Situation analysis in Kyrgyzstan

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 Dosage

mg, etc.

number

Cost of reimbursement for 1 piece (in som)

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

KG State Agency for Drug Control Annually Estimate For 2013 – April 2012

International Narcotic Control Board

Has access to SADC data base

The system of drug control

Pharmacy Warehouse

Storage

Pharmacy

Medical Practitioner

Prescription

Patient

Health Insurance Fund

Copayment

Pharmaceutical Distribution

Company

Department of Medicines Supply

and Medical Equipment of the Ministry of Health

Registration

State Agency for Drug Control

Get approval and include to the Register List

Customs

Customs Clearance

Hospital (Oncology Center)

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

National Oncology Center PC Department (25 beds)

Inter oblast Oncology Center PC Department

Family Medicine Center

Family Medicine Center

Family Medicine Center

Pharmacy

1. Morphine in 10 mg injection form 2. Promedolum in 20 mg injection form3. Tramadolum

Opioids are always available in specialized hospitals (oncology centers)

Diploma of a physician or feldsher.

Maximum amount of:Morphine for on prescription form - 20 vials Tramadol - 10 vials

Length of Rx is 10 days

Morphine is allowed to prescribe to patients with cancer on 4th stage only

In other cases, doctors prescribe Tramadol and Promedol

2 hospices for HIV/AIDS patients

Opioid accessibility

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:3. Ketoprophen – 36000 mg or 360 vials 4. Promedol – 4800 mg or 240 vials 5. Morphine – 3000 mg or 300 vials

The cost of medications and health insurance coverage

Coverage by State Guarantee program of preference patients (9 months of 2012, number of preference patients , % of coverages)

Эпилепсия Бронхиальнаяастма

Параноиднаяшизофрения

Аффективныерасстройства

Онкологическоезаболевание

4172(56%)

4172(61%)

2360(40%)

497 (21%)1430 (79%)

9311

6806

5905

2348

1804

кол-во бн на учете кол-во пациентов с Rp

Epilepsy Bronchial Asthma

Schizophrenia Affective disorders

Cancer IV stage

All registered patients

Number of patient with Rx

The volume of sold medicines (during 9 months 2012)

0.5 1 1.5 2 2.5 3 3.5 4 4.50

10000

20000

30000

40000

50000

60000

Ketoprophenum 100мg50609 units

1665,9 thousand som

Morphine 10 мg25026 units

603,8 thousand som

Promedolum 20мg15764 units

647,6 thousand

Tramadol 50 и 100мг765 units

12,2 thousand som

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)