Pharmacy Crisis Under the Sponsorship of the Ministry of Health

At the end of the year, Health Minister Anahit Avanesyan announced the global deficit of medicines. She explained that the disappearance of several drugs in Armenia is a consequence of this situation. In reality, the deficit of many vital medicines and the high prices of several drugs are the results of the policies pursued by the minister. This is reported by "Hetq".

Since the beginning of last year, the importation of highly demanded medicines for the population from Russia and the European Union has been banned. The only explanation (apart from inadequate reasoning) is the targeted servicing of several foreign pharmaceutical manufacturers and importers’ interests by the ministry officials, supporting them in every situation. The minister continues to paralyze the sector: she created this crisis and is now announcing that there is a medicine deficit globally. In fact, there is no global medicine deficit; there is local patronage and unprecedented manipulation of the population.

In the same interview, the minister noted that "the war in Ukraine has also become a factor that disrupted certain contracts for the importation of medicines into Armenia, altered their import paths, etc." However, she did not focus on what is meant by the partnership regarding imported medicines into Armenia, what specific contracts are in question, what changes to the import paths of these contracts are being discussed, and what the term "and others" refers to.

Then she informed about the ministry's decision to counteract the medicine deficit. "To solve these issues, the law on medicines in Armenia has certain flexibility. Until February 2023, medicine importers have the opportunity to import deficit drugs, which have been approved by the Ministry of Health and are not registered in Armenia, from European, American, and Japanese manufacturers. This is a temporary tool that we sometimes use to mitigate the situation, but we understand that, overall, there is a deficit in the international pharmaceutical market."

Let me explain what this is about. We met with the minister at the beginning of October to explain the situation once again. After more than a month of deliberation, they allowed only a few groups of medicines to be imported, specifically anti-cancer and psychoactive group drugs. However, these are sold very little in the market sector; the government purchases them after announcing tenders. Here, too, it turns out that the government’s decision about purchasing prohibits state institutions from buying unregistered medicines. In other words, on one hand, we have been allowed to import, while on the other hand, it is unclear for whom. After all, 95% of these medicines are purchased by state medical centers.

These cosmetic changes were achieved not through the ministry's initiative or political concern but as a result of our pressure and the desperate situation and dissatisfaction of patients. We appeal to the Ministry of Health to allow us to import other highly demanded vital group medicines (which account for 98% of the sector's turnover), but we are rejected with the claim that when importing unregistered medicines, we must follow the list of anti-cancer and psychoactive drugs approved by the ministry. This means that we are requesting permission to import several antibiotics from the anti-infective group or emergency shock medications, while they are telling us to bring instead, for example, anti-epileptic or anti-Parkinson’s drugs.

The head of the Medical High Technologies and Humanitarian Assistance Coordination Division, Marine Harutyunyan, is more direct in her statements: she does not leave room for global crises or "disruptions of the partnership for importation." "For almost two years, we have had no problems related to medicine availability in the market. However, this is a huge burden for our expert center, since unregistered medicines do not have specific samples and many issues arise in conducting comparison and identification of medicines, consuming enormous human resources and lacking documents. A vast amount of work has been done over the past 1.5 years, but it cannot continue this way," Harutyunyan concludes.

She does not want to fulfill her duties; she is tired. Harutyunyan herself affirms that due to the importation of unregistered medicines, there have been no issues related to medicine availability in the country for two years, yet this does not seem to her. In her opinion, the main goal of medicine importers is not to create added value and satisfy the demand in the sector, but deliberately to import so many medicines that the employees of the Medicine Agency and the ministry are exploited. The Medicine Agency is a profit-seeking institution that has set the rates for import examination in such a way to ensure its own profits, and it receives substantial sums for every import, with our organization alone having paid 19,250,000 drams for import examination to the Medicine Agency even in 2022, despite significant restrictions on imports.

The experts of the Medicine Agency are precisely called to carry out these examinations, and that is why we pay this commercial structure, and since they have a shortage of employees, they merely need to replenish with new staff. The ministry, being the 100% founder of this agency, could easily initiate the process if desired. Moreover, the current law was written at the Medicine Agency at the right time, and it was devised in a "customized" way to ensure that the import process is strictly controlled by them.

According to the law, the Ministry of Health has seven working days to issue an import certificate, of which five days are allocated for the Medicine Agency’s conclusion. In many cases, our matters have been prolonged for up to two months. No one at that agency took their legal work seriously to fulfill their duties within the timeframe set by the law. As for public servant M. Harutyunyan, she is also paid from the state budget. That compensation is ordered by us, the tax payers. The demand for medicines in the market is created by the prescribers, that is by doctors. The volume of imports is a result of that demand, and if there have been no issues related to medicine availability for two years, that is also a consequence of organizing the import process meticulously.

Furthermore, those glaringly inappropriate imports are the reason behind the existing positions and salary scales of the experts of the Medicine Agency and public officials. Harutyunyan does not comprehend these cause-and-effect connections; likewise, it would not be accessible to the noble Australian aborigine tribes to understand the cause-and-effect relationship between sexual acts and childbirth.

“Pharmaceutical suppliers want to bring unregistered medicines from all countries, which is impossible. Now, when the entry of unregistered medicines into the country is banned, except for a few groups of drugs, many pharmaceutical organizations may complain, as importing unregistered drugs is very easy and profitable for them, but it poses significant security risks for the state,” Harutyunyan states, clearly rattled. Besides believing that importers exploit the officials at the Medicine Agency and the ministry, she also perceives that by bringing in unregistered drugs, importers easily make money.

We have submitted numerous references to the ministry to show how hundreds of highly demanded medicines have dropped in price multiple times in the market. They go through all the import invoices at the ministry. Apart from seeing all the import prices, they also observe how many more importers have appeared in the market, and competition has strengthened. Nonetheless, in her eyes, the import process is akin to catching money out of thin air, posing massive security risks for the state.

All of our imports undergo rigorous state examination, and the documents accompanying the medicines reflect the entire import chain from the manufacturer to the last supplier. There has not been a single incident related to safety. When the legal importation of vital medicines registered in the EU and Russia was banned, the importation of many urgent medications was put on a smuggling, reliable conveyor belt. Medicines are brought sneakily and through smuggling routes, circumventing the inspection authority of the Medicine Agency. This is the Ministry of Health’s policy to ensure the "safety" of the medicines circulating on the market.

Harutyunyan notes that even individual persons are allowed to import unregistered medicines—three boxes or as prescribed in the prescription; she describes that they receive 6-7 applications weekly from citizens regarding those few boxes of medicines while describing bureaucratic hassles that citizens must also go through, just like importers do when importing one entire truckload of medicines.

It turns out that we are not allowed to import at the time when we are specialized, procure more cheaply, and do so more safely while adhering to special preservation conditions while transporting the medicines. Meanwhile, in the populist and impractical decision regarding individual imports, no safety risks arise. "When unregistered medicines easily enter the country, the meaning of registration becomes devalued; rights holders no longer want to register medicines in Armenia," Harutyunyan resorted to threats. She does not mention that Armenian importers, in parallel importation, acquire those same medicines from the markets where the same rights holders have registered those drugs. Thus, in many cases, the same medicines are resold by those market importers at much lower prices than would be sold directly in Armenia by the rights holder.

Rights holders also register medicines in other markets and generate significant revenues; otherwise, they would not operate there. Simply put, the state authorities there do not subjugate the interests of their citizens to this degree. In Armenia's case, for the authorities responsible for the sector, serving the interests of registration rights holders is of utmost priority, and the competition for importation is restricted at all costs to ensure that medicines are imported solely from them.

The significance of addressing both the minister's and her subordinate's statements is to demonstrate how a vital sector can be paralyzed in an unbalanced area. Other sectors are equally paralyzed. Removing the current minister is not a solution. If he is removed, Pashinyan will appoint someone even less competent. Armenia needs radical solutions arising from changes at the highest levels. As long as that option does not currently seem visible, solutions must be imposed through the persistent pressure of the citizens. When prescribed medications are not found in pharmacies, people should go directly to the Ministry of Health and demand the indicated medicine from the minister personally.