Prishtinë, 14 January 2015
Hundreds of individuals who suffer from cancer every year are necessarily subjected to therapies with cytostatic drugs. Cytostatics, as the most expensive pharmaceutical medicaments, bring astonishing profits to numerous smugglers. In this case, healthcare, which is known as the most humane profession, loses its sense and takes completely different dimension. Commerce with health and lives of desperate patients is very wild. It does not choose means to get the profit, regardless of the fact that doing business with this kind of medicaments may be fatal for many patients.
The supply by the Ministry of Health is far from meeting the needs of patients who are treated in Oncology Clinic of KCUC.
As a consequence, patients are forced to by cytostatics in private market where the circulation of smuggled medicaments is rather high too.
During its research Preportr not only found smuggled cytostatics, mainly in pharmacies close to KCUC, but also noticed high differences in prices that, according to professionals in this field, show that the said medicaments are smuggled.
Due to lack of supply with medicaments Oncology Clinic treats its patients with cytostatics bought in private markets by the very patients that, according to our research, in most of the cases are smuggled drugs.
In order to avoid responsibility in case of side effects caused by these cytostatics or in terms of the use of smuggled cytostatics in a public institution, doctors in Oncology Clinic make patients sign a document. According to this document, which apparently remains unknown to any and all responsible institutions, patients are responsible for effects they might have from treatment with illegal medicaments.
According to available data, cytostatics that end up in private market apparently come from countries in the region where these medicaments are reimbursed by respective countries.
Moreover, there are suspicions that some of these cytostatics come or are stolen from public institutions, such as Oncology Clinic or Central Pharmacy, and end up in private market.
Kosovo Agency for Medicinal Products and Equipment and the Ministry of Health were surprised and felt no responsibility whatsoever when presented with all these facts. It seems that competent institutions are very unlikely to take responsibility and no one takes over the lead to make steps in order to prevent the smuggling of cytostatics, which, according to this research, is a business that runs quite freely.
When MH does not supply, smugglers do
Only in 2013, 730 persons were diagnosed with cancer in Oncology Clinic. This number does not include patients that are diagnosed in Albania, Macedonia, in Turkey and other countries. The average number of patients that are treated in Oncology is usually 100 but there are cases when this number reaches 300 patients.
Ministry of Health was never able to fulfill 100% of the vital list, i.e. the list of medicaments that should by all means be found in health institutions, including cytostatics.
Faik Hoti, Director of Information Department at MH says that the absence of cytostatics is also linked with the lack of budget, since there is discrepancy between demand and possibilities. “The demands of Oncology Clinic for cytostatics in 2014 was around 9,3 million euros, whereas the available funds of MH for this category of medicaments was 4,4 million euros”, he added.
According to an analysis of Ministry of Health related to essential list products for 2013, Kosovo is among countries with the lowest percentage of budget for health (around 2.3% of GDP), compared to countries in the region with 5‐7% of GDP, or compared to European countries with 10% of GDP. This shows that health has never been a priority of any of the governments since the end of war.
Despite partial supply with cytostatics by MH, another evident thing is wrong budget management, with supply in the first part of the year being quite higher compared to the rest of the year.
The document from Oncology, which was provided by Preportr, shows that the vital list of cytostatics is far from being fulfilled.
Although there are 59 types of cytostatics, on October 27, 2014 Oncology Clinic only had 7 types, while there was a lack of those medicaments that were mostly required for patients’ treatment. This situation causes further increase of demand for these medicaments in private sector, and thus increasing their smuggling.
The Director of Oncology Clinic, Behxhet Osmani, says that cytostatics without banderoles are brought in Oncology every day. “Even when this Clinic is supplied with 50% of cytostatics by the Ministry of Health, the other half comes from smuggling”, says Osmani.
Oncology Clinic from time to time is left with no cytostatics at all and has many complaints regarding supply, while MH blames procurement procedures for this matter.
“Economic operators that got the right for supply often use last days of legal deadline in order to deliver the supply, causing irregularities in supplies. For instance, if the deadline for the operator to deliver the medicament is 40 days, it happens that they do not do this dissemination within the first days but rather during the very last days, and in certain cases also after the deadline, for which MH has fined some companies but that did not affect them much”, stressed Faik Hoti.
But even after waiting and insisting for two weeks, he did not answer to the question regarding the companies that were fined and the amount of fines.
Commerce with health
Preportr team conducted a research on illegal cytostatics in pharmacies in Prishtina. As a sample the team used Herceptin 440 mg, product of French company Roche. This cytostatic is used to treat breast cancer and it is one of the most wanted and at the same time very expensive medicament. Only Herceptin costs 40 % of the value of total budget that Ministry of Health spends for cytostatics, and in monetary terms it is more than 1,7 million euros. Ministry of Health buys one Herceptin for 1 thousand 550 euros. Frequent demands, its absence in KCUK and its high price have made this medicament become among the most smuggled ones.
Preportr team asked for this cytostatic in some pharmacies of the capital city, mainly in those around KCUK, to see where this smuggled cytostatic could be found in the market.
In pharmacy (A) the price for this medicament (Herceptin 440 mg), was 1595 euros. The owner of the pharmacy claimed that this medicament had a banderole. We were thus given a receipt that, according to the pharmacist, we could give to Ministry of Health and get 70 percent of the amount in return.
The same medicament in pharmacy (B) cost only 700 euros. Preportr team did not manage to see it since this medicament was not kept in the pharmacy, The owner, after talking over the phone with someone, went out, met a person and told us we could get the medicament for only 700 euros. To our hesitation that this medicament with that price might be without a banderole and not have the desired effect, the pharmacist stated that this is the same medicament as the one found in other pharmacies, that it is by the same producer and also has a banderole.
Three weeks later, Preportr team once again asked for this cytostatic (Herceptin 440 mg) in pharmacy (B). After three weeks, we were offered this same medicament with a price of 800 euros. This time as well, we were told that this medicament is not kept in the pharmacy but we could have it in half an hour. At this time Oncology Clinic did not have any Herceptin 440 mg at all. Pharmacies made use of the absence of this and other cytostatics for some weeks in order to increase their prices.
With a much lower price, for only 450 euros, pharmacy (C) offered us this cytostatic. This means three times cheaper then the market price, or the price paid by the Ministry of Health, which is 1550 euros. But here too, it was impossible to see the cytostatic because it was not kept in the pharmacy but we could have had it in half an hour.
During research Preportr team tried to get Herceptin 440 mg also from other companies and pharmacies. The owner of a well-known company that imports medicaments did not admit that they had cytostatics. However, this owner referred us to another pharmacy, giving us the owner’s phone number. He also told us that he did not have this kind of medicament but that someone else might get if for us. The third person that we contacted turned our to be the one who could get us a Herceptin.
“I sell Herceptin 440 mg for 750 euros, I bring it to you, just tell me where you are. It is well preserved, don’t worry, no concern. These ones, with papers, are very expensive. Herceptin is by Roche; it is best before 10/2016, I think. It does not have a banderole. For example, if I wanted I could take a banderole and stick it on, but that’s not it. I should tell you the truth, that we, for instance, got those from Macedonia and Albania, and it doesn’t make sense to bring them with their banderole”, said the vendor of smuggled cytostatics.
Representatives of pharmaceutical companies and experts of pharmaceutical market issues say that cytostatics enter Kosovo from countries in the region in small amounts using illegal routes and transporting those in bags and similar gear.
But taking into account the price, we are talking about big amounts of money.