Proposal for a rational drug policy

This article is a summary of our new analysis and proposal for drug policy reform in Bulgaria.

What did we find out?

• The analysis covers 56% of health-insured persons and 40% of the funds reimbursed by the NHIF and includes 4 groups of diseases: cardiovascular, malignant tumors, diabetes mellitus and rheumatoid.
• In 2016 , over 2.5 million health insured persons were treated with original medicines, for which the NHIF paid over BGN 535 million or BGN 208 per person. At the same time, nearly 3.9 million health insured persons were treated with generic medicines, for which the NHIF paid nearly BGN 97 million or BGN 25 per person. The data shows that treatment with original medicines covers 1.5 times fewer patients, but costs 5.5 times more.
• In malignant tumors:
  • As a result of generic entry and use, there has been a decrease in the costs of treatment per health insured person from BGN 664.61 in 2014 to BGN 541.28 in 2016, or a decrease of 18.6%.
  • Where treatment is entirely with generic medicinal products, the costs per insured person decreased from BGN 425.70 in 2014 to BGN 193.09 in 2016, which is a decrease of nearly 55%. At the same time, the costs of treatment with original medicinal products increased from BGN 912.97 per insured person to BGN 968.38 in 2016, or an increase of 6%.
  • The NHIF was able to save over 2.2 million BGN, or a saving of over 38% of the funds for the treatment of these diseases, as a result of an increase in the number of health insured persons treated with generic medicinal products.
  • With the saved funds, it is possible to increase the coverage of health insured persons by over 7,900 people, which is an increase of 53% compared to the persons treated in 2016.
• In diabetic diseases:
  • The results of the study of the five groups of drugs with a generic equivalent for the treatment of diabetic diseases show that in 2016 alone, the NHIF was able to save nearly 2.7 million BGN, or a saving of about 33.5% of the funds for the treatment of these diseases.
  • With the saved funds, it is possible to increase the coverage of health insured persons by over 66,400 people for the same group, which is an increase of 54.3% compared to the persons treated in 2016.

  What did we conclude?

• Implementing a progeneric policy even in the 11 drug groups considered could lead to savings of about BGN 5 million in 2016, which represents about 22% of the reimbursed funds for these drug groups.
• If the policy is replicated on other groups of drugs with an available generic equivalent, the potential for savings is significant. These savings should be used to expand access to pharmaceutical care for health-insured persons, as well as to limit the growth of citizens' spending on it by increasing the reimbursement percentage.
• Particular attention should be paid to access to medical care for cardiovascular diseases. They are one of the leading causes of both mortality in the country and preventable mortality in Bulgaria. Preventable mortality in Bulgaria in 2014 was at a level of 289 per 100,000 population compared to an average level for the EU of 126 per 100,000 population.
• The average reimbursement rate for cardiovascular and cerebrovascular drugs is around 33%, with the remainder paid by patients. A further aggravating factor is that actual reimbursement is even lower, increasing the financial burden on patients.

What do we recommend?

In connection with the estimates and calculations made, the recommendations that can be made to institutions with the aim of optimizing the costs of the NHIF and those of households are the following:

• Conducting a broad information campaign by the Ministry of Health and its affiliated institutions on the benefits of using generic medications among the population, medical specialists and pharmacists.
• Gradual increase in the reimbursement rate for medicinal products related to the treatment of diseases of the circulatory system (cardiovascular and cerebrovascular).
• Prohibition on transferring funds from medicinal products for home treatment to other items in the LBZHIK with the aim of solidary and year-round access to medicines for all patients in Bulgaria.
• Ensuring appropriate competitive, administrative and regulatory conditions to prevent shortages of medicines for common diseases and life-saving medications.
• Reform of the price-referencing mechanism to ensure access to mass therapies and life-saving medications.
• Introduction of electronic prescription by the end of 2019 for the purpose of timely analysis of the pharmaceutical market and monitoring compliance with Art. 92, item 4 of the Health Act, namely: The treating physician is obliged to inform the patient about diagnostic and therapeutic alternatives.

| Full text of the analysis |

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