Health systems in transition : Uzbekistan

5.6 Pharmaceutical care
Since independence, Uzbekistan has faced the challenge of maintaining the 
supply of drugs and vaccines, while developing and implementing its own 
national drug policy. The gradual development of a national drug policy 
resulted in a clear division of the roles of the government and the private sector. 
The government maintained mostly regulatory functions, while production and 
distribution were delegated to the private sector. 
Uzbekistan inherited a well-developed drug distribution system from the 
Soviet period. This included the centralized state pharmacy (
Farmatsija
) 
system and its regional divisions and pharmacies (Ilkhamov, Jakubowski & 
Hajioff, 2001). State pharmacies are now almost completely privatized, either 
as part of a joint shareholding association (Dori-Darmon, the former sole 
drug distributor), or as a single or group pharmacy. The relative success of 
privatization has helped to ensure competition and provided new opportunities 
for circumventing the shortages of foreign drugs. However, it is difficult to 
obtain up-to-date data on operational private pharmacies (such as their number 
or scope), as they are outside the framework of the Ministry of Health and do 
not report to any of the Ministry of Health agencies.
Dori-Darmon has traditionally been the main source of drugs for hospitals, 
but the share of private distributors has recently been growing. Each hospital 
places an annual order with Dori-Darmon, and deliveries are normally made 
on a weekly basis. Private sector supply is based on individual negotiations. 
Private drug distributors also supply drugs to pharmacies, polyclinics and 
private practices. Vaccines for the public sector are directly distributed by the 
sanitary-epidemiological services.

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Health systems in transition
  
Uzbekistan
85
Uzbekistan has a long-term strategy for increasing domestic drug production 
and seeks to become self-sufficient in the production of essential drugs, infusion 
solutions, vaccines, blood preparations, disposable blood transfusion systems 
and blood substitute products. Investments were made in the domestic industry, 
and the aim is to apply international manufacturing standards to domestic 
pharmaceutical production. While estimates from different sources vary, they 
all report a rapid expansion of the pharmaceutical market in Uzbekistan over 
the last few years. In 2010, medications worth over US$ 370 million were 
imported. In 2012, this number increased to over US$ 530 million. The share 
of domestic products in the market is estimated to be 20–30%. Over 50% of 
sales are accounted for by generics. There are about 130 companies involved 
in the production of pharmaceuticals in Uzbekistan, with over 80 wholesale 
companies and over 5000 drugstores (Chemrar, 2013; Uzpharmsanoat, 2013; 
А
cierto Consult, 2013). 
Challenges for the purchase and distribution of pharmaceuticals include 
a cumbersome registration process for imported drugs, and the limited 
hard currency available for the purchase of drugs from abroad. Updates of 
evidence-based essential drug lists, as well as quality and price control for 
pharmaceuticals still need to be addressed.
Pharmaceuticals for outpatient care are fully covered by out-of-pocket 
payments, except for selected population groups and clinical conditions. Patients 
with oncological, endocrinological or psychiatric conditions, tuberculosis, 
HIV/AIDS, leprosy, cardiac surgery, and organ transplants are eligible for free 
outpatient pharmaceuticals. This eligibility also extends to selected groups of 
the population, such as veterans of the Second World War, workers disabled 
in the Chernobyl nuclear disaster, and single pensioners (Cabinet of Ministers, 
1997b). However, no data are available on how far the need for pharmaceuticals 
in these groups is met. 
Coverage of pharmaceuticals in secondary and tertiary care depends on 
the source of funding. If patients are not eligible for any reimbursement or 
benefit packages, the costs need to be fully met by nongovernmental sources, 
primarily out-of-pocket payments by patients. When patients are eligible for 
reimbursement by the government, they only need to pay out-of-pocket for 
pharmaceuticals that are not available at the health care provider (Cabinet of 
Ministers, 1994). Pharmaceutical expenditure as a percentage of total health 
expenditure has shown some strong fluctuations in the years since independence. 
However, public pharmaceutical expenditure accounts for a small portion of 
overall pharmaceutical expenditure. 

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Health systems in transition
  
Uzbekistan