Write off a prescription: patients with skin diseases are denied preferential medicines

In some regions, they refuse to provide drugs to patients with atopic dermatitis, pemphigus and urticaria. This follows from a letter from the Public Chamber to the Ministry of Health, FFOMS and the government. The reason is a vague wording in the list of systemic chronic severe skin diseases. In particular, patients from the Moscow and Volgograd regions, Crimea and Bashkiria complain about the non-prescription of medicines. The article in Izvestia explains why patients are not provided with the genetically engineered drugs they need.

Why are they not giving out medicines?

Citizens with atopic dermatitis and urticaria who are eligible for preferential medicines do not receive them due to misinterpretation of government documentation on the ground, follows from a letter from the Public Chamber to the Ministry of Health, FFOMS and the government.

"In the list of population groups and categories of diseases for which outpatient medications are prescribed free of charge, there is a category such as "systemic severe chronic skin diseases," the appeal explains. "At the same time, there are no official explanations to determine which diagnoses belong to this category and what are the criteria for their classification."

Local authorities, at their discretion, classify diagnoses as "systemic severe chronic skin diseases," said Natalia Ilyina, chief physician of the State Scientific Center "Institute of Immunology" of the FMBA of Russia, speaking at the Public Chamber.

In this list, which is approved by the Government, there are five codes of the international classification of diseases for this category of disease. There is a specific indication of psoriasis, parapsoriasis, dermatopolymyositis, systemic sclerosis, but there is also a code for "other systemic connective tissue lesions." This point, according to the participants of the round table in the OP of the Russian Federation, makes it possible for regional authorities not to purchase drugs to provide for patients.

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A woman from the Moscow region told Izvestia that she has been suffering from atopic dermatitis since childhood, but learned about the possibility of receiving the right medicine for free only in 2023. Before that, she had been purchasing treatment at her own expense.

— Since 2023, I have been writing appeals to the Ministry of Health of Russia, the Ministry of Health of the Moscow region and to the governor. They refused to give me the drug at the district hospital, referring to the fact that they do not buy such drugs and that I am almost the only one of the patients with atopic dermatitis who knows about my right to receive therapy for free," she said.

The patient clarified that in 2024 she was given several injections for free, but her condition worsened before receiving them. She also complained that, despite having a disease that cannot be completely cured, she has to undergo medical examinations every six months and confirm the presence of atopic dermatitis.

According to Olesya Mishina, head of the Path to Health Association, patients from the Moscow and Volgograd regions, Crimea and Bashkiria complained about refusals to prescribe free drugs to this organization.

Who else is eligible for free medicines

Refusals affect not only those patients for whom the regions purchase drugs, but also those who are supported by the federal budget, Natalia Ilyina said. So, according to her, the regional Ministries of health do not take into account patients with "other skin lesions," respectively, and do not send data on the need for medicines for centralized purchases. Therefore, according to her, it is necessary to clarify which diagnoses should be attributed to this category, which presupposes a vague interpretation.

These explanations should, in particular, include atopic dermatitis, purulent hydradenitis, idiopathic urticaria, granulomatous skin and subcutaneous tissue changes, the letter of the Public Chamber states.

The press service of the Russian Ministry of Health told Izvestia that they had received proposals from the Public Chamber, and they were currently under consideration. The ministry clarified that the expediency of taking into account the proposals will be worked out by the department with the involvement of representatives of the professional medical community and key freelance specialists.

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The editorial board sent inquiries to the FFMS and the government about whether it is planned to implement the proposed recommendations. The government's press service forwarded the issue to the Ministry of Health.

Izvestia also sent requests to the Ministries of Health of the Moscow and Volgograd regions, Crimea and Bashkiria with a request to clarify why local hospitals refuse to provide free medications to patients with atopic dermatitis and whether they plan to review their list of systemic chronic severe skin diseases.

The incidence is increasing

According to the Path to Health Association, 58.4% of the total volume of genetically engineered drugs purchased were prescribed to patients with psoriasis in 2024. People with atopic dermatitis accounted for 13.49%, with urticaria — 2.55%, with purulent hydradenitis — 0.44%.

In 2023, more than 7.8 million cases of skin and subcutaneous fat diseases were registered, said Andrey Tomilin, head of the Organizational and Methodological Department of Dermatovenerology and Cosmetology at the Moscow Department of Health. Their prevalence in 2020 was 4.9 thousand cases per 100 thousand people, and in 2023 it was already 5.38 thousand.

"The prevalence of psoriasis increased by 13.2% from 2019 to 2023, atopic dermatitis — by 3.5% in 2023 compared to 2022, uncontrolled asthma — by 60%," the letter from the Public Chamber says. "The number of patients with chronic skin, allergic and pulmonological diseases is increasing every year, and the number of cases of severe course of these diseases is growing."

Expanding the list of diagnoses that will be classified as systemic chronic severe skin diseases in all regions will help reduce the spread of skin ailments, the authors of the letter believe. According to them, this measure guarantees the provision of preferential medicines to all patients.