Recently, the self-proclaimed Minister of Health of Crimea said that the peak of the shortage of concessional medicines has been overcome. But fifty thousand Crimeans with diabetes hardly agree with this statement. How the occupation authorities “overcame” the deficit and what consequences is it already leading to?

One of the key problems in the supply of concessional medicines in Crimea is different types of insulin, which are included in the list of vital medicines and should be available in social pharmacies with appropriate prescriptions. For this to happen, the Crimean “Ministry of Health” has to buy them at an open auction at the lowest price. However, somehow it turns out that these offers are usually lower than the cost of the drug, and suppliers simply ignore such an auction, waiting for an adequate price.  

The Crimean authorities “solved” the problem by reducing the list of required concessional drugs from five to seven options to one or two. The rest were not formally removed from the list, but it was noted that there is no need for such types on the peninsula - they say that patients “do not ask for such medicines”. According to human rights activists from the initiative “Tribunal. Crimean Episode” initiative, citing a source in the ‘Ministry of Health’, the lack of demand for certain types of insulin was created artificially. 

“Doctors were simply ordered to replace scarce drugs in prescriptions with generics, and in some cases with drugs with a different composition but similar effects,” the source explained. That is, instead of selecting the best option based on the characteristics of the disease and other factors, endocrinologists must issue prescriptions only for the insulin they have at their disposal. This is despite the significant risks of deterioration of patients' health. 

One of the residents of Simferopol, named Vyacheslav, who has been suffering from diabetes for twelve years, told our CEMAAT correspondent that he was reckless to agree to change the drug he had been using for a long time to a new one, which was provided by an endocrinologist on a reduced prescription. “One of the complications of my disease was serious vision problems. But for a long time, as long as there was no deficiency of my insulin, this condition did not worsen. However, when I switched to the recently proposed Russian analog, my eyesight plummeted in just a month. Within two months, I had to admit that I was completely blind in one eye, and with the other, I could only see blurry silhouettes. The doctor has now prepared his conclusion for the commission, which should consider the possibility of returning me to the previous type of insulin, but even if this happens, my eyesight will not be restored.”

As another Crimean woman from Simferopol district named Lyudmila explains, patients are forced to experiment with replacing medications at home, although according to the procedure, such processes should take place in a hospital under constant supervision. “To get hospitalized, you have to go through all the circles of hell: go to the district clinic, see a general practitioner who will give you a referral to an endocrinologist, see an endocrinologist who has an appointment a month or two in advance, because he is the only one in Simferopol and the district. From him, I have to get a referral for hospitalization to the Semashko Republican Hospital, as well as a referral to a subspecialist in the district hospital, get coupons for subspecialists from the general practitioner again and stand in lines for hours,” explains Lyudmila. 

Since the wait for hospitalization is long - from one to three months, and the stocks of tested insulin are over, most people simply have no choice but to “test” their bodies for compatibility with the prescribed analog at home and without medical supervision. “Those who have money can at least postpone the transition by buying the insulin they need in commercial pharmacies. But people like me, who have lost their ability to work and do not have an extra ten thousand a month, are forced to conduct medical experiments on themselves,” says Lyudmyla. 

However, even the insulin offered under the benefits is only sometimes available in social pharmacies. “I have already traveled to Simferopol and Yevpatoria several times because there was not a single package in our city,” says a resident of Dzhankoy, whose mother has been suffering from diabetes for the past six years. According to him, each patient prefers to have a 5-6 month supply of insulin because all this time, as long as he has been taking care of his mother, there has been no stability in providing the beneficiaries with the necessary medicines. Sometimes, according to this man from Crimea, the wait for the delivery of the prescribed insulin lasts for two or three months, and without proper stocks, it would be a disaster.     

In an informal conversation on the condition of anonymity, one of the Crimean doctors suggests that endocrinologists could have received “an order from the top” to prescribe a limited range of insulin types and admits that there is a problem of adequate supervision of such patients. “This (limitation of the range of concessional types of insulin) is caused by the refusal to supply by many European and American companies due to sanctions risks. Unfortunately, almost no one in Crimea thinks about why these risks have appeared, for what reasons,” the doctor believes.

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