This is an excerpt from an unpublished article written by a top executive at a major international pharmaceutical company. A Russian woman who has long worked for Western firms was responsible for the distribution of complex and very expensive medications in our country. This primarily refers to cancer drugs, which account for more than 40 percent of government drug procurement , according to data from DSM Group analysts × . Like almost no other, she illustrates the scale of corruption in this industry and, most importantly, understands that everyone is well aware of this corruption: American and European drug manufacturers, Russian distributors, regulatory agencies, and doctors. They all remain silent about how this market operates because the status quo benefits everyone. Everyone except the patients, that is: every year in Russia, approximately 280,000 people die from cancer, accounting for one in six deaths , according to 2023 data (detailed mortality statistics were classified in subsequent years) × .

Antonina — name changed (our interviewee still visits Russia from time to time and, for this reason, asked that her real name be kept confidential — × recalls that she had long observed the practices prevalent in her industry but decided to speak out after the death of Alexei Navalny in 2024. The ongoing war and intensifying repression only strengthened her resolve.

In late 2025, she contacted Proekt with a draft of an article she had intended to publish in the independent press. The interviews with Proekt journalists that followed Antonina’s letter, as well as the documents provided by her, formed the basis of this investigation; the facts were verified through conversations with other players in the pharmaceutical market and with the help of the government procurement database. Our partners in the U.S. and Switzerland also provided significant assistance in preparing this piece.

Proekt calculated that in 2025 alone, the Russian healthcare system purchased drugs from eight foreign pharmaceutical companies , according to a report by Cursor × worth a total of RUB 386 billion. If we use the lowest of the estimates provided by Antonina to gauge the scale of the bribes, this would mean that corruption consumed about RUB 38.5 billion — just under half a billion dollars. The same thing happens every single year.

This “bribery chain”, she explains, arises from the fact that all Russian distributors of Western drugs purchased with public funds receive huge “commercial bonuses” from manufacturers — on average, 30% of the cost of each package of medication. Such bonuses probably don’t exist anywhere else in the world. They are used to carry out what is known in the industry as “procurement support” — that is, bribing the decision-makers who determine what, when, and at what price the government will purchase, as well as paying “protection money” to government officials.

Bribery Chain

Who profits from unprecedented bonuses for cancer drugs

In October 2025, 47-year-old Olga Lender died in St. Petersburg after a four-year battle with breast cancer. She had been receiving treatment at the City Clinical Oncology Center (GKOD), one of St. Petersburg’s leading cancer treatment facilities. The center treats 40,000 patients annually. Its doctors perform more than 1,000 surgeries per month, with about 2,500 people receiving chemotherapy at any given time.

When Olga first came to the GKOD for an appointment in 2021, she already had her test results with her: a tumor biopsy performed at another facility at her own expense, and a CT scan that already showed suspicious lesions in her liver and sacrum — these were likely metastases , as Olga herself wrote in the Telegram channel she ran during her lifetime × . However, the GKOD did not conduct any additional examinations; instead, they prescribed Olga some basic tests. They collected urine and blood samples, performed an ECG, reviewed the biopsy slides once more and made the diagnosis: stage 3 hormone-dependent breast cancer. She was prescribed intensive therapy, the so-called “red chemo” a course of intravenous chemotherapy consisting of several drugs, one of which is bright red in color, hence the name. This is one of the most poorly tolerated treatment regimens for breast cancer: after each infusion, patients often experience severe weakness and nausea, hair loss, and a decline in blood values and immune function. Lender’s regimen was “intensified” — the drugs were administered at shorter intervals, meaning the treatment was even more grueling × , one of her breasts was removed, and she then underwent radiation therapy as well.

But Olga didn’t feel any better. Tormented by pain, she sought out private consultations with other doctors. They told her that her initial diagnosis might be incorrect. If the lesions in her liver and spine were metastases, then she had stage IV cancer. Treatment for her type of tumor should have been radically different: she should have been prescribed several imported oral medications. Olga had no illusions about a cure, but she still filed complaints with various authorities—she wrote to the chief physician of the GKOD, the Federal Service for Surveillance in Healthcare (Roszdravnadzor), the Prosecutor General’s Office, the Mandatory Health Insurance Fund, and so on. As a result, a criminal case was opened under Article 238 of the Criminal Code of the Russian Federation “Fulfillment of Works or Rendering of Services Which Do Not Meet Safety Standards”; the case was later reclassified under Article 293 of the Criminal Code of the Russian Federation “Neglect of Duty”, as a relative of the patient explained in her blog × , but Olga did not live to see the end of the investigation.

Why the doctors chose this particular treatment strategy for Olga and whether it was the right one must be determined by the expert review of the case, which her relatives are currently awaiting . the GKOD did not respond to Proekt’s inquiries × . That said, an experienced oncologist who reviewed Lender’s case at Proekt’s request says that the doctors at the GKOD may have been guided, in part, by economic considerations. The treatment chosen for Olga — surgery, chemotherapy, and radiation therapy — was performed in the hospital, and the hospital received payment for it from the Mandatory Health Insurance fund. If the GKOD had prescribed pills for her to take at home, it would not have received any payment.

But even more importantly, the therapy Olga was seeking is much more expensive than the one she received. Given her diagnosis and stage of the disease, she should have received targeted therapy to inhibit the division of tumor cells so-called CDK4/6 inhibitors × , which in theory could have extended her life expectancy . This is not just an assumption. According to data from the “State of Oncology Care for the Russian Population” reports for 2022–2023, the number of people who died in St. Petersburg from malignant tumors in the first year after diagnosis is higher than the number of people diagnosed with stage IV cancer in the previous year. The Leningrad Oblast ranks first in Russia for this rate. This indirectly suggests a possible systematic underestimation of disease stages in the region and, consequently, the selection of inappropriate treatment for such patients × . St. Petersburg procures several such drugs — ribociclib, palbociclib, and abemaciclib — all of which, at the time Olga was undergoing treatment, had no Russian equivalents and were purchased with state funds from foreign manufacturers. The cost of an annual treatment course for a single patient ranges from RUB 950,000 to 1.4 million rounded, according to data from the St. Petersburg Health Commission’s government procurement records × . Any one of these three drugs is nearly 300 times more expensive than the therapy prescribed to Olga . Following surgery, chemotherapy, and radiation therapy, Olga received letrozole as monotherapy from the city as part of her maintenance treatment under the subsidized program. The cost of its annual supply in 2023 was 3,185 rubles × .

Corruption Fund

How bonuses turn into bribes

In practice, the main role of these front companies in the regions is to negotiate with local doctors and officials responsible for government procurement — and to pay them bribes.

“Large distributors don’t want to deal with under-the-table cash themselves — it’s quite a hassle”,

— explains Proekt’s source who works at one of the Western pharmaceutical companies. Cash is mainly used, he explains, and to obtain it without compromising their public accounting records, these companies resort to “cash-out schemes”. For example, they pay contractor companies for logistics, marketing, or warehouse repairs, but in reality they receive no services, since the contractors are actually shell companies whose only point of existence is to participate in such schemes — i.e., to convert funds into cash for a bribery slush fund. On the Russian market, the fee for this service is about 6% , our source claims, This is confirmed by numerous publications about the “cash-out” market × .

Palbociclib and ribociclib, which Olga Lender sought to have approved in 2023, were procured twice by St. Petersburg during that period. Both tenders were ignored by manufacturers and major distributors despite the apparent profit.

Palbociclib (brand name “Itulsi”) is manufactured by Pfizer; in Russia, it has a subsidiary called “Pfizer Innovations”, which holds a full license to sell drugs. However, the American giant’s Russian subsidiary did not participate in the bidding. Instead, the drug is distributed by “Pharmstandard”, but this company also did not participate in the tender either. The only bidder was “Pharmcomplex”, a secondary distributor of “Pharmstandard”. It predictably won the right to supply 6,460 packages of palbociclib for just under half a billion rubles RUB 472m × .

Ribociclib (brand name “Risarg” or “Kiskali”) is manufactured by the Swiss company Novartis. However, neither Novartis nor its main major distributor “Pharmimex” participated in the St. Petersburg tender either. The sole participant and supplier of 9,407 packages of the drug, worth over one billion rubles, was “Wholesale Medical Company” — a secondary distributor from St. Petersburg.

“These are very large tenders for widely used cancer drugs. They are not held in remote regions of Russia, where the pharmaceutical companies’ reliance on intermediaries could be explained by logistical difficulties, but rather in St. Petersburg, where there are no issues with transportation access, warehouse capacity, or even finding a specialist who can prepare the company’s tender documents. And yet, we see no competition at all in these tenders. Every single time, like clockwork, only one company submits a bid, and that company wins the contract. For each such tender, the chain of intermediaries will receive at least 25–30% in commercial bonuses — about RUB 400 million from these two contracts alone! That’s quite a profit margin”, Antonina chuckles . The St. Petersburg Health Committee did not respond to Proekt’s inquiry regarding drug procurement × .

The fact that a significant portion of distributors’ earnings goes toward bribes is, in a sense, common knowledge. In 2020, shortly before Olga Lender was given her terminal diagnosis, Roman Koval, a member of the local legislative assembly, was arrested in St. Petersburg. In exchange for a 20% “kickback” on the value of the contracts, he helped the very same “Wholesale Medical Company” (OMK) that supplied the city with the Ribociclib Olga was seeking.

The scheme was ingenious: the MP, using his authority and connections within the city government, helped hospitals obtain subsidies from the local budget, and the hospitals, in turn, entered into government contracts with companies whose interests the MP lobbied for. . The case involved ten contracts totaling over RUB 109m, which were ultimately signed with OMK and several other companies × .

The decision to purchase ribociclib and similar medications for home use is made by a special commission of the city’s health department, but the list of such drugs is compiled by a specific individual: the city’s chief oncologist. Dmitry Gladyshev, a surgeon from City Hospital No. 40, has held this position for several years. “He’s part of the St. Petersburg ’surgical mafia,’” one of Gladyshev’s colleagues says of him. “He’s a graduate of the Military Medical Academy. The secret behind his appointment is simple: in 2019, Dmitry Lisovets, a graduate of the Military Medical Academy, took over as head of the committee, and brought his own people in.

The drugs used for inpatient treatment at the GKOD are selected by the hospital’s chief physician, Eldar Topuzov, and the chief specialist in clinical oncology, Rashida Orlova. Both were born in Uzbekistan, worked together for a long time, and got married in 2014, although few of their colleagues know about it. The reason is that after their wedding, their working relationship should have, at the very least, been subject to a conflict-of-interest review. The anti-corruption requirements in effect for St. Petersburg government agencies stipulate that spouses must not be in a subordinate or supervisory relationship.

Orlova, Topuzov, and Gladyshev all disprove the widespread belief that doctors in the Russian public healthcare system are destitute. Even officially, they receive substantial income from pharmaceutical companies — up to several million rubles a year in addition to their salaries — in 2021, Orlova and Topuzov’s combined annual income, based solely on their official tax returns, amounted to RUB 35m. Gladyshev has no public financial disclosures, but leaks reveal that he also received official income from one of the pharmaceutical companies × . This is compensation for participating in marketing events organized by drug manufacturers the amounts of such expenses are carefully tracked, and pharmaceutical companies publish them in their public financial reports × . But this isn’t the main compensation received by doctors who have the ability to influence tenders.

The total value of the Gladyshev family’s real estate (his wife also works at the hospital) exceeds RUB 100 million. The couple also owns a nice dacha on the Karelian Isthmus, a favorite summer vacation spot for wealthy St. Petersburg residents. Orlova and Topuzov also have a spacious house there, as well as an apartment in the city itself, and additional real estate in Spain and Bulgaria This is known from Topuzov’s latest public asset declarations. The value of Orlova’s real estate in Russia is about 50 million rubles × . The couple takes expensive trips abroad several times a year; they are accompanied on these trips by their children and grandchildren, who, by all accounts, are also quite well-off. Orlova’s daughter Oksana Baikova, and her husband Boris have real estate registered in their names with a total value of about RUB 140 million . This includes an apartment in a gated community in the Kommunarka district of Moscow, a house in a cottage community in the southwestern part of the capital, and an apartment in St. Petersburg in a clubhouse on Kirochnaya Street, just a stone’s throw from Tavrichesky Garden × . Baikova herself, a dentist by training, does not appear to be currently employed. Her husband, an IT manager, currently heads sales at Huaxun Group RU, a company that supplies Chinese equipment; his monthly salary there is about RUB 500,000 . Orlova, Topuzov, and Gladyshev did not respond to Proekt’s letters × .

“They are beneficiaries of state procurement”, says an acquaintance of Topuzov, a practicing oncologist. “In fact, there’s not a single chief physician at an oncology center or institute who doesn’t steal. Many have literally taken bribes right in front of me. Once, a distributor handed a bunch of 5,000-ruble bills to the late chief physician of the Arkhangelsk Cancer Center right at a banquet”.

In 2025, the GKOD signed more than 800 government contracts worth RUB 4.9 billion, nearly 40% of which were for the purchase of imported drugs. Yet neither major international pharmaceutical companies nor their primary distributors in Russia are among the clinic’s suppliers.

Let’s take a look at one of the recent contracts. “Bavencio”, or avelumab, is an immunotherapy drug for treating bladder and kidney tumors, manufactured by Merck. There are no domestically produced equivalents for this drug, which means patients are vitally dependent on how much of it the government purchases. The official distributor of “Bavencio” in Russia is “Pharmstandard”. However, you will not find this company listed among the suppliers of avelumab to the GKOD. Once again, only one supplier — the St. Petersburg-based company “Central Medical Base” (CMB) — submitted a bid for the tender , which was announced at the very end of 2024 × . The contract price for CMB amounted to nearly RUB 81 million for 1,478 packages of “Bavencio”.

The entire supply chain that brought the drug to the GKOD looked like this:

“Pharmstandard” purchased it from Merck for RUB 75 million, excluding VAT (Merck’s Russian division charges approximately RUB 50,800 per package).

Merck then paid “Pharmstandard” a 25% bonus totaling RUB 18.7 million. Thus, the entire batch cost the Russian company RUB 56.3 million.

“Pharmstandard” resold the batch to CMB, sharing a portion of the bonus with it. The cost price for CMB came to about RUB 62 million.

CMB, in turn, sold the batch to a state hospital for RUB 73.6 million excluding VAT (RUB 81 million including VAT). The difference of RUB 11 million between CMB’s cost price and the contract price constitutes the “bribe fund”. The GKOD did not respond to Proekt’s inquiries regarding drug procurement × .

While the owners of Russia’s largest distributors in the state segment are more or less well-known, it is usually unclear who stands behind their numerous regional resellers. Who are these people?

Very Smart Guys

Oligarchs with ties to the government are the ultimate beneficiaries of the bonus system

Repik has four passions: Japan, California, poker, and national security. He’s been having some difficulties with the first three lately — partly because of the fourth.

In 2013, Repik bought a very expensive mansion on “Billionaires’ Alley” in San Francisco — that’s what they call the Pacific Heights neighborhood, where the houses overlook the Golden Gate Bridge , as reported by the anti-corruption initiative Scanner Project × . Repik paid $12.75 million for the mansion (it’s now worth about $20 million).

This isn’t just an expensive piece of real estate — it’s a house with a history. In 1945, a reception was held there for delegates to the conference that established the United Nations , as noted by the San Francisco Chronicle × . “He’s in love with California, and he’s lived here most of the time; his children were born here”, says a California acquaintance of his. However, after the invasion of Ukraine began, that love ceased to be mutual — several countries imposed sanctions on Repik, and now he is wary of traveling to the West. His wife Polina still frequently stays at their California home, although she travels there under her maiden name (Rybakova). She enjoys hiking in the picturesque hills surrounding San Francisco, and their daughter is still attending a local private school. The Repik family also adores Japan — Alexei used to trade Japanese alcohol as a hobby, headed the Russian-Japanese Business Council, and was passionate about local art, while Polina sewed Japanese-style clothing.

But their business there has been sold, and visits to Japan are now also in doubt — all because Repik has become a key player in Russia’s political system. For the same reason, he has also stopped participating in international poker tournaments, where he had achieved significant success (at one point, he was among the world’s top 10 amateur players).

“A very smart guy”, is how a former high-ranking official describes Repik. His official biography seems to confirm this: he graduated from high school as an external student and, at just 15 years old, landed a job as an economist at Moscow Hospital No. 29, where he learned all the ins and outs of purchasing medications. At 22, he founded his own company with a capital of just $40,000, $15,000 of which he borrowed from his mother.

In reality, his mother lent her son a little more than just money. Forbes magazine once reported that someone close to Repik was connected to the FSB’s logistics and supply service and helped the young entrepreneur secure his first orders for medicine from the Ministry of Internal Affairs and the FSB. Repik’s small firm received these orders right at the very beginning of its existence — something that truly had to be earned. At the time, someone hinted to journalists about the special role Repik’s mother played in this story. Now, one of Proekt’s sources, who is acquainted with the businessman, says that

Repik’s mother Valeria Daeva worked in the 4th Directorate of the Ministry of Health during the waning days of the Soviet Union. This directorate was responsible for servicing and supplying medicines to the government, law enforcement agencies, and all manner of protected facilities.

In the ’90s, Daeva was a business partner of retired KGB foreign intelligence officers this refers to the “Mobiltrust” company, founded in 1999, where Daeva was a co-founder. Her partners in this business were former managers of the “National Reserve Bank”—Vladimir Chernov, Sergei Shakin, and Anvar Sataev. All of them, like the bank’s owner at the time Alexander Lebedev, had previously served in the KGB’s foreign intelligence service, according to Vedomosti × . Already in Putin’s Russia, Repik’s mother was a member of the “Strogino” motorsports club—a small nonprofit organization for people whose hobby is racing expensive cars. Among the club’s founders are individuals who are simultaneously involved in the pharmaceutical business and have ties to the intelligence services . Club president Arkady Zyatkovsky previously co-owned the “36.6” pharmacy chain with Alexander Udodov, the former son-in-law of Prime Minister Mikhail Mishustin; he also owned other pharmacy ventures, “A.V.E”. and “120/80”. He plays on an amateur hockey team alongside officers from the FSB, FSIN, and GRU, as reported by The Insider. Alexander Losev, the son of another auto club founder Vyacheslav Losev, serves as director of the “Kronopharm Industries” pharmaceutical company, which is linked to the “Kanonpharma” group . “Kronopharm Industries” is currently building a drug manufacturing plant in Shchelkovo × .

Repik himself has a longtime acquaintance Sergei Vakhrukov, a security official and former governor of the Yaroslavl Oblast. Repik and Vakhrukov literally lived next door to each other in a gated cottage community built specifically for them on the banks of the Volga River in Yaroslavl , as Scanner Project revealed × . In this region, “R-Pharm” firmly controlled public procurement of medicines. Today, Vakhrukov is the right-hand man of former FSB head Nikolai Patrushev, the security official closest to the president. Repik also does favors for Putin’s own family. He flew Putin’s daughter Katerina Tikhonova to Europe on his Bombardier Global 5000 jet , as reported by iStories and Der Spiegel × .

Repik denied any ties to the security services with a joke: he said he likes to feel like a “felt boot with the FSB behind it”. Be that as it may, Repik is highly favored by the security forces. He has supplied — and continues to supply — medicines to the Ministry of Defense, the FSB, the Ministry of Internal Affairs, the Ministry of Emergency Situations, and the Federal Penitentiary Service (FSIN). After the invasion of Ukraine began, Repik started doing business in the occupied territories, which also implies approval from the security services: his company, “R-Stroy”, is building housing and social facilities in Mariupol , as Scanner Project revealed in 2023 × .

“There are two things to understand about Alexei. First, he’s always ready to help the authorities in every way — whether that’s due to his upbringing or his character. Second, he needs to be admired. So if Putin praises his business, Alexei will go out of his way to please him”, says an acquaintance of the pharmaceutical tycoon, another person on the list of Russia’s wealthiest individuals.

In addition to his mother and the authorities, another boost to Repik’s career came from the father-in-law of popular singer Nikolai Baskov. It was in this capacity that the country came to know businessman and politician Boris Spiegel in the early 2000s. His connection to the singer was not his main achievement though — at the beginning of the Putin era, Spiegel essentially devised the current system of government procurement of medicines. Until 2021, he was the owner of “Biotech”, one of Russia’s five largest pharmaceutical distributors.

In 2005, the then-director of “Biotech” introduced the young Repik to Spiegel as a junior partner. “He already had a pharmaceutical business, but it was small. We talked, and I liked him: a talented, forward-thinking guy. We entrusted him with certain regions and some fairly complex drugs (this refers to drug distribution — Proekt). He handled it well, and that’s how ‘R-Pharm’s’ rise began”, Spiegel recalls.

In 2021, at the height of the COVID-19 pandemic, Spiegel, his wife (who was also his business partner), and several managers and officials associated with them were detained. According to investigators, Spiegel paid bribes to Penza Oblast Governor Ivan Belozertsev and other local officials in exchange for favorable treatment during tenders for the procurement of medicines for hospitals in the region. Spiegel was handcuffed right at the airport, where he had arrived from a medical examination in Israel; his wife, Evgenia, was taken into custody at their country home near Moscow. Investigators and judges were not deterred by the fact that Spiegel suffered from several serious chronic illnesses and even kept his oxygen tank with him in his pretrial detention cell. The businessman received a harsh sentence — 11 years — and was released from prison on health grounds only after 3.5 years; his wife and accomplices remain behind bars to this day . Except for one former official, who was able to leave the prison system by signing a contract to fight in the war in Ukraine × .

After his release, Spiegel left for Israel. He told Proekt that he still does not admit to the charges. The former senator was accused of accepting not only monetary bribes but also those in kind — he provided the governor with a car from the “Biotech” fleet and gave him a watch as a birthday present. Spiegel doesn’t deny the watch: “They never found the money. But the watch?! Am I not allowed to give him a watch? He gave me an antique dinner set for my birthday, and I gave him a watch”.

Technically speaking, even this single incident could be interpreted as bribery (the case involved a Breguet chronograph, which can cost up to several tens of thousands of dollars). But Spiegel’s ties to Penza officials were, of course, far closer and more informal than the gifted watch. A political strategist who worked for Spiegel puts it simply: “It was literally his region; he could do whatever he wanted there”.

Our source at “Biotech” says that someone even more influential than Spiegel himself was behind the attack. “Look at who ended up with this business after he was jailed”, he says . Spiegel himself declined to comment on this version of events. According to him, the immediate trigger for the attack was his refusal to share a cut of the profits from state tenders he had won with his protectors in the Ministry of Internal Affairs × . “Biotech” went bankrupt, and its main creditor became the company’s primary competitor and current market leader in government procurement — the “Pharmstandard” holding company . “Pharmstandard” had been supplying drugs to “Biotech” for many years and, by the time the group collapsed, had accumulated more than RUB 600 million in accounts receivable. Even after the Spiegel family’s problems began, the debt was not collected immediately; instead, it was restructured and secured with a valuable asset — as collateral, “Pharmstandard” received the controlling stake in the Penza-based pharmacy chain “Pharmatsia”, which belonged to Spiegel. At that time, “Pharmatsia” had a large retail market, a portfolio of government contracts worth RUB 1.8 billion, and real estate valued at RUB 1 billion × .

“Pharmstandard” and its owner Viktor Kharitonin are perhaps the best example of just how interconnected everything is in the Russian pharmaceutical market. Ironically, a former government official familiar with the players in the market describes Kharitonin using the same phrase he used to describe Repik: “A very smart guy”.

Unlike Repik, Kharitonin didn’t enter the pharmaceutical industry right away. In the late 1990s, he managed investments on behalf of billionaire Roman Abramovich. In 2003, Abramovich and his partners acquired the Russian operations of the American company ICN Pharmaceuticals: five manufacturing plants and a pharmacy chain. “Pharmstandard” grew out of these assets. By that point, Abramovich was already more than just a billionaire. Since 2001, he had served as Governor of Chukotka. In other words, from the very beginning, Kharitonin’s pharmaceutical empire was built on a combination of money and power. “Pharmstandard” really took off in the 2000s, and not because of its medicines at all: we’re talking about “Arbidol”, a drug with no proven therapeutic properties, yet one that became one of the most popular anti-flu remedies in Russia. And here, once again, the state stepped in to help. In 2009, during the swine flu epidemic, the government designated “Pharmstandard” as the sole supplier of “Arbidol” for the federal reserve. The health minister who lobbied for this procurement at the time was Tatyana Golikova, a close acquaintance of Kharitonin. As a result, sales of the drug doubled that year and brought the company RUB 5.5 billion in revenue , as reported by “Kommersant” × .

A similar story unfolded with “Velcade”, a genuine and expensive drug from Johnson & Johnson intended for the treatment of multiple myeloma. “Pharmstandard” is the main distributor of “Velcade” in Russia. In 2009, the Russian company “Pharm-Sintez” registered the first domestic generic version of “Velcade” — “Milanfor”. Just a month later, however, Golikova initiated the revocation of “Milanfor’s” registration. “Pharm-Sintez” attempted to fight this in court, but in the end, their drug never made it to market. Golikova still serves as the deputy prime minister in charge of the healthcare sector. Her stepson Vladimir Khristenko worked for Kharitonin as a manager and later became a co-founder of the pharmaceutical company “Nanolek”, which received massive state investments and is now also controlled by “Pharmstandard”.

Broadly speaking, it is Repik and Kharitonin who currently control the lion’s share of the government drug procurement market in Russia. They are the ultimate beneficiaries of the bonus system.

In 2025, “R-Pharm” and “Pharmstandard” supplied the government with cancer drugs worth RUB 52.8 billion , according to Cursor × . This amount alone sounds very impressive. But if we take into account several major companies within the top 10 suppliers to the state segment alone, “Pharmstandard” effectively controls “Nanolek”, “Biokad”, and “Medipal-Onco”, and the major distributor “Lancet” has historically been linked to “R-Pharm”; the total volume of state contracts for these four companies is estimated at approximately RUB 120 billion × and the hundreds of small secondary distributors they effectively control in the regions, their actual market reach is several times greater.

* * *

Paradoxically, the purchase price for most complex anticancer drugs in Russia remains lower than in the developed world, even given the level of kickbacks factored into the cost of these drugs for the Russian budget. For example, the price of Pfizer’s “Itulsi” (palbociclib) — the drug Olga Lender had been fighting to have prescribed — is RUB 66,700 (approximately EUR 700) per package of 21 capsules. The same drug costs EUR 1,800 in Germany. “Itulsi” costs about the same in other European countries, with a difference of a couple hundred euros , as a research group led by the Netherlands Cancer Institute established by comparing the procurement pricing of cancer drugs in 23 hospitals across nine European countries for 2022 × .

Our interviewee is convinced that banning or drastically reducing these bonuses would benefit everyone.