Nifantiev: For All The Time That I Have Been Dealing With Pharmacies, I Don’t Remember Such A Crisis With Medicines

Nifantiev: For All The Time That I Have Been Dealing With Pharmacies, I Don’t Remember Such A Crisis With Medicines
Nifantiev: For All The Time That I Have Been Dealing With Pharmacies, I Don’t Remember Such A Crisis With Medicines

Video: Nifantiev: For All The Time That I Have Been Dealing With Pharmacies, I Don’t Remember Such A Crisis With Medicines

Video: World Pharmacists Day 2019 2022, November
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At the end of October, pharmaceutical companies announced problems with the supply of 40 million packages of drugs - about 10% of the volume sold monthly in the country. Ordinary citizens faced a shortage, calling pharmacies showed that many drugs are really impossible to buy. Against this background, on November 3, the government simplified their labeling system. Ilya Kopelevich, Editor-in-Chief of Business FM, in an interview with Evgeny Nifantiev, Chairman of the Coordinating Council of the Russian Association of Pharmacy Chains and General Director of the Stolichka Social Pharmacy Network, discussed this problem.

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Our guest is Evgeny Nifantyev - General Director, founder of the Neopharm pharmacy company, which is known in Moscow and other cities under the Stolichki brand, as well as the chairman of the coordinating council of the Russian Association of Pharmacy Chains. Today the topic of our conversation is clear without preliminary explanations. I would put the question this way: what medicines can be found exactly in any pharmacy now? Now people are faced with the fact that a huge number of positions need to be looked for, to go to the other end of the city, if there are any at all.

Evgeny Nifantiev:

Pharmacies usually keep track of shortages - this is when you, for some reason, do not have the opportunity to sell a certain drug. In ordinary life, the defect can be up to 5%, now this figure is 15%. Only? But nevertheless, maybe these 15% are the most in demand?

Evgeny Nifantiev:

Not all medications were gone. Everyone noticed that Nurofen is everywhere, but paracetamol is not everywhere.

Evgeny Nifantiev:

There is paracetamol. We are some pharmacy managers

they said that he disappeared too

Evgeny Nifantiev:

Paracetamol disappeared in the first wave of the spread of coronavirus infection. This was indeed the case. They said on TV that paracetamol literally in a matter of days, or even hours, heals the coronavirus - and we understand that this is not so. Naturally, everyone ran to buy our domestic paracetamol, preferably for themselves, family, colleagues, as much as they would give, especially since it is a fairly inexpensive drug. And literally within a couple of weeks there were real interruptions in the country with paracetamol. But then this problem was solved. The Ministry of Industry and Trade, manufacturers, pharmacy chains and distributors - everything worked as a single mechanism, and there were no more interruptions with paracetamol. Now we see more interruptions with antibiotics and with such drugs as "Kleksan", "Heparin", "Fraxiparin". This is primarily due to the increased demand for them. There are a number of other reasons. We talked a lot about them. We told, you told, including with us, that the labeling actually blocked the supply of drugs both from manufacturers to distributors and from distributors to pharmacies, and even sales in pharmacies themselves, since in a pharmacy it must also work at the final stage. but it doesn't work. And even what has reached the pharmacy cannot be sold. Some measures have now been taken. Has anything changed over the past week with the supply of these drugs?

Evgeny Nifantiev:

The history of the issue began on July 1, when marking was made mandatory. This was very controversial, given that, after all, the first wave of covid at that moment either passed or did not pass. It is clear that there could be a second wave of the spread of the infection. And this was not a surprise to anyone, but nevertheless it was decided to make it mandatory on July 1.At the same time, one must understand that the period from idea to implementation was quite short, and no one else in the world launched such a complex system so quickly. Moreover, the system does not just control at the entrance to the turnover and at the withdrawal from the turnover, the system controls the complete traceability of the entire chain. Even by the example of just one manufacturer. The manufacturer has seven operations when he accesses the system and must receive an acceptance. And now you can imagine that there are manufacturers, there are distributors, there are pharmacies, each has a number of operations that need to be addressed, and the system may not respond for half an hour, an hour, or two. At some point, the system did not respond for a day. Therefore, this path of passage of the package to the patient turned out to be very, to put it mildly, thorny. Probably, this is the answer to the question, because we remember how labeling was applied to a wide variety of goods, and there were always worries and some kind of failures. But the most popular product that was subjected to such labeling is alcohol - EGAIS. Probably, in terms of the number of pieces and the volume of sales, these are approximately comparable markets, if we count in the number of these products and brands. There were some individual failures in alcohol, but they were local, and no alcohol shortage occurred when the Unified State Automated Information System was introduced. But when the labeling of medicines was introduced, there was not only a shortage, but actually a collapse. It seems to me that you have probably explained why now: because the bottle is only once, but here it is seven times.

Evgeny Nifantiev:

Yes. Still, the lack of alcohol in stores, fortunately, did not leave such an indelible impression as the lack of drugs. If he were absent, it would have left, believe me, no less than medicine.

Evgeny Nifantiev:

And he was absent. At the beginning, during the implementation of the Unified State Automated Information System, there were days when he was absent. Couldn't sell. The question is that EGAIS did not develop in the way that they took and immediately made traceability - for several years it was going to this. And we also proposed here, since such serious problems have arisen: let us also take a step back and transfer from manufacturers absolutely all control identification marks to the system, to the NWFP, and pharmacies will read all control identification marks when withdrawing from circulation. Thus, there will be a reinforced concrete guarantee of two points. The first is that it will definitely work, because it is an uncomplicated system. And second - that the buyer, having scanned in the "Honest Sign" application, will understand for sure that this is exactly the drug that was produced exactly at this site of a certain manufacturer. Nevertheless, so far we have gone to such a half-hearted decision, they made it possible, upon receipt of the goods, if the system does not respond within 15 minutes, to accept it in a notification manner. But there is a nuance, you still need to understand that both the accounting systems of distributors and the accounting systems of pharmacy chains were written for processes that were fully traceable. Therefore, they cannot be taken and switched to a new government decree with some kind of toggle switch. In particular, we have our own, self-written program, and we understood that this decree would be issued, and day and night we tried to rewrite, test, and so on. I think that maybe a day is left before everything will work for us under the new decree. I really hope that our colleagues will also work quickly in order to solve the problem with the passage of goods. But this also applies not only to pharmacies, this also applies to the manufacturer at the time of large-scale wholesale delivery, this also applies to the distributor who sells to pharmacy chains throughout Russia. They all have to rebuild, right? Should we expect that 40 million, as distributors said, of packages in warehouses that cannot reach the sale, that it will somehow move?

Evgeny Nifantiev:

Most likely more.Even if you take our organization, which today is slightly more than 3% of the market share of the Russian Federation, we had more than 200 million rubles in goods, in medicines that we could not register. What is the share for this period?

Evgeny Nifantiev:

Here the question is not even about the share, here the question is that this is a scarce product that we really want to launch so that people have the opportunity to buy it. In general, what are the main reasons for the shortage that has arisen: labeling or increased demand? Although for some drugs, anticoagulants, we read that in fact there was

sold

significantly less in October than in October last year. That is, the increased demand has nothing to do with it, it simply does not physically exist.

Evgeny Nifantiev:

Here it cannot be said that only the labeling spoiled the whole situation, because in any case we were pushing the drugs along the chain with all our might, we were tormented, nervous, but still, in a semi-manual mode, we were pushing this business. After all, the drugs in the end, maybe not in the same volume, but still reached. There is still a difficult moment, there is an absolutely correct system that adds stability at a stable time. It is a price recording system for essential essential drugs. It is necessary and important. And it really kept the prices of drugs really low all the time. But the problem is what happened with the spread of the coronavirus infection. After all, the market for substances is the world global market, and when the demand in the world increased, the prices for substances increased - for some of them at times. And it turned out that many drug registration prices are lower than their prime cost, taking into account the rise in prices for substances. And the substances are in dollars and euros. Take the same anticoagulants. The problem is that the substance has grown significantly, and the registration price for many manufacturers has not been revised. It means that you need to be more flexible in relation to some of the positions that are needed right here, now and today, and in large quantities - this is the first moment. And the second point is that we have (and what we warned about) the Federal Antimonopoly Service. The Federal Antimonopoly Service, naturally, is guided by the interests of citizens, of course, I cannot think differently and I don’t want to. It is in the interests of citizens, first of all, to have drugs at all. And secondly, so that they do not cost too much.

Evgeny Nifantiev:

It is in the interests of citizens, of course, that the prices for medicines are lower. Provided that there are medications.

Evgeny Nifantiev:

Yes. But according to the new method of calculating prices for medicines, including imported ones, it turned out that many positions were dropped in price by about 50%, and somewhere by 55%. At the same time, we understand that our dollar and euro have grown in recent years, and substances have also grown. Today our pharmaceutical manufacturers are really strong, good, technological, and with high quality equipment, personnel and substance they buy the same. That is, at the exit we get a product of the same quality as the drugs that are imported to us from abroad. But when a person comes to a pharmacy and asks for some international non-proprietary name, then, as a rule, a foreign-made drug costs two, two and a half, three times more, a domestic analogue costs much less. And a pharmacist or pharmacist can always offer a domestic analogue and say: "Why do you need to overpay two or three times, take our analogue." And, as a rule, people switch. And now, attention, the question: what if the original drug, imported, will cost the same as ours, domestic, as a pharmacist or pharmacist at the first table will switch, even if it is imported here? Because you need to understand that the Western manufacturer has a fork in the road: either stop importing here, and this original drug will not be available, which, I think, is definitely not in the patient's interests, and the second option is to subsidize the price here at the expense of other world sites. And this and that is bad, because if a foreign manufacturer subsidizes, then the domestic manufacturer has nowhere to subsidize.And here, it turns out, we either do not receive the drug, because it is not imported, or we get a price that corresponds to the domestic analogue, and then the domestic counterparts stop buying. This is about VED.

Evgeny Nifantiev:

Yes, VED. And, in general, wherever you look, such regulation can lead to not very good consequences in the medium or long term. I mean just such a directive: and we will take and reduce the price three times. I remember very well that the warnings "let's leave the labeling aside - the established prices for most items of vital and essential drugs are already below cost" have been heard from the pharmaceutical and pharmacy community since the beginning of the summer. They sounded pretty loud, it was broadcast, it was broadcast. And it was concluded that some time will pass, and these drugs will simply disappear. This happened not only in the offices, probably, where the community brought its opinion, backed up by numbers. It was in public space in the media from June to October. Didn't anyone react to this at all?

Evgeny Nifantiev:

I think there is not enough courage. And to bring to a situation where people are actually left without drugs, when doctors have nothing to treat?

Evgeny Nifantiev:

Imagine. You are a big person. And you are holding this position this year for the first time, just a big position. And in front of you, your predecessors have simply not indexed prices for domestic producers for about ten years. So you have to come and index prices for some drugs? If they were indexed for eight, nine, ten years, at 5-6% by domestic producers - we are talking about a cheap segment - then gradually they would have already cost conventionally, maybe not 20 rubles, but 38, but they were. And you come, and where is this determination and courage to take and double the price index? Running situation with this issue."

For almost 21 years that I have been in pharmacy, I don’t remember such a crisis in drug supply.

“The same story already happened several years ago, when VEDs began to disappear, although antibiotics and anticoagulants did not disappear. In fact, the list is much wider, we called pharmacies of different classes for different drugs, for different purposes, completely unrelated to covid, many are missing.

Evgeny Nifantiev:

Yes, many drugs are not available now. That was the same situation, I don’t remember exactly what year, it seems to me, in 2016-2017, when in the end, by a decision from the very top, it nevertheless reached the point that it was necessary to index these very low prices, in some cases seven-ruble, ten rubles. There, even 100% indexation has practically no effect on the buyer's wallet, because there are simply no such prices, they are fantastic. All this has already happened. No conclusions are drawn, and will we constantly step on this rake?

Evgeny Nifantiev:

I think, as they stepped on a rake now, it is definitely impossible to step a second time. Because it was fucking strong, you must agree. For almost 21 years that I have been engaged in pharmacy activities, I do not remember such a crisis in drug supply. That is, there were separate positions, for some positions everything was somehow decided. But there has never been such a systemic crisis. True, I very much hope that, nevertheless, thanks to the decree signed by our Prime Minister, the situation will begin to level out. And thanks to the fact that we are trying to convey our position that excessively strict regulation can lead exactly to the opposite effect, it also begins to reach those people who regulate it. We remember that conversation with you, it was on a direct line with our esteemed President. Indeed, there were some progress after that, but the situation in the cheap segment has not changed yet.After all, you need to understand how our price registration system works today: for the same international non-proprietary name from Russian manufacturers with the same dosage and number of tablets, the registered prices may differ several times. That is, everyone himself: "My paracetamol costs so much." - "And I have so much." - "Okay. And you, too, feel good. " Therefore, we say that there are several ways out. The first one is to make a conditional registration form for medicines up to at least 50 rubles or up to 100 rubles. And then the market will rebuild, because if the manufacturer has the capacity, he can produce and sell with minimal profitability, he will do it - this is a market economy. And the second point: look at how many prices are registered, and, perhaps, pull them up to the upper bar or at least to the median. What happened in the low-cost segment? Conventionally, within the framework of one medical device, 22 rubles can be registered, maybe 36, maybe 44, and maybe 52. It is clear that when a substance grows in price, 22 rubles flies out, and then a person who comes to a pharmacy has only options for 36 or 52. When it starts to grow further, the next one flies out, then the next one flies out. And we sense when medicines go to waste, when the highest registered price does not fit into the cost price. In the meantime, we see that individual manufacturers disappear and the price simply rises. But the price rises not in pharmacies or distributors. It's just that the manufacturer who produced and sold at lower prices is no longer in the market, he cannot do this. At the same time, mind you, we live in Russia, we have a lot of our own aluminum, you took the blister in your hands, saw the foil. Do you know that a company that extracts raw materials in Russia, produces foil in Russia, sells it to our domestic enterprises for dollars? Not ruble price. When our currency grows, exchange commodities also grow, and these are substances, this is aluminum, this is cardboard, a lot of things.

We bought the last batch of masks at a high price for 28 rubles, and in the end we sold them for 10 rubles.

When people go to a pharmacy, they very often return from there indignant, even if they have found medicine. Indeed, the reaction to the increase in the price of medicines is not at all equal to the public reaction to the increase in the price of buckwheat or anything else. Or on an aluminum blister. Even if masks rose in price, and not only in pharmacies - they were sold anywhere and rose in price anywhere, or they were not sold at all, but they demanded to check the pharmacies and close them if they were wearing expensive masks, although in the next supermarket they were not at all cheaper. Do you yourself feel such an attitude towards a pharmacy from the side of the population that a pharmacy is almost a point of the Ministry of Emergency Situations, where they should help, and if something becomes more expensive there, is it wrong?

Evgeny Nifantiev:

In general, our social pharmacies "Stolichka" at one time even replaced to some extent the branches of the state bank, where they came to talk. That is, people come to us, among other things, to tell us that prices have increased for buckwheat, for medicines, and so on. And I do not see any negative from the side of the population. As for the masks: we bought the last batch of masks at a high price for 28 rubles, and in the end we sold them for 10 rubles. We always try to be the first to lower prices. We saw that the market was going down, we sold them at 10 rubles per minus. Pharmacies didn't make money on masks. When pharmacies were scolded for the fact that masks were 15 rubles, and they glued a red circle to all of us, we bought them at that moment at 14.50, 15.10 and sold them for 15 rubles, because I immediately said: masks are not what we make money on. As for the increase in prices, if we look at the numbers, if we take away the emotional component, then before this deficit happened, the inflation component for medicines in September was 3.6%. Agree, this is not a lot.Nevertheless, with such a figure, we came to this crisis, when many drugs simply disappeared.

Evgeny Nifantiev:

We discussed why they were gone. Then someone said that pharmacies and distributors did not cope due to the fact that the load on pharmacies has grown dramatically. On March 17 of this year, there was a maximum load on pharmacies. It was the day when everything was swept away. If you imagine it as 100%, then now the load is about 46-48%. Then we survived everything, there was no defect. That is, after all, the defect did not arise due to the fact that there was an unnecessarily high load on pharmacies and distributors. Yes, we worked in soap, yes, it was hard, but we coped with everything. That is, after all, this is not the root cause. Let's move on to some other issues related to currently popular drugs. About five years ago, in my opinion, prescription antibiotics were introduced in Russia. Antibiotics are very popular in Russia, doctors love them, and people just drink them just in case they have any cold. And now, as it turns out, many doctors are completely

mistakenly and without any sense prescribing antibiotics

at the first sign of covid, a viral disease that itself cannot be cured by antibiotics. And without any prescription, people also try to stock up. Does this prescription leave work at all?

Evgeny Nifantiev:

Prescription leave for antibiotics, as far as I can remember, has always been. This is the 107th recipe form. Any recipe must be presented. Another question is that this is an unaccounted form of a prescription. That is, you can present it, get the same antibiotics, go further and, most likely, present the same prescription at another pharmacy. There is a 148th form - an accounting form, when we take a prescription, write it down in a special journal, and this recipe is stored for five years, and at any check we must present all this and report on the prescriptions. This is the so-called subject-quantitative accounting. With regard to dispensing antibiotics, of course, antibiotics should not be taken for any sneeze. You may develop resistance to antibiotics, and when you really need them later, they may simply not help. I think that many people understand this. But now doctors really prescribe antibiotics for the treatment of covid, because in addition to coronavirus infection, there can be a secondary infection with pneumonia."

You may develop resistance to antibiotics, and when you really need them later, they may simply not help.

"As they say, without waiting for peritonitis. There is no secondary infection yet, but antibiotics are already.

Evgeny Nifantiev:

In this case, the disease is so serious that it may be justified. Now the Ministry of Health has said that it is not really necessary. A few more questions about what awaits the pharmaceutical industry. Firstly, we all think that this year everyone was bad, but it should have been very good for the pharmaceutical industry and, accordingly, for the pharmaceutical retail. Is this really so? The volumes have probably grown a lot.

Evgeny Nifantiev:

We had a high month of March, and the revenues were really high enough. But then there was a very hard fall - almost twice. Our revenue in July fell by 46% to March. You can imagine, if you work with deferred payment, then for those drugs that you took from distributors in the high season, on the same March, you will have to pay in the summer. It was, of course, very difficult. We took out loans, asked for additional deferrals, and so on. It was the toughest year in my 20 years as an entrepreneur. There was a lot of work, but this absolutely unpredictable situation with revenue, with its fall - sorry, after all, self-isolation, whatever one may say, despite the fact that pharmacies were open, revenue fell almost twice. At the same time, we did not fire a single person. After all, you didn’t close, unlike many others, so it would be strange if you also fired.

Evgeny Nifantiev:

What I am talking about: your expenses, your expenses do not fall, but at the same time your cash flow falls by half. Therefore, the cash gap in the market was very serious for everyone. In conclusion, I would like to ask you to give a clear orientation, because this is a question that worries everyone - sick and healthy: when can we expect a real disappearance of the deficit, when most of the positions on pharmacy shelves will be filled and under what conditions? Have these conditions been created at the moment?

Evgeny Nifantiev:

Firstly, thanks to the government decree, which was adopted the other day, the problem with labeling will be removed. Will be removed, because the software product rewriting is still to be done.

Evgeny Nifantiev:

I think that all market participants take this responsibly and now a huge number of people hit the keys of keyboards and rewrite codes and programs. Everyone is doing it now. But this is a process, not a one-minute action.

Evgeny Nifantiev:

This is not a one-minute action, of course. You need to rewrite, test for everything to work. We have already moved on to the testing process. We in our network will remove exactly this problem, I think, within a few days. The question is different: we get medicines from distributors and manufacturers. It is important that the problem is solved at these stages as well. But I really hope that this will happen in the near future, one or two weeks. But at the same time, one must understand that some drugs are simply not physically available in the country or they are not physically produced - their production was stopped due to low registered prices. I think, of course, now is the time to look not necessarily at everything, but at least at what is missing, to really estimate the cost price and make the prices more realistic so that medicines appear on the shelves.

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