Approaches to the justification of targeted subsidies for drugs in providing medical care in ambulatory conditions in military medical organizations

This study presents the results of the analysis of the funding mechanisms for drug supply of assigned contingents in the provision of outpatient medical care in military medical organizations. Existing approaches to determining methods for optimizing the need for drugs are considered. In addition, this paper presented approaches to the formation of a formulary list of medicinal products of a military medical organization. This study also showed the possibility of using pharmacoeconomic assessment in justifying targeted subsidies for drug supply. The relevance of the analysis of the assortment structure for entry into the approved list of vital and essential medicines is emphasized. A possible algorithm for substantiating a targeted subsidy for drug supply in the provision of outpatient medical care within the framework of military health care involved eight stages. First, the incidence of attached contingents entitled to drug supply at the expense of the Russian Ministry of Defense for outpatient treatment was analyzed. Second, the nomenclature of medicines was determined by comparing the incidence pattern of attached contingents with the list of medicines presented in the standards of medical care and clinical recommendations. Third, groups of drugs (with specific and wide spectrum of action) normally used are distinguished, considering the uniqueness of consumption when predicting (planning) demand. Fourth, the need for medicines were formulated using the normative method, modeling method, and logicoeconomic and other methods for determining the need, taking into account the peculiarities of their application in medical, social, and economic conditions of the military medical organization. Fifth, the created drug list was optimized based on the combined ABC-VEN analysis. Sixth, the formal list of the military medical organization was optimized by taking into account the results of pharmacoeconomic research on the treatment of specific diseases. Seventh, an analysis of the assortment structure in relation to the list of vital and essential drugs was performed to further substantiate their economic, clinical, and pharmacoeconomic effectiveness. Eighth, a targeted subsidy for drug supply was calculated, and application was filed, which contained calculations of planned costs with the appendix of the list of planned drugs for purchase, as well as commercial proposals justifying its cost.