ORM Medications Programme

A vital part of ORM programmes, access to the necessary and appropriate medications. When we arrived in 2000, the only support these vulnerable children were getting was as a part of a larger micro drug programme being run by PSF. Unfortunately these medications were very basic as the extent of illness and necessary medications had not yet been established. As we established our medical programme we uncovered the enormous level of support required to bring these children back to an acceptable level of health.

ORM took the full burden of sponsoring all medications until 2003 until the state stepped in with their evolving medical insurance programme. It is hugely flawed to this day, but it does mean that they are now taking responsibility for at least some of the medications required. The state budget has increased but their methods of procuring medications still leaves much doubt as to their level of appropriate care.

Under Moldova's new health insurance initiative basic medications will be provided. examples of these are basic pain relief medications, basic antibiotics and some other basic generic medications. Restrictions on procurement mean that they must go out to tender with at least 3 national drug manufacturing companies. Whom ever produces the cheapest tender wins the contract for a 12 month term.

The flaws exist where our patients who now are resistant to basic antibiotics (e.g. penicillin - which is covered by the insurance) will not respond to this drug and need a stronger medication to see improvement. Especially relevant in the cases of CF where the children are prone to respiratory tract infections and can become very unwell, very quickly. They need a broader spectrum antibiotic, which is not covered by their health insurance. Also many of the drugs available on the insurance scheme are only available in intramuscular form. ORM medication policy favours oral (in suspension or syrup form) or IV route over the painful IM route where at all possible.

Further examples where the insurance system fails our patients is in the area of anti seizure medications. A handful of medications are available on this system. Having worked with a specialist team of neurologists for the last 8 years we have seen a dramatic decrease in seizures and status. This is mainly due to the fact that you can not assume every person with seizures will respond to the same medication. Each individual will respond differently to any given medication and in some cases will need more than one medication at a time to treat the seizure activity. Once on these medications, the patient needs to be monitored very carefully for side effects, dosing difficulties, changes in their blood profiles. Any difficulties and the medications will be changed appropriately. It often takes time and trail and error with these drugs to get the combination and dosing schedule right.

Further difficulties of the insurance scheme include the lack of antiviral medications. We have more than 20 children with viral hepatitis, who need very specialist, very expensive medications, that are not available on this scheme. 

Where ORM provided all drugs up until 2003, we now provide the following expensive medications not covered under their medical insurance scheme;

• Anti viral medications (>20 children)
• Anti convulsants (>117 children)
• All Broad spectrum antibiotics in powder, suspension & syrup form and all other antibiotics that are not on the list of basic medications
• Syrup form of pain relief and NSAIDS
• All Steroids
• All emergency medications for ACLS
• All anti parasitic medications
• All inpatient stay medications, including medications needed in intensive care situations
• All medications used in dentistry including anaesthetics
• All Anti fungal medications
• All other medications that are not provided by the insurance scheme

Although the state has started to contribute to the costs of the medication programme since 2003, we have seen a sharp rise in our costs of our medication programme, a direct result to the sharp rise in the number of patients in our care since that time.