In January 2005 the Programme for Supplementary Pharmaceutical Provision (DLO) was implemented in the Russian Federation, enabling, for the first time, uniform, free access to medicines to the most vulnerable social groups in need of extensive pharmaceutical care due to poor health status or disability (federal eligibles). Attitudes towards the programme show increasing levels of satisfaction; utilisation of needed medicines has increased several-fold, particularly in under-provided regions and predominantly for expensive medications, including those for cancer, mental illness, haematology and cardiovascular disease. In order to ensure financial sustainability, further reforms will be implemented aiming at improving efficiency and cost-effectiveness, whilst maintaining quality and equity.