The treatment of people with serious diseases in Russia is financed by the state through budget allocations that cover drugs and medical services. While the system aims to ensure access to care for all citizens, doubts have arisen about the real value of some innovative, high-cost medications. In a discussion reported by Parliamentskaya Gazeta, a leading physician and State Duma Deputy, Airat Farrakhov, highlighted that not every cutting-edge therapy yields the promised benefits for patients, even when funded publicly. This reality prompts a closer look at how the state procurement framework handles expensive medicines and the outcomes for those in need.
Farrakhov argued that the current public procurement model limits the ability to achieve meaningful cost reductions when evaluating highly priced drugs. He proposed adopting a risk-sharing approach, where payment would be tied to demonstrated efficacy. Under this model, if a drug does not deliver the expected therapeutic results, the financial burden would be shared or shifted, releasing resources to help more patients access treatment. The aim is to safeguard the budget while expanding the pool of individuals who can receive effective care, rather than allowing expenditure on therapies that may not translate into tangible health gains for a substantial portion of those treated.
The deputy noted a structural gap: the existing law governing contract-based medicine supply does not provide a mechanism for public buyers to enter into supply agreements that impose additional obligations on manufacturers or suppliers. This limitation constrains government purchasers from negotiating terms that would lower overall costs or introduce performance-related clauses. Consequently, even when faced with strong evidence of limited benefit, state guarantees continue to cover expensive medicines for patients, leaving room for questions about value-for-money in the public health system. The lack of flexible contracting terms means the state is often compelled to rely on traditional pathways that may not align with the best outcomes for health budgets or patient welfare.
To address this mismatch, Farrakhov proposed an amendment that would empower the state to enter into contracts for the supply of original or reference medicines, including those without registered generics, with a built-in framework to share risk in the event of treatment failure. Such a clause would allow public health authorities to negotiate terms that reflect real-world effectiveness rather than theoretical efficacy alone. The envisioned approach would enable more nuanced pricing and accountability, ensuring that taxpayers’ money is directed toward therapies that reliably improve health status while leaving room to revisit decisions if results do not meet expectations. This proposal envisions a more balanced relationship among the state, pharmaceutical providers, and patients, anchored in evidence-based outcomes and fiscal responsibility.
In related development, prior announcements indicated collaboration among national experts from NUST MISIS and the University of Chemistry-Technology DI. Mendeleev concerning innovative methods to enhance drug effectiveness through nanotechnology. This line of inquiry underscores ongoing efforts to improve the therapeutic value of medicines, potentially reducing the need for expensive alternatives by increasing bioavailability, precision, and targeted delivery. While such research is at a relatively early stage, it illustrates the broader strategy of aligning scientific advancement with public health needs, to deliver better outcomes without unsustainable increases in public spending. Attribution: Parliamentskaya Gazeta and institutional press reports cited in coverage of these developments.