By Olha Chepil | 2025-11-19

When Russia launched its full-scale war on Ukraine, few expected ordinary Russians would soon struggle to find basic medicines. But as Western drugmakers pull out, supply routes fracture and prices surge, pharmacies from Moscow to provincial towns are increasingly running out of essential treatments, analysts say.

Innovations blocked

After the war began, major pharmaceutical companies halted almost all clinical trials in Russia, leaving about 5% in place and cutting patients off from access to new drugs years before they would typically reach the market.

Ukraine's Foreign Intelligence Service says Russia has "essentially deprived its citizens" of innovative treatments by refusing to recognize international studies that do not include Russian doctors and patients.

Payment hurdles, fears of secondary sanctions and rising prices for active ingredients have further strained supplies. Generics and domestic versions now dominate pharmacy shelves, but doctors and patients often question their quality.

Tatyana Chaikovskaya, a Moscow civic activist who opposes the war and spoke to Kontur under a changed name for safety, said pharmacies may advertise "exact equivalents," but most options are Russian-made and vary in quality.

She said diabetics are among the hardest hit: fast-acting insulin vanished after foreign firms left, reserves ran out and patients began searching nationwide as endocrinologists shifted them to local substitutes.

Although manufacturers still import active ingredients from India and China, she said many patients struggle with allergies and must adjust slowly.

Most people, Chaikovskaya said, are trying to cope by altering dosages, looking for alternatives or relying on volunteers for rare drugs.

"People still ask me -- don't big cities have imports?" she said. "They assume originals are better, and they're right. The same goes for antidepressants. Everything's been swapped for substitutes."

The risk group

The shortages grow more severe for people who rely on innovative, lifesaving treatments for cancer, HIV and other serious illnesses. Chaikovskaya said these patients now face the most frequent and dangerous gaps in supply.

"Yes, it's a problem," she said, adding that people still "manage however they can," despite soaring prices.

While residents of Moscow and Saint Petersburg mainly struggle to afford high-cost drugs, people in the regions increasingly lack even basic medicines.

Svetlana, who lives in Astrakhan and asked Kontur to withhold her last name, said finding routine treatments has become exhausting.

She once bought everything at one pharmacy; now she travels across the city because "one place has one drug, another place has a different one." She said she and her daughter rely on an app to check which pharmacies still have stock.

Pharmacy chains recently stopped assembling orders at centralized warehouses.

"Before your order would be sealed carefully," Svetlana said. "Now they just give you a little bag that's tied closed," an indication that staff assemble orders on the spot and that refills have changed in quality.

Novaya Gazeta reported that more than 130 lifesaving drugs, including cancer and HIV treatments, disappeared from Russian pharmacies in 2024.

A black market for medicine

Amid the shortages, a black market for medicine has flourished in Russia, largely through Telegram chats. A Novaya Gazeta investigation found at least 1,280 drugs circulating there last year.

Daria Talanova, the journalist behind "The Resellers of Health" article, told TV Rain that Telegram groups fall into two categories: commercial channels and "Charity Pharmacy" chats, where people share unused drugs because selling them is illegal.

Even sellers, she said, "don't go out of their way to publicize it."

These channels have grown rapidly since spring 2022. More than 40 offer everything from vitamins to antitumor drugs. Talanova said "dark channels" focused on sales make up the bulk of them.

Buyers risk counterfeit, expired or improperly stored medicine, but some still turn to the black market, often because they distrust generics or Russian-made versions.

Analysts say the shortages stem from Russia's isolation, sanctions and internal system failures: major companies have withdrawn, supply chains have collapsed, and bureaucracy and a weakened ruble have made imports largely unaffordable. Physicians are losing touch with innovations, and patients are losing access to modern treatments.

"All of this is part of a bigger picture," said Svetlana. "The healthcare system is gradually deteriorating, while it's getting harder and harder for sick people to get the medicines they need."