Diabetes is the number-two category in the Russian DLO program after cytostatics and accounts for more than the global average
of 10% of overall healthcare expenditure. Since 70% to 80% of people with diabetes have the "disabled" status they need to
be eligible for the DLO program, it is no wonder that more than 85% of Novo Nordisk's sales (the highest percentage of all
the top players) come from the program.
Novo Nordisk has been working for years now to diagnose late complications of diabetes and to screen for diabetes in different
regions with the help of specialists from the Endocrinological Scientific Center of the Russian Academy of Medical Sciences
who work in the Novo Nordisk Mobile Diabetes Center. The company placed its Mobile Diabetes Center next to the Inter-Parliamentary
Assembly of CIS Countries in St. Petersburg when parliament deputies were to discuss the model law on diabetes.
"After they had been tested and educated about diabetes, they adopted this because they already knew what it was all about,"
says Smirnov. "Closing the gap between the treatment currently offered and what could be offered based on available guidelines
and scientific knowledge saves both money and lives and is part of the sustainable development of healthcare systems."
Smirnov is confident that Novo Nordisk's advocacy of a more seamless system of care, in which medical treatment is just one
element, will serve to defend his stable 50% market share against three new Russian insulin manufacturing ventures that plan
to come online with enough capacity to meet the overall demand of the Russian market.
While many multinationals are still marketing old-generation products like 17-year-old antibiotics and ACE inhibitors that
no longer exist in the West, the DLO has improved access to more modern and efficient insulins, like the short-acting insulin
aspart (NovoRapid), thus improving predictability and control.
The clear advantage, according to Smirnov, is that the majority of people do not know exactly how much or what they are going
to eat. Our dosage, however, is based on exactly what they eat. Giving treatment that's adequate to a person's diet has helped
us to reduce HbA1c significantly."
Despite the common view that diabetes may be the only disease given special priority by the Russian authorities, only 2.3
million of the estimated 8 million people with diabetes have been diagnosed, and the average consumption of insulin per capita
in Russia is 57 international units, compared with 350 units in Germany.
Need for Transition
Stefan Jentzsch, head of representation for Russia and the CIS region at Eli Lilly Vostok, came from the fairly structured
Saudi Arabian market in 2003 to find quite a different situation in Russia.
Jentzsch believes that Russia needs "to transition to a better funded, insurance-based system, while strengthening outpatient
care (which accounts for only 35% of public health resources versus 60% in the EU) and developing treatment standards as the
main basis for reimbursement decisions in order to ensure better access to innovative medicines."
Jentzsch's local unit lags far behind Eli Lilly as a whole, which received a number-10 global ranking from Pharmaceutical
Executive in 2005, yet he explains that unwavering global compliance standards and a disconnect between charitable acts and
product inclusion in the DLO program are to blame.
While up to 80% of prescription drugs are sold without prescription in Russia, Jentzsch claims: "We are complying with the
highest ethical standards in Russia. We are not encouraging patients to buy a prescription drug in a pharmacy without having
received a prescription from a physician."
Increasing Access to Innovation
In 2006, Lilly took a leading role in the process of updating the Code of Marketing Practices of the Association of International
Pharmaceutical Manufacturers (AIPM), the main industry voice of the international pharmaceutical community. "We want every
company in the Russian market to play by the same rules, in full compliance with all applicable laws and regulations," says