Ukraine’s diabetics, unlike people suffering from other diseases, can’t complain that the state doesn’t fund their treatment.
Activists, officials and pharmacies all agree that more than enough money has been allocated for diabetes sufferers in 2016 – approximately $25 million for Ukraine’s 1.2 million diabetics.
However, the problem is that the money isn’t being spent wisely: Local officials place orders for, say, insulin, with a supplier and use up all of their budgets just on that, rather than buying the other medicines and supplies that sufferers of diabetes need.
So for the past decade activists have been trying to put in place a reimbursement system, whereby the state would pay pharmacies for the medicines on patients’ prescriptions, instead of just giving out insulin.
Legislation for the system, intended for type 1 diabetics, has been passed and was on the cusp of implementation. But then Prime Minister Arseniy Yatsenyuk’s government was dismissed in April, and since then, activists claim, the effort has stalled.
Renewed vigor
But with World Diabetes Day approaching on Nov. 14, the ministry seems to be approaching the problem with renewed vigor. They say they are determined to implement the system, which currently exists only on paper, in January 2017. The ministry also said that thanks to a recent vote in parliament, type 2 diabetes treatments will also be funded through a reimbursement system starting in January of 2017.
At present, regional health officials purchase insulin through tenders, a process that is heavily criticized by activists. Tablets for those with type 2 diabetes can rarely be found, and often only one type of insulin is purchased. Activists often accuse regional officials of colluding with pharmaceutical companies and allowing them to offload stock, though the evidence for this is indirect.
The current purchasing process also means pharmaceutical companies can block tenders if they fail to sell the desired amounts. One of the worst years was 2014, when five tenders were blocked, according to Nataliya Vlasenko of the Kyiv Diabetic Charitable Fund. Unblocking a tender through the Anti-monopoly Committee can take one to two months.
“Patients went without their medication for almost half the year. How people survived, god only knows,” said Vlasenko.
In these cases, diabetics unable to afford to pay are forced to take whatever insulin is available, even if it’s not suitable for their particular condition, or they lower their dosages to get through the dry spell. Both actions can lead to the diabetes worsening, according to diabetes activists.
The Ukrainian Association of Diabetics says that the reimbursement system will save the state enough money to reimburse most, if not all of the patients’ costs, depending on their status. Moreover, it will mean that patients receive the medication they need, and on time.
Lack of policy
A register of type 1 diabetics (roughly 200,000 out of the 1.2 million people with diabetes in Ukraine), which is essential for the new system to operate, was almost completed by a third party before April. The ministry wants to return the register to state hands for security reasons, but is short of money to do so.
“The register is being held in private hands. The state should either buy it or pay for access to it. We’re now searching for money to buy it so that it will become property of the state, because if we did it ourselves from scratch it would take another two years,” said Acting Health Minister, Ukrainian-American Ulana Suprun.
Pavel Lukashevych, the head of hospital medicine at Ukraine’s Farmak pharmaceutical company, says that the pharmaceutical companies have supported the association in their efforts to bring in the new system. He places much of the blame for the delay in progress on the government’s lack of policy direction.
“They allocate so much money, but there is no aim. It’s just insulin, insulin. No tablets. They don’t say what they want to achieve,” said Lukashevych.
Unlike the diabetes charities, Farmak has argued that patients should contribute more to the cost of their treatment. Under the current legislation, patients pay up to Hr 150 for a package of medication that lasts up to two weeks, but many are exempt from any payment.
Farmak says that there is a big difference in the price it costs to manufacture the medicine and the price that patients will pay. By paying less, or nothing at all, according to Lukashevych, patients take their condition less seriously, which can encourage behaviors that make their condition worsen.
“They think: ‘Well, I have the best insulin, so I can drink, eat, smoke and do whatever I want,’” said Lukashevych.
“There is almost no effort on behalf of the government in getting diabetics together to educate them about how to manage their diabetes,” he said. “We, the pharmaceutical companies, do a lot of this.”
