Transcript Kyrgyzstan Revised OM_Situation analysis in Kyrgyzstan_05_03_2013

Situation analysis in Kyrgyzstan
Making Opioids Available in Eastern Europe
and Central Asia
March 5-6, 2013 Vienna
Opioid analgesics are currently registered in the
country
WHO List
Codeine
Morphine inject form 10 mg
Morphine oral
immediate and sustained release
+
-
IAHPC List
Codeine
Fentanyl
Methadone
Morphine (immediate release)
Morphine (sustained release)
Oxycodone
Tramadol
+
+
+
List of medicines for
cancer patients under
State Guarantee
Program on
preferential terms
Code and Brand name of
Medicines
Medicine’s
form
Code and
of
Medicine
form
Cost of reimbursement for
1 piece (in som)
Dosage
mg, etc.
number
The system of drug control
International Narcotic Control Board
Has access to SADC data base
KG State Agency for Drug Control
Annually Estimate
For 2013 – April 2012
Ministry of Health
Statistics on controlled
drug usage annually
Than chief nurse reports to
regional Health Department
Doctor reports to Chief
Nurse the list of
prescriptions with patient’s
name
Department of
Medicines Supply
and Medical
Equipment of the
Ministry of Health
Registration
Pharmaceutical
Distribution
Company
State Agency for
Drug Control
Pharmacy
Warehouse
Get approval and
include to the
Register List
Storage
Pharmacy
Hospital
(Oncology Center)
Customs
Customs
Clearance
Barriers
•Special prescription form
•Four stamps and two signs
•Pharmacy dispense limit time (9:00 am – 4:30 pm)
•Limit on q-ty (20 vials of morphine)
•Limit time – prescription form works 10 days
Health Insurance
Fund
Medical
Practitioner
Copayment
Prescription
Patient
2 hospices for HIV/AIDS patients
Opioids are always available in specialized
hospitals (oncology centers)
National Oncology Center PC
Department (25 beds)
Morphine is allowed to prescribe to patients with
cancer on 4th stage only
In other cases, doctors prescribe Tramadol and
Promedol
Inter oblast Oncology Center PC
Department
Pharmacy
1. Morphine in 10 mg injection form
2. Promedolum in 20 mg injection form
3. Tramadolum
Family Medicine
Center
Maximum amount of:
Morphine for on prescription form - 20 vials
Tramadol
- 10 vials
Family Medicine
Center
Family Medicine
Center
Length of
Rx
is 10
days
Opioid accessibility
The cost of medications and health insurance coverage
Health Insurance Fund covers cost of medicines by two ways:
1.
Additional Package – for all insured people according to the list of medicines
2.
State Guaranty Program (SGP) – for 5 types of monitored diseases, including
cancer on 4th stage only
The cost of one vial of Morphine – 25,73 KGS (0.53 USD)
one vial of Promedol – 42,73 KGS (0.91 USD)
Reimbursement by Health Insurance Fund – 97%
Limits of SGP for cancer patients:
1.
Ketoprophen – 36000 mg or 360 vials
2.
Promedol – 4800 mg or 240 vials
3.
Morphine – 3000 mg or 300 vials
Coverage by State Guarantee program of preference
patients
(9 months of 2012, number of preference patients , % of coverages)
9311
6806
5905
4172
(56%)
2348
1804
4172
(61%)
2360
(40%)
497 (21%)
Эпилепсия
Epilepsy
Бронхиальная
астма
Bronchial
Asthma
Параноидная
шизофрения
Schizophrenia
All registered
кол-во
бн на учете
patients
Аффективные
расстройства
Affective
disorders
Number
of patient
with Rx
кол-во
пациентов
с Rp
1430 (79%)
Онкологическое
заболевание
Cancer IV stage
The volume of sold medicines
(during 9 months 2012)
60000
Ketoprophenum 100мg
50609 units
1665,9 thousand som
50000
40000
30000
Morphine 10 мg
25026 units
603,8 thousand som
20000
Promedolum 20мg
15764 units
647,6 thousand
10000
Tramadol 50 и 100мг
765 units
12,2 thousand som
0
0
-10000
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Opioid prescription’s forms
Prescribed opioids registration book
Patient chart and list of opioids injection chart
1. References for pharmacy registration book for taking
opioids
2. Sample of reference form
The registration book of used opioid’s ampoules
1. Registration book of certificates damaging empty
ampoules of opioids
2. Sample of certificate
6. What is the projected need for morphine in the
country by dosage form (IR, SR, and injectable)
Mortality:
Cancer - 3400
AIDS - 100
TB – 600
Need in Palliative Care – 4100
Need in morphine – 24,9 kg