects the cheaper Russian analogues had. Now, in order to continue receiving quality medications, patients partner up and purchase drugs in Turkey.
One of the main reasons for the disappearance of drugs from pharmacies was a problem with logistics. The supply of drugs from abroad by air and even by road after the outbreak of war was limited, and within Russia transport companies were not ready for such an increase in demand. Therefore, the rate of stock replenishment in pharmacies was slower than the rate at which the drugs were being purchased.
«Drugs are imported into the country by manufacturing companies that have their own warehouses in Russia,» explains Nikolai Bespalov, development director of RNC Pharma. «Under normal conditions, the warehouses in Russia always have stocks of goods for an average period of six months. These stocks allow us to provide drug supply throughout the country without interruptions or disruptions.
Pharmacies, on the other hand, do not keep large inventories. They are not designed for large demand surges. Therefore, solely due panic buying, the goods disappeared at some point in time, and we just needed time to get the drugs from the manufacturers' warehouses to the distributors and then to the pharmacies. In terms of Russia's geography, this task cannot be solved in an instant.» In March, the Russians bought up a year's, or even a year and a half's supply of some drugs, such as the synthetic hormone L-thyroxine, which should be taken by people with thyroid disorders on a regular basis, Bespalov says.
In March, the Russians bought up a year's or even a year and a half's supply of certain drugs
Because of the shortage of L-thyroxine in pharmacies, people are trying to organize exchanges. Announcements about finding any remnants of a cheap drug can be found on social media pages, and there is even a chat room in Telegram, where people buy and send each other the drug when it appears on sale in pharmacies. One of such chats has been joined by 2,500 people over the two weeks since the beginning of March.
«I created the chat room because I saw people panic over the fact that the medicine was vital,» says Abror, the administrator of the largest L-thyroxine exchange and co-purchase chat room. «My younger brother had his thyroid removed in December. He said drug dealers had sprung up online, trying to cash in on the fact that people couldn't find the medicine in pharmacies. They buy up several packs in different dosages, and then sell them at a price many times higher than the one asked by the pharmacy.
By the end of March, supplies to Moscow pharmacies had stabilized, but it was still difficult to find medicines in the provinces. Then one of the chat room's volunteers, Anastasia, began helping to reserve the medicine in pharmacies where it was available, so that the other volunteers who happened to be nearby could buy it and send a parcel to the provinces where the medicine was still unavailable. «I was horrified at how many people were left without the medicine. When we were able to help some people, they, in return for our kindness, began helping everyone else. Some sent their pills, some went to pick up expiring reservations and sent them to those in need, some sent me their confirmed reservations, and I added them to the list.»
Double price, not for everyone
Irina has been taking medication prescribed by her psychiatrist for depression and cyclothymia (a mild form of bipolar disorder) for two years. In the spring she was supposed to finish the course, but the war began, and in early March the psychiatrist advised her at an appointment to continue taking the medication. «My medications are Cipralex and Lamictal. When I went to my pharmacy, the pills were gone. During the next week, the medication was never there. And by early March there was no Lamictal either, and the pharmacies stopped taking orders. In the end, I managed to find the medication I needed, but at double the price. I used to spend 3,000 rubles a month on it, but now I need 5,000-6,000 rubles.
The price increase is connected with both the devaluation of the ruble and a sharp and significant complication of logistics, Nikolai Bespalov explains.
«Stocks were bought up at the old prices in a matter of days. Logistics costs in these conditions have risen seriously. At the same time, distributors take into account the fact that the next procurement of even those drugs that are produced or bottled in Russia, will cost much more. Substances for Russian-manufacture drugs are mostly imported. In monetary terms, about 15% of the raw materials are Russian, and the rest are imported».
Patients with chronic diseases, who need to take their medications regularly, have felt the changes particularly acutely. The largest group of chronic patients are diabetics.
A year and a half ago Igor had a heart attack. He was prescribed Ezetimibe to lower LDL (a class of blood lipoproteins that is one of the main carriers of cholesterol). Its Russian version, Otrio, was given free of charge in the outpatient clinic. At the last appointment with the cardiologist, Igor was not given the drug, it was gone, and it had also disappeared from pharmacies: «I managed to buy a few months' supply online. But it is unclear what will happen next. An acquaintance of mine with type I diabetes is in real trouble. Decent French insulins have disappeared as a class. Russian analogues still remain, but they don't work properly. Ezetimibe may not be as critical as insulin, but in patients like me, according to the rules, it's a lifetime necessity.»
Patients with type I diabetes in many regions of Russia receive insulin and supplies for free, even if they are not registered as disabled. However, according to Polina Rysakova, the administrator of the Telegram channel «Diabetes and its books,» it has to do with the insulin that is produced in Russia. There is no shortage of drugs that are produced in Russia, but according to the expert, they are not insulin - they are biosimilars. Unlike generics (analogues of original drugs that are synthesized chemically), a biosimilar is an analog of a drug that is derived from living cells, it cannot be made completely identical to the original.
In particular, Russian-made biosimilars have not been tested for suitability for pregnant women and children. Some patients have found the Russian equivalent of a foreign drug is not suitable for them. Polina Rysakova, who tried to switch from imported Humalog to Russian RinLiz, also encountered this problem: «For the first two or three months everything was fine. After that my body stopped reacting to it. Then, the resistance to the drug grew sharply, which means my body does not react and the blood glucose does not go down. Consequently, insulin does not have the desired effect. I gave it up.»
Russian insulin analogues were not tested for suitability for pregnant women and children
However, this is an individual reaction, and Russian insulin will still suit many. Diabetics may face a much more serious problem: disruptions in the supply of consumables - they are mostly imported, and because of complicated logistics there are bound to be disruptions in the supply chain. In addition, because of the devaluation of the ruble the cost will increase significantly. For example, the price of a month's supply of consumables for an insulin pump - a device that continuously pumps the drug from a special reservoir into the subcutaneous fatty tissue - has now gone up from 4,000 to 8,000 rubles, and they are already hard to buy. Such consumables have also disappeared from state procurements.
According to Baza, on April 7 doctors were warned that supplies of foreign asthma drugs were about to stop. Doctors say analogues of these drugs work much worse. And for children under 4 years of age, there are no Russian analogues at all. Usually, children with asthma are prescribed Pulmicort, a drug that is administered through a nebulizer. Now this drug is almost nowhere to be found.
In addition, doctors have noted a shortage of foreign prophylactic vaccines, such as the American vaccine Rotatek (prevention of rotavirus infection), the French drugs Pentaxime (pertussis, diphtheria, tetanus) and Avaksim (hepatitis A).