BACKGROUND: In Russia all drugs for state medical organisations and programs are purchased through public tenders in order to enhance competition, decrease price and prevent corruption. Drugs for rare diseases (DRD) are often produced by the only manufacturer thus being monopolistic. There is lack of information about the effectiveness of tender procedures for DRD in real life.  OBJECTIVES: To assess the competition in public procurement of DRD and effectiveness of tender procedures.  METHODS: The analysis was conducted on the basis of 1499 selected trade procedures on DRD procurement in 2013. We evaluated the proportion of procedures that have passed with the only one participant, the level of price reduction resulted from trading, the amount and volume of purchases of DRD in the subjects of the Russian Federation. Data on drug procurement procedures were obtained from the official website of state purchases www.zakupki.gov.ru. Data collection and processing were performed using the program Microsoft EXCEL and Statistica 6.1. RESULTS: Total amount of spending for DRD in 2013 was €192.23 million, with declared procedures on €197.93 million. Competition was absent in 592 (74.47%) procedures of monopolistic drugs procurement. 75% of tenders were performed without reducing the price. There were €5.69 million savings generated by purchases (3% of the amount of declared procedures).  CONCLUSIONS: Tender procedures used for the procurement of monopoly drugs are ineffective because of the lack of competition; distributors are not interested in price reduction at noncompetitive procedures.