What stock of insulin should be prescribed in the clinic. Prescription or not insulin: is it possible to buy a hormone in a pharmacy
Insulin is a vital hormone in the human body that regulates blood sugar. The pancreas is responsible for the production of this hormone, in case of a violation of this organ, insulin begins to be poorly developed. This leads to metabolic disorders and the development of diabetes.
Diabetics are forced throughout their lives to control the level of glucose in the blood, observe therapeutic diet, engage in physical exercise, as well as administer insulin every day when prescribed by a doctor. If these simple rules are not followed, various complications develop, which are very difficult to treat.
Many patients and relatives of diabetics are interested in whether prescription insulin is acquired or not. You can get the hormone for a fee without a document, as well as for free, after providing a prescription indicating the exact dosage of the drug. However, it is important to understand that when buying a hormonal drug without a prescription, a person puts himself at risk of an overdose, which can lead to dangerous and irreversible consequences.
How to get insulin
Buying a drug is quite simple. If a dose of the hormone is urgently needed, and the diabetic has run out of insulin, in emergency cases it can be bought at a pharmacy that deals with the preferential delivery of the drug. It is better to call all the nearest points of sale in advance and find out if this product is on sale, since not all pharmacies sell such goods.
You can purchase the drug for free if you go to your doctor endocrinologist and write a prescription. Preferential medicines are provided by law to citizens of the Russian Federation and foreigners with a residence permit. Who have been diagnosed with insulin-dependent diabetes mellitus. The provision of these benefits is regulated by federal law on state social assistance 178-FZ and Government Decision No. 890.
An endocrinologist or general practitioner, who is on the list of people who provide preferential drugs, has the right to give a prescription for the free purchase of insulin. This register is formed by the territorial health authorities.
Such a recipe cannot be obtained on the Internet, so you should take care of getting the document in advance if insulin comes to an end. A diabetic must personally visit a doctor, after examining and approving the treatment regimen, a certain dosage is prescribed, which the patient can receive for free.
To prescribe a prescription, the patient must have a number of documents with him:
- A prescription form is issued at the place of registration of the diabetic, so a passport is required. It is important to consider if a person does not live at the place of registration, you should pre-select a medical institution and attach to the selected medical organization with a document. You can change the clinic no more than once a year.
- When visiting the clinic must be in the hands of a medical insurance policy and an individual insurance policy (SNILS).
- Additionally, a disability certificate or other document confirming the right to benefits should be provided.
- It is also required to provide a certificate from the Pension Fund confirming the absence of a refusal to receive social services.
These documents are necessary in order to fill out all the boxes of the preferential recipe with the exact indication of numbers.
Where is insulin given for free
Sugar level
A pharmacy with which a medical institution has signed an agreement has the right to issue a drug for free. Usually, the doctor gives a few addresses where diabetics can be served on preferential recipes.
The prescription form is valid for the free purchase of the hormone for two to four weeks, the exact period can be found in the recipe. Not only the patient has the right to receive insulin, but also his relatives on the provision of the prescription form.
It may happen that the pharmacy is temporarily absent free medicine, in this case it is worth using the following procedure.
- First of all, you should contact the pharmacy administrator in person to register a medical document confirming the right to receive preferential medicine in a special journal.
- Further, according to the order of the Ministry of Health and Social Development of Russia, a hormonal drug should be provided to the patient for no more than ten days. If this is not possible for good reason, the pharmacy should tell you how to proceed with diabetes.
- If the pharmacy fundamentally turns out to give insulin by prescription, you need to bring this problem to the doctor. Additionally, they file a complaint with TFOMS or QS - these organizations are responsible for observing the rights of patients in the field of general health insurance.
If you lose the prescription form, you should also consult a doctor, he will write out a new prescription and report the loss to the pharmacy with which a contract has been concluded.
This will not allow unauthorized persons to take advantage of the preferential document.
If the doctor does not give a prescription
Before you make a complaint to higher authorities, you need to understand that not every doctor has the right to issue a prescription. Therefore, it is worthwhile to clarify in advance who has the authority to issue the document.
A list of these doctors can be obtained directly at the clinic, it must be provided to the patient upon request. This information is public and generally available, therefore it is usually placed on information boards.
If, for any reason, the doctor has not written a prescription for a free preferential drug for diabetics, despite the diagnosis, you need to send a complaint to the head doctor of the medical institution. As a rule, at this stage, the conflict is resolved, the patient and the manager come to a mutual agreement.
- In case of refusal from the management for unreasonable reasons, a complaint is written against all employees who prevented the opportunity to receive preferential medicine to the Federal Service for Supervision in the Field of Health. To do this, it is best to use the official website of Roszdravnadzor, which is located at http://www.roszdravnadzor.ru.
- Using the feedback form, you can get to the section of citizens' appeals, where there is complete information on how to properly send a complaint, where are the regional offices and what time they work. Here you can also find a list of authorized bodies that control the activities of other organizations.
- Before filling out the application, it is recommended to photograph all available documents confirming the right to use the benefits using the telephone. All files are sent through the same form where the complaint will be sent. It is very important that the situation is described as detailed as possible, with specific facts.
Photo by Sergey Markelov
How many bosses I had, they all dislike one and the same when employees leave for sick leave. And if someone finds out that there is a chronic disease, then this will entail some sanctions. Moreover, diabetes is a disease that people know little about, because no one, as a rule, advertises this. Everyone thinks: it’s one thing if there is simply a problem and it can be corrected with a diet or lifestyle. Another thing is if a person takes pills. Well, if injections, this is the region and the last stage. Although the only problem is that insulin is not absorbed in the stomach and injections are required. It's just a way to take the medicine, ”says Elena [name changed]. The heroine of the material asked not to indicate her personal data due to possible problems at work.
Substitution
The case of Elena is rather exceptional. She has been living with diabetes for 18 years, she has the first stage (the one that requires injections). At first, she was prescribed a Danish drug, but was canceled due to the strong rejection of one of the components. Then they transferred to the American Humulin. Now it is being produced together with Russia - raw materials are brought to us and packaged. Elena’s medicine was perfect. So, she gave birth to a healthy baby without an insulin pump [a special device that automatically delivers insulin to the body during childbirth].
In February 2017, Elena came to the clinic for the next portion of the drug.
I came, as usual, to write out a prescription. There were no changes in the recipe, as before it was indicated: insulin, the active substance isofan. In the book, in the "invalidka", as I call it, the name of the drug is written: "Humulin." I am giving the prescription with all the seals to the window of the pharmacy and this very book, in which they should make a note about which drug was given to me, and should be my signature. The pharmacist sees that this is “Humulin,” and he must give it to me. But instead, I get a box that says “Rinsulin,” says Elena.
Biological products can not be shuffled, like headaches or vitamins. Insulin needs to be changed in a hospital or at least under the supervision of a doctor - it is built into almost all body processes. And for transferring a patient from one biological preparation to another, good reasons are needed: sugar is poorly reduced, an allergic reaction. Someone should be responsible for changing the medicine for the patient - Elena was simply given the drug in the window. She did not want to take it.
I say: "What is this?" The pharmacist replies: "This is what you need." I say: "No, this is not Humulin." She tells me: "This is now such a" Humulin "." I say: “This is not Humulin. On “Humulin” is written “Humulin”. I can show the box. Here on the box it says: “Rinsulin.” Pharmacist: “Girl, don’t delay, if you don’t like it, I can give out Insuman.” I say: "No, these are not the drugs that I need, I do not want to risk it."
Elena nevertheless took the medicine and put her signature on the card of the disabled person.
Other patients in such cases, out of ignorance or frivolity, leave with the words: “Ah, is this insulin now? Well then, ”says Elena. She went to her endocrinologist. She listened, said: “Don’t worry,” and added that “Humulin” is no longer there when it will be - it’s not known, because there is an order to transfer everyone to Russian-made drugs.
Children do not touch. The most troubled part of the population is turned off from this process: these are the mothers, who will raise everyone to the pitchfork and smash everything in their path. Those who are newly diagnosed do not care where to start. And why touch everyone else? If I live on this insulin, I live normally, and there is no reason to transfer me to another drug? I said that tomorrow I’ll go to ask questions. In the evening, she called me back and said that she had discussed the matter with the outpatient clinic, with the clinical pharmacologist, that, indeed, I have the right to receive what I need, and they are ready to give me the last pack of Humulin from the stock of the clinical pharmacologist. The next day I received it, ”says Elena.
According to doctors, she has the right to take the drug that suits her. And especially for her, they allegedly can buy Humulin - but in the conditions of import substitution, will anyone go to an auction to purchase an American drug? The stock that was issued at the clinic, Elena is enough for a month. In the first months, Elena's family will be able to purchase medicine abroad or in pharmacies at her own expense, but what will happen next?
Order
Elena tried to find reviews about Rinsulin in specialized forums. Diabetics willingly share information about medicines, but there are few references to the Russian drug. Only official data: how many clinics took part in the test, the results of using the drug, a clear hypoglycemic effect, and the like.
At the largest forum, I found only one review from 2015. The man gave his consent to switch from Khumulin to Rinsulin, and does not help him. Sugar walks in all directions and, if he makes a joke [an extra dose of insulin, which is given during stress or the use of sugar-containing products] with Rinsulin, the effect is practically zero, and if with the remnants of Humulin, the effect is normal. Another review was neutral: “Well, I’ve moved and moved, without any particular consequences.” And one more (as a veteran of diabetes, I’ll say that a diabetic will not write this): “I tried this, I tried this way, Rinsulin is the same as everyone else.” And how did you try this and that, if you endocrinologist selects the drug individually? It’s not to come to the pharmacy and buy some kind of analogue instead of no-shpa, ”says Elena.
“I was also transferred from Protafana and Actrapida to Rinsulin, the effect is the same as Wall described. The downward trend in the efficiency of maintaining blood glucose was confirmed with lightning speed. Sugar with them began to roll over to 25. I had enough for three days. I went back to Protafan and Actrapid. I will switch to another insulin, there is no way out. I want to try Lantus with Humalog, ”writes volniy-s.
“I came to the endocrinologist for a prescription, she told me that there is no imported insulin, it must be translated into Russian bioinsulin! They say that you need to go to the hospital for adjustment! Honestly, I'm in shock. I have been using Humalog / Lantus for more than five years. Who has encountered this and what should I do? ”Asks kif.
This is most likely not the last entry. The experiment on the introduction of Russian drugs continues. And not always predictable.
Contrary to logic
Sergei Veselov from Murmansk communicates with diabetics from other regions of Russia: medicines, he says, change in different ways. He was suddenly replaced by the Russian “Lantus” with the German “Tujeo”. And one and the other: insulin-glargine.
The Murmansk Ministry of Health, in response to the request “”, explained that they also buy insulin, based on Decree No. 1289, which has one more nuance: the ban on foreign drugs is valid if at least two suppliers have entered the auction, one of which offers foreign medicine manufacturer. In the case of Tujeo, only one application was filed (here the decision ceases to be valid), and a foreign drug entered the Murmansk polyclinics.
True, the Ministry of Health of the Murmansk region in its response to the request indicated incorrect purchase number insulin-glargine dated February 27, 2017 is an auction for the “Supply of reagents and consumables for the Department of Radiation Diagnostics”. Perhaps by mistake.
We found the necessary purchases ourselves. In February there were two: approximately 12 million rubles. and 2 million rubles respectively. In both cases, the auction for the supply of Tujeo was won by the only St. Petersburg supplier: Non-public joint-stock company Medico-Pharmaceutical Company North-West. It is noteworthy that the amounts procurement Russian “Lantus” by the Ministry of Health of the Murmansk Region in the same month do not exceed 140 thousand rubles.
And yet, “Lantus” the Ministry of Health bought. And not only in February - another purchase was in March. But Sergei Veselov was prescribed a prescription in the clinic and said: "Pay attention to the dosage." The generic name was indicated in the recipe: insulin-glargine. He called the point of issuing preferential recipes, where they confirmed: patients are now given an analogue. Sergey went to the clinic again.
I say: “An analogue is a loose concept. As far as I know, this is a different drug, its effect may be different. How will my body react to it? ” To which they simply told me: "If you do not like something, write a refusal of insulin and leave the office." I say: "I understand." I turned to the deputy head doctor, he was shocked, said that the nurse was just slightly motivated in terms of salary and to tell the diabetic what kind of drug it was, she simply didn’t have a desire. As a result, I heard from the deputy head doctor what kind of drug this is. But I was still surprised how this is, the introduction of a new drug without consultation, without supervision? Simple: don’t worry - that’s it, says Sergey.
A nurse was punished for inattention. Sergei still has a supply of the old drug. He has not yet switched to a new one - he is afraid.
I'm afraid why? I communicate with diabetics from different cities, I am interested in who has what. One sugar is so low that it feels bad every day. They started injecting in the same way as the doctor told them, as many units. Others say that we cannot get rid of sugars: 20, 21, which is a very bad indicator. That is, the body reacts differently for everyone. This already suggests that everything is not so simple: took, injected the same dose and rejoice. Moreover, the new drug, it has an effect longer, in my opinion, by six hours. I therefore do not pass and worry. In social networks and forums everyone is asking each other: how are you, how are you feeling? Some say: in vain I switched, because now uncontrolled blood sugar, respectively, there are more consumables for glucose control, - said Sergey.
Afraid to switch to a new drug and Elena. But the supply of pharmacists and doctors in clinics is not unlimited. She found a pharmacy in Moscow that works with a Humulin supplier directly. The annual supply of the drug will cost her 20 thousand rubles. The main thing is that the supplier now does not leave the country permanently. And so, it seems, the choice is small: take what they give, and go.
As the Murmansk example shows, there is an option: one supplier can enter the auction, and a contract will be signed with him, even if he offers a foreign drug.
Hello Andrei Nikolaevich! In Russia, diabetes is recognized by the state as a socially significant disease and a huge amount of money is allocated each year from the budget to combat it. It should provide patients with preferential insulin and other sugar-containing drugs, test strips and syringes for injection.
The legal framework for the provision of concessional drugs and related drugs for patients with diabetes is prescribed by the Federal Law on Social Assistance of July 17, 1999, 178-ФЗ and Government Decree of July 30, 1999 No. 890. According to it, not only citizens are provided with concessional drugs RF, but also persons holding even a residence permit in the Russian Federation. The main benefits for type 1 and type 2 diabetics are the provision of free essential drugs and insulin.
In order to receive the necessary insulin or other sugar-lowering drug for free, you must go through an examination with the endocrinologist's doctor in the clinic at the place of residence (it is imperative that you be registered at this site). Based on these analyzes, the endocrinologist writes a prescription for the required dose of insulin. It is very important that recipes for preferential insulin are prescribed by the doctor by the endocrinologist every month and are given to you personally by the patient (since the doctor does not have the right to write a prescription with a dose of drugs that exceed the monthly rate). This is done to closely monitor the patient’s treatment and the doses of drugs that he takes. And also in order to prevent the waste of drugs. Depending on the course of the disease and a number of concomitant factors, the dose of the drug may vary according to the level of sugar in the blood.
To get a prescription for insulin, you need to have a passport, an insurance certificate, a medical policy. The doctor does not have the right to refuse to write you a prescription for insulin which belongs to the group of vital medicines. Preferential drugs are financed directly from the country's budget and the regional budget, and the administration’s arguments that the medical facility is not adequately provided are not convincing - the drugs are paid by the state, not the clinic.
Insulin must be obtained at pharmacies with which the medical institution has entered into an agreement. Their addresses are provided to you by the doctor who wrote the prescription. The validity period of the form for the provision of drugs and insulin can vary from two weeks to a month, this must be indicated in the prescription.
Unfortunately, not always in patients diabetes there is an opportunity to use your legal right to purchase preferential insulin. The most harmless reason why a patient cannot get insulin is a temporary absence from the pharmacy. In this case, you need to write in the social journal with the pharmacist the number of the document (your prescription), which gives the right to receive free insulin. Within ten days after this, the medicine should be provided to you. If for some reason this cannot be done, the pharmacy administration is obliged to warn you and send it to other pharmacy institutions.
If the pharmacy has all the prescription drugs (insulin in your cases, but refuses to provide them for free, then you should contact the regional department of the Mandatory Health Insurance Fund. This organization must monitor the observance of the rights of patients, including diabetes, in the field of medical care If you refuse to give you insulin at any stage, you need to demand a written refusal, indicating the reason for the refusal, the date, signature and seal of the organization, as a rule Table of Contents refusal in writing leads to a rapid resolution of the conflict and the provision of essential drugs, or information on how to obtain them elsewhere.
If the doctor himself refuses you to write a prescription, then you should contact the chief physician of the clinic for clarification. If the administration of the polyclinic this time also refuses to issue a prescription, you should send a request in writing and in two copies, one of which should bear a note of the medical institution about incoming correspondence (this is your copy), request to provide you with a request motivated written refusal. The medical institution is obliged to respond within the time limits established by law. You also need to contact the Compulsory Medical Insurance Fund, with a statement about non-compliance by the medical institution with its obligations to provide prescriptions for preferential medicines. You can contact your Ministry of Health or social security authorities with a request to understand the situation. All appeals must be in writing only and each copy must bear marks on the registration of correspondence of the institution where the request was received. If there is no response within a month, you need to send a complaint to the Prosecutor's Office, the Commissioner for Human Rights with a request to stop the violation of your rights as a patient with diabetes mellitus in providing preferential insulin.
Respectfully, Valery N. Napalkov.
