The doctor does not write a discounted prescription. How to get preferential medicine. What to do if the medicine is not in the pharmacy

• 24. 11. 2016

What do doctors and officials do to avoid giving patients free medications they are entitled to?

"You are not sick." “That’s not what you’re sick with.” "You don't need this medicine." “You need this medicine, but another, cheaper one will also do.” “You need this drug, but it’s not there, wait.” This is how doctors and officials respond to thousands of people who are entitled by law discounted medicine. They are deceiving. They know that a person is sick and they know what medicine he needs. But according to rough estimates, the state is already short of 45 billion rubles for drug provision. . In some regions, only 10% of those who apply can be provided with subsidized drugs. Officials and doctors refuse patients in such a way as to make breaking the law as difficult as possible to prove. The Ministry of Health and Roszdravnadzor regularly report: the situation with preferential drug coverage in the country is stable. The numbers underlying these reports have no relation to reality. The true scale and cruelty of the war between patients and the state is amazing

“Every time they say: “Sorry, there are no medicines!” I can’t help it!” But they are entitled to me by law. If they are not available today, the state must purchase them tomorrow. Is not it so?"

Veronica has repeated this question many times, but her voice still sounds surprised. When she speaks, her hands with long, graceful fingers tremble slightly, as if she, too, cannot contain her amazement. She has been taking hormonal inhalers for 15 years and cannot breathe without them. She has asthma, lots of concomitant diseases and disability. She has the right to receive free the dose she needs is at the pharmacy, but the medicine has not been given out for a year and a half.

“They were always issued intermittently,” says Veronica. “We had to find out in advance the day when the drug would appear, and run to the clinic when it opened in order to get it in time.” If you don’t have time, they’ll say it’s over, and do whatever you want. But I only came across the fact that there are no medicines for months last year.”

The pharmacy said that there was no point in asking - there would be no medicine.

Then, after six months of waiting, Veronica first contacted the Moscow Department of Health. All you had to do was leave a request, and the inhaler, which was missing from the pharmacy in the morning, was found in the evening. But the magical effect of calling the department did not last long. After a couple of months, the medications were stopped being given again. This time, when Veronica called the department, she was told that the situation was complicated. You can leave a request, but no one knows when the drugs will be available. On the same day, she received a call from the pharmacy and was told that there was no point in asking - there would be no medicine. Now Veronica’s relatives buy inhalers, the amount is several thousand rubles a month. According to Veronica, for many people waiting in line to see a pulmonologist, this amount is unaffordable. The words “there are no cures” sound like a death sentence for them.

Veronica's case is one of thousands. It is enough to flip through the regional press over the past month to read a dozen such stories. In Mordovia, pharmacies for beneficiaries do not have not only prednisolone, but even iodine and bandages. In the Oryol region, a woman with lymphoma managed to get medicine only after local media wrote about this case. In Khakassia, due to the huge number of patient complaints, the situation with preferential medicines will be investigated by the Chamber of Control and Accounts. Organizations involved in protecting patients' rights constantly talk about the growing number of requests. Such growth is recorded, for example, by the Movement Against Cancer society. In September of this year, cases of refusal to people with oncological diseases there were so many that the General Prosecutor’s Office dealt with violations of the law in a number of regions. According to online monitoring as of September 2016, conducted by the head of the League of Patients society, Alexander Saversky, more than 80% of respondents experience difficulties in obtaining subsidized medications. Only 35% of them manage to obtain a prescription for the drug without any problems. Similar figures were given in last year’s monitoring by the All-Russian Popular Front: half of the patients who apply for medications are not given medications on time.

Illustration: Rita Cherepanova for TD

A 2016 government report stated that about 45 billion rubles are missing for drug provision.. This is not surprising: the standard cost per citizen receiving free drugs, decreased from 849 rubles per month in 2011 to 758 rubles in 2016. At the same time, according to Rosstat, drug prices have increased by 24% this year. In 2015, the government even allocated an additional 16 billion rubles to save the situation - but they unexpectedly turned out to be not in demand. The Ministry of Health stated that all necessary medicines have been purchased.Roszdravnadzor regularly monitors the drug supply in the country and is satisfied with its results. According to reports from these departments, in the Moscow region, for example, about 98% of beneficiaries receive drugs, and in other regions the situation is stable. The ability of the Ministry of Health to force health officials to shape reality in accordance with reporting goals surprises even the president.

If not in a good way

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Despite the fact that quite a few citizens have the legal right to receive free medicines, pharmacists either refuse to dispense medications or declare the absence necessary medications. Roszdravnadzor has developed a clear algorithm for the actions of pharmacists in pharmacies that do not have the requested drug, but citizens do not know about it. In this article, we will tell you what to do if the pharmacy does not have subsidized medications, how a pharmacy employee should act in the absence of medications, how soon medications should be provided, and how and where to file a complaint.

Algorithm of actions of a pharmacy pharmacist in the absence of subsidized drugs

Important! According to the text of Federal Law No. 122-FZ dated August 22, 2004, if a citizen has completed all the actions prescribed by law to receive free drugs (or discounted drugs), that is, collected Required documents, went to the clinic, received a discounted medicine and came with it to the pharmacy on time to the pharmacy that participates in state program providing citizens with preferential medications, the pharmacy pharmacist has no right to refuse to dispense the drug.

If on the date of the patient’s request the pharmacy does not have the subsidized medicine he needs in stock, the pharmacist has the right to offer the citizen analogues of this medicine, the effect of which is completely similar to the medicines prescribed by the doctor.

• But the pharmacist has no right to impose a replacement on the client. In case of refusal of substitute drugs, the pharmacist acts as follows: suggests contacting another social pharmacy located in the same, and with which this institution has an agreement;
• if the citizen refuses, accepts a prescription for a subsidized medicine from the applying citizen;
• registers the fact of its receipt in a pharmacy journal, specially established for recording cases of unsatisfied demand;
• assigns the citizen’s request the status of “deferred service”;
• enters information from the prescription form into computer program pharmacies;
• sends a request to the supplier for medications that are out of stock;
• waits for a response from the supplier company about the availability or absence of the requested drug;
• if the medicine is delivered, the pharmacist waits for delivery and notifies the patient about the availability of the medicine by phone;
• if the medicines are not available from the supplier, the pharmacy purchases them independently for own funds(expenses will be reimbursed later from the federal budget).

How soon will the pharmacy provide a discounted medicine that is out of stock?

If a citizen applies to a social pharmacy with a prescription, but it doesn’t have the right medicine, Roszdravnadzor allows you to assign the application the status of “deferred service”, take the patient’s phone number and call him back when the drug appears in the pharmacy. No more than 10 working days are allotted to resolve this issue (that is, weekend pharmacies are not included in the calculation).

However, if a prescription for a subsidized drug was issued by a medical commission medical institution, it is allowed to provide it to the citizen within 15 working days.

What to do if there are no discounted medications at the pharmacy - where to complain

Unfortunately, it happens that pharmacy pharmacists completely refuse to accept a prescription from a beneficiary or report the absence of the required medicine. First, you can complain about the pharmacist to the pharmacy manager. If this does not help, there are still many options to protect your rights:

What to do if the pharmacy does not have discounted medications

Here is how they comment on the situation with the refusal to issue preferential medications lawyers. If a citizen is not provided with what he has the right to, the algorithm of actions should be as follows:

1. It is necessary to record the fact of refusal to provide a medicine for which there is a special, correctly completed prescription. To do this, you first need to submit an application addressed to the head physician of the clinic where the drug was prescribed.
2. If there is no response to the application, and the medicine suddenly appears in the pharmacy, or nothing happens at all for unexplained reasons, you should file a complaint with the regional department of the Ministry of Health or directly with the Prosecutor's Office.
3. If there are no subsidized medications at the pharmacy vital necessity, or their issuance was refused, you need to contact Rospotrebnadzor. The most effective way is to write a statement to the prosecutor.

Legislative acts on the topic

Common mistakes

Error: The pharmacy pharmacist called back the citizen, for whom the subsidized medications were not available on the date of the call, a month later.

Good afternoon.

1. To receive discounted medications at a pharmacy, you must write out a prescription for them from your local doctor. The basis for issuing a prescription is a written recommendation (extract) received from a specialized medical institution where the patient is observed for his underlying disease.
2. The local doctor may refuse to issue a prescription due to lack of this drug at the pharmacy. This refusal is illegal, because even if the drug is not available this moment at a pharmacy, upon receipt of a prescription, the pharmacy is obliged to purchase the drug specified in the prescription within ten days. If there is no prescription, then the pharmacy is not obliged to do ANYTHING, and you will never see the medicine. Therefore, you need to “remind” your local doctor about this and continue to insist on writing out a prescription. 3. If the doctor continues to refuse to issue a prescription, demand it and write it down on the card: “the prescription was not issued due to the lack of medicine in the pharmacy.” He cannot write something like that, so he will either write out a prescription or refuse to write down on the card that he did not write it out. In this case, it is necessary that the doctor MUST make an entry in the card stating that the patient on such and such a date was at an appointment and was examined by a doctor on such and such (he will not be able to refuse this).
4. Immediately after leaving the doctor’s office, write a complaint in 2 copies addressed to the head doctor of the clinic with approximately the following content: “To the head doctor so-and-so from so-and-so... Please explain on what basis the therapist so-and-so refused to write me a prescription for medicine (name) , necessary for my life's indications. I consider this refusal illegal on the basis of Order of the Ministry of Health and Social Development of the Russian Federation dated February 12, 2007 N 110, Decree of the Government of the Russian Federation dated July 30, 1994 No. 890...
5. Give one copy of the letter to the secretary of the head physician, ask the secretary to put a stamp on the second copy.
6. If the secretary refuses to accept the complaint, you must send it by mail - registered mail with a list of attachments and acknowledgment of delivery. The inventory will be given in two copies, one to be placed in the letter, the second to be attached to a copy of the complaint stored in your home. Attach the payment receipt there registered letter and a notice of receipt of the complaint signed by the secretary of the head physician. 7. In the future, act depending on the reaction of the head physician. He may offer to agree verbally, but it is necessary to insist on a written response. After this, a prescription for the medicine is usually given.
8. If unsubscribes begin (they are prohibited from writing out this medicine in the Department of Health, there is no money in the budget, etc.), then you need to contact the prosecutor’s office, regional Ministry healthcare, Roszdravnadzor (you can go to 3 of these places at once). Send there COPIES (not originals) of all documents (your complaint, postal documents - list of attachments, receipt, delivery of notification; responses from the head physician). If there was no response from the head physician, you can safely complain to the prosecutor’s office. Usually, after a complaint to the prosecutor's office, doctors themselves call home and ask when it is convenient for you to come for a prescription.

To the prosecutor (name of the prosecutor's office)

from a citizen (full name, address)

According to Part 1 of Art. 41 Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens dated July 22, 1993 No. 5487-1 (as amended on August 22, 2004

No. 122-F3), citizens suffering from socially significant diseases are provided with medical and social assistance free of charge or on preferential terms.

Since my disease (specify which one) is on the list

socially significant diseases(approved by Decree of the Government of the Russian Federation of December 1, 2004 No. 715), I have the right to purchase preferential medications.

However (state the essence of the claims with numbers and addresses of pharmacies, dates

requests and names of officials and motivation for refusals).

According to Art. 4 Federal Law dated June 22, 1998 No. 86-F3 “On medicines" and art. 20 ich. 1 tbsp. 41 of the Constitution of the Russian Federation, everyone has the right to health protection and medical care.

According to Part 4 of Art. 41 Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens dated July 22, 1993 No. 5487-1 (as amended on August 22, 2004 No. 122-F3), financing of medical and social assistance to citizens suffering from socially significant diseases,

is an expenditure obligation of the constituent entities of the Russian Federation.

Failure of pharmacists to comply with all these standards violates my constitutional right to free medical care, including to receive vital and essential medicines due to budget funds. In addition, this causes me losses associated with the restoration of violated rights. The right to compensation for losses is justified by Part 1 of Art. 15 Civil Code of the Russian Federation. Since I was denied subsidized medications, I was forced to purchase them at my own expense. The amount of losses is confirmed by photocopies of sales receipts bearing pharmacy stamps. In order to restore my legal rights, I ask that a prosecutor’s investigation be carried out based on the facts I have stated and that I be notified of its results.

Application:

(attach copies of all documents that may be relevant to the case and the identity of the applicant - disability certificate, extracts from the medical history, copies of sheets outpatient card with a doctor’s note about the diagnosis, photocopies of sales receipts from pharmacies, etc. and so on.)

Date Signature

More on the topic Complaint to the prosecutor's office about the lack of subsidized medications:

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2. § 4. Prosecutor's office: concept, constitutional system of the prosecutor's office, goals of prosecutorial supervision

Everyone faces the impossibility of obtaining free medicine prescribed by the attending physician. large quantity patients. The reason for this is not only the frequent absence the necessary drugs in pharmacies, but also the dishonesty of their employees who refuse to serve beneficiaries. How to protect your rights?

According to the requirements of Roszdravnadzor, there is a clear algorithm of actions that the pharmacist must adhere to if the pharmacy does not have the subsidized medicine needed by the patient. But not all citizens know about it. Therefore, having heard a refusal, they purchase expensive drugs at personal funds, while leaving violators of their rights without punishment.

What should a pharmacy employee do if there are no subsidized medications?

If the free drugs prescribed by the doctor are not available in the pharmacy at the time of the patient’s request, the pharmacist has the right to offer similar drugs that are available. If the client refuses to receive substitute medications, then the pharmacist is obliged to act according to the following algorithm:

1. Take from patient preferential prescription.
2. Register it in a special pharmacy journal of unmet demand, assigning it the status of deferred maintenance.
3. Enter recipe details into electronic program institutions.
4. Submit a written/electronic request for medications to the supplier company.

The authorized pharmaceutical organization must also register the incoming request and provide an official response to the pharmacy regarding the presence/absence and availability of this drug. If the application cannot be satisfied on its part, the pharmacy must purchase the drug itself, and the costs incurred will subsequently be compensated by the state.

If the drug is not available in the pharmacy indicated by the doctor who wrote the preferential prescription, the patient has the opportunity to get it at another social pharmacy, provided that it is located on the territory of the same municipality, and the heads of both institutions agreed on this point among themselves. If the drug is not available in the right dosage, the pharmacist can replace it with a medicine with a lower dosage, but increasing its volume to an amount that will be sufficient for therapy. At the same time, to dispense the drug in a larger dosage than prescribed, you must contact your doctor for another prescription. No pharmacy has the right to limit the volume of subsidized medicine. Only the attending doctor has this competence.

How long does it take for the pharmacy to provide medications?

Roszdravnadzor allocates 10 working (not calendar!) days for the delivery of previously unavailable medications. If the drugs were prescribed through a medical commission, then this period increases to 15 days. The client is notified of the arrival of the order often by telephone on the same day that the necessary funds arrive at the pharmacy.

Where should I file a complaint against a pharmacy?

If after specified period delivery of the missing medicine was not carried out, or the pharmacist completely refused service to the client with a preferential prescription, you can first try to resolve the controversial situation by filing a complaint with the manager of the pharmacy. If the violation is not eliminated, you must file an oral or written complaint against the establishment, outlining the essence of the problem. Below are the main ways to file a complaint against a social pharmacy that violates the rights of a beneficiary to receive medicines:

• Call the hotline of the Department of Health of your city/region. You can find out its number from the help desk operators or on the structure’s website, where you can also familiarize yourself with the specialists’ work schedule;
• Contact the hotline operators of the Pharmacy Department of the Department of Health of your city/region, finding out its contact information in a similar way;
• Leave a request on the official website of Roszdravnadzor, indicating your contact details, name and address of the pharmacy, detailed description the situation;
• Contact the administration of the clinic where the preferential prescription was issued. The specialist on duty is engaged in the solution controversial issues problems encountered by patients, including the provision of subsidized medications. Information about his work schedule, as well as a contact phone number, can be obtained from the reception desk;
• Submit an application to the prosecutor's office against the organization or official who created obstacles for the patient to receive free medicines, attaching copies of your passport, beneficiary ID, and prescription.

Each pharmacy has the right to refuse to issue a medicine to a person if the preferential prescription was not written on an official form or its validity period has expired. In this case, complaints against the pharmacy will not be considered. And the patient will need to contact his doctor with a request for a new prescription.