Assistance on wheels: mobile pharmacies may appear in Russia
Mobile pharmacy centers may appear in remote and sparsely populated areas. This initiative, proposed in the State Duma, was supported by the Government of the Russian Federation. The bill provides for the creation of special mobile points of sale of medicines equipped in cars. With high-quality implementation, the new norm is a reasonable step, experts say. This is a necessary measure for territories where it is impossible to organize a stationary infrastructure. How mobile pharmacies will work is in the Izvestia article.
With the support of the authorities
The Russian government has supported a bill by State Duma deputies proposing to conduct a federal experiment on the retail sale of medicines in special mobile pharmacies. We are talking about mobile points equipped in cars. They will appear in villages that do not have stationary pharmacies, medical organizations and individual entrepreneurs with a license for pharmaceutical activities.
The government believes that the bill will improve the supply of medicines to people in remote and sparsely populated areas. However, it needs to be improved. In particular, the document should set out the requirements for such pharmacy facilities, as well as develop a procedure for acquiring the status of an experimental participant.
The regions will be included in the federal experiment by order of the government, based on the petition of the head of the subject of the Russian Federation. Regional authorities will be able to regulate the specifics of the experiment — to select pharmacies and determine their final list. They will also approve the route and schedule of the mobile pharmacy.
Such mobile points will be considered a "subdivision of a pharmacy organization." But not all medicines will be sold in them. You will not be able to buy psychotropic and potent substances, drugs with an ethyl alcohol content above 25%, and medicines that need to be stored at temperatures below 15 °C.
Previously, pilot projects on mobile pharmacies have already been conducted in several Russian regions. In particular, experiments were conducted in Khakassia, Krasnoyarsk and Krasnodar territories.
Evgeny Nifantiev commented on the creation of mobile pharmacy points in October last year. The deputy noted that they will be a structural unit of the pharmacy of ready-made dosage forms. One mobile pharmacy will be able to serve up to 50 small and hard-to-reach settlements.
According to Nifantiev, the initiative aroused the greatest interest from state pharmacy chains, "which, as a rule, bear the main burden of providing medicines to residents of small settlements."
The editorial board of Izvestia sent a request to the Ministry of Health of the Russian Federation. No response has been received at the time of publication.
First-class assistance
The initiative with mobile pharmacies was born for a reason, says Sergey Vesnin, chiropractor, speaker of the regional schools of the Academy of Orthopedic Traumatology in the field of Rehabilitation.
— There are still villages in our country where you have to travel tens of kilometers to get medicines. Moreover, sometimes it happens that these several tens of kilometers can either be driven by your own transport, or walked, or not overcome in any way," the expert draws attention.
The problem with the availability of medicines in remote areas is serious, says the operating director of the pharmacy chain "Medicines.<url>" by Vadim Trenkin. One in seven Russians (13%) does not have the opportunity to walk from home to a pharmacy and purchase the necessary medications for treatment.
Due to the distance of the pharmacy from the place of residence, patients often do not take prescribed medications, Vesnin confirms.
At the same time, it is important to understand that you cannot build a pharmacy in every village, including for objective reasons, explains Sanjar Yunusov, a general practitioner and nutritionist.
— The fact is that, according to the current legislation, in order to open a pharmacy, it is necessary to comply with fairly strict licensing rules. The requirements for such an organization include the required number of rooms, matching wall finishes, availability of water supply, sanitation and lighting, and proper storage conditions for medicines," the specialist lists. In addition, the salary of a pharmacist, the cost of housing and communal services and logistics, and so on are added, which makes opening pharmacies in small towns unprofitable.
And this is becoming a serious problem, because it is not always possible for health workers to provide proper care to the patient due to the lack of medicines.
— There are often situations when you come to a remote village where there is no pharmacy, and you have to use your imagination to the maximum in search of the right group of drugs from those that the patient has. The worst thing is when there is nothing to choose from," Yunusov shares his experience.
However, today any citizen of the Russian Federation has the right to equal medical care, he emphasizes.
— The initiative of the parliamentarians is aimed at equalizing the rights of citizens in the possibility of being treated with certain medications. Thanks to her, there will be no need to ask relatives or friends to bring the necessary medicine from the city or a neighboring village," the therapist believes.
With high-quality implementation, the initiative is a reasonable and necessary step, Vesnin agrees.
— For an elderly patient with hypertension, diabetes or heart failure, a trip to the regional center for medicines is a separate test, sometimes more dangerous than the disease itself. In such conditions, it is logical that it is not people who go to the pharmacy, but the pharmacy that goes to the people," the doctor believes.
Pilot projects in the Krasnoyarsk Territory, Khakassia and Krasnodar Territory conducted in 2024 have shown positive results, Trenkin recalls. The population appreciated the opportunity to buy medicines near their homes.
— In the Krasnoyarsk Territory, in a village with a population of 123 people, the model showed working capacity. Although for settlements with a population of less than 50-100 people, the economics of the project remains questionable," the Izvestia interlocutor notes.
The undeniable benefits
It should be borne in mind that the benefits in the case of mobile pharmacy points are distributed asymmetrically, points out Sergey Vesnin. Residents of small and remote settlements benefit the most, especially lonely elderly people. The basic assortment will become available to them, and there will be no need to travel dozens of kilometers to regional centers, adds Vadim Trenkin. And the participating regions of the project will improve their indicators of access to medical care.
At the same time, state and regional pharmacies will receive preferences, which will be facilitated by the coverage of the market with state support, the expert believes.
— The state, in turn, will receive a deferred bonus: when people have fewer treatment failures, the number of emergency hospitalizations, complications and disabilities decreases. And this is already a matter of costs for the entire healthcare system," Vesnin believes.
For businesses, however, the situation turns out to be more complicated, since a mobile pharmacy involves the presence of a pharmacist, refrigeration equipment, as well as fuel, repair and logistics costs, he lists. In a large city, such costs are offset by the flow, but in a village with three streets, the check will be small, and the costs will be the same.
— A large network can still integrate such flights into the general routing. It's almost impossible for a small pharmacy to get into this story. Therefore, without well—thought-out economic conditions, there is a risk that the experiment will be limited to several showcase projects in "convenient" regions, and the most problematic territories will remain without attention, the doctor warns.
But the implementation of the initiative will help automobile factories that produce special vehicles for mobile pharmacies, says Trenkin.
— For example, Gorky Automobile Plant has already created special vehicles with increased cross-country ability, energy consumption and refrigerating chambers for these purposes. It is possible that their products will be interested in the framework of the project, — the interlocutor of Izvestia expects.
However, it is not yet clear at whose expense the pharmacy fleet will be replenished, Sanjar Yunusov draws attention.
— And it's not an ordinary flatbed van that is required. The car needs to be equipped with expensive equipment," the therapist notes.
The right initiative
It is important to take into account that on paper the implementation of the initiative looks quite simple, but in real life it comes up against several difficulties, warns Sergey Vesnin. The first of them is problems with the schedule.
— If a bus with a pharmacy arrives once every two weeks on clear days and hours, people get used to it, record it in advance, ask neighbors to pick up medicines. If the schedule is constantly changing, flights are postponed and disrupted, then it can be very difficult to catch such a mobile point. Especially for the elderly, the main target audience of this experiment, the specialist draws attention to.
It is also important what exactly will be in the back of the car, he clarifies, because few people will need cough syrups, vitamins and cosmetics.
— The real help is the availability of antihypertensive, hypoglycemic drugs, statins, inhalers, anticoagulants, consumables for diabetics. The list can go on, but the principle is the same: the focus should be on chronic patients," the doctor lists. And in this case, there is a serious issue with the proper planning of not only logistics, but also the optimal set of necessary, but not always universal drugs.
In addition, it is extremely difficult to ensure a stable temperature regime for a number of drugs in the field, notes Vadim Trenkin.
— The car stands in the cold in winter, basks in the sun in summer. Even for relatively simple tablets, it is not so easy to keep the temperature. And for drugs with harsh temperature storage conditions, this task becomes even more difficult," confirms the source of Izvestia.
He recalls that lawmakers have already limited the range, including excluding the "cold" group of drugs. But even the remaining medicines require good technology, temperature logs and real monitoring, otherwise the patient risks purchasing substandard medicines.
The personnel issue is also a difficult task, the expert is convinced. A pharmacy should have a specialist who understands well what they are selling.
— In the regions, inpatient pharmacies are not always equipped with pharmacists properly. In this connection, the question arises: who will go to small villages to work all day from the car? We don't have an obvious answer here yet. If in practice it is a salesman after a short training, and not a pharmacist, then we will get a drug trade, but not pharmaceutical assistance," warns Vesnin.
The issue of staffing remains open at the moment, Sanjar Yunusov agrees.
— Most of the pharmacists I know are skeptical about the initiative. After all, in fact, their working conditions will worsen," the therapist points out.
In other words, the proposed norm is indeed very correct, but without sufficient material and technical base and the necessary personnel, its implementation will face certain difficulties, he believes.
Difficulties may also arise in transferring data to the Honest Sign labeling system due to unstable communications in the villages, adds Trenkin.
The result is a complex picture, Vesnin believes. Mobile pharmacies can become a real help for residents of small towns and a new tool to expand the availability of medical care for the state. But only on condition that this is not the only and not decorative step.
— Strict rules are needed for the storage of drugs with reliable control of these conditions, an understandable and optimal set of medicines for at-risk patients, a clear route economy and a link to local medicine. Then it will not be a beautiful experiment, but a normal part of the healthcare system," the doctor concludes.
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