Table 1.

Pharmaceuticals in the Russian health system

State medical institutions in the Russian Federation provide free medical treatment to all in-patients but, after discharge, patients must pay the full cost unless they are in one of the groups entitled to free medications or at a 50% discount, as set out in a law from 1994. These include children in large families who are under a certain age (3 or 6 depending on family size), those receiving the minimum pension, invalids, veterans of the Great Patriotic War and other military operations, and those involved in the Chernobyl disaster. Entitlement extends to immediate family members. Since 2008, those in these categories can choose an alternative, whereby they receive monetary benefits instead. In practice, a growing number of the 19 million potential beneficiaries choose monetary benefits, leaving less than 4 million receiving. This can be explained by how free and subsidized medicines are available only in certain pharmacies in specific medical institutions and a widespread belief that essential drugs are often unavailable in these pharmacies. Those choosing monetary compensation can thus obtain their medicines from private pharmacies, albeit at additional cost. A recent study of medicines availability and affordability in state and private pharmacies in six Russian citizens did, however, find that common cardiovascular medicines were widely available and, in private pharmacies, reasonably affordable. However, where state pharmacies stocked generic versions, they did not also stock branded equivalents [8].

Information on prescribing for hypertension in Russia can be found in the RELIF III study. The most frequent classes of drugs were angiotensin-converting-enzyme inhibitors (78%), diuretics (40%), beta-blockers (36%), and calcium antagonists (19%). The authors reported that angiotensin-converting-enzyme inhibitors were more likely to be taken regularly, specifically Prestarium, Renitec, and Hartil [9].