Patient access to antirheumatic medicinal products

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The analysis examines the challenges of access to medicines for the treatment of rheumatic diseases and their associated socio-economic consequences in Bulgaria. Based on data on the number of health insured persons, the costs of outpatient and clinical procedures, as well as the number of lost working days, we highlight the significant health and economic losses that these diseases impose on society and the economy. Between 2020 and 2023, a significant increase in the number of clinical procedures and clinical pathways for patients with rheumatic diseases was reported, highlighting the increasing burden on the healthcare system.

Among the main conclusions are the insufficient access to therapy, the complicated administrative procedures and the financial burden on patients. A survey among patients conducted by the Association of Patients Active in Healthcare shows that a significant part of them face serious financial difficulties related to the costs of visits to medical committees and the need to pay extra for medicines and examinations. The average annual personal expenditure per patient amounts to about 1000 leva, and the amount can increase significantly if medical devices are needed. These out-of-pocket payments are particularly burdensome for low-income patients, who often do not have sufficient funds to cover their needs.

The need for more effective policies to optimize the patient's path to treatment and reduce the financial burden on the health system and society is highlighted. Recommendations include regularly updating the Positive Medicines List, improving reimbursement for innovative therapies and simplifying administrative procedures for access to treatment. These measures would reduce financial losses related to work absences and improve the quality of life of patients.

It also emphasizes the differences in access to healthcare services in different regions of Bulgaria and calls for better support for patients with rheumatic diseases, through joint efforts by healthcare institutions, public organizations and the state.

Here are some of the conclusions:

• In 2023, lost working days due to rheumatic diseases amounted to about 89,000, leading to direct economic losses of about 65 million leva for state insurance and the economy.
• The average weighted personal cost per patient is nearly 1,000 BGN per year, plus over 3,500 BGN in case of need for a medical device.
• In 2023, the number of health insured persons who use drug therapy for the treatment of rheumatic diseases partially paid for by the NHIF amounts to approximately 18 thousand patients, which is an increase of about 30% compared to 2020. In addition, pharmaceutical companies pay the difference of BGN 33 million to the final price so that the product can be "free" for the patient.
• There is an urgent need for easier access to therapy, which in other countries is prescribed by any doctor with an acquired specialty.

Read the full analysis at this link.

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