Medicine Prices Soar: Some Drugs in Bulgaria Have Doubled in Cost

Pharmacists and patients have reported dramatic increases in the prices of certain medicines in recent months. Data indicate that the rises are not isolated incidents. The most notable increases affect medicines dispensed through the National Health Insurance Fund (NHIF). According to industry representatives, the causes are not related to the adoption of the euro but to a lack of control over manufacturer pricing.

The price hikes affect both prescription and over-the-counter medicines.

Milcho Bagashki said: “For my blood pressure medication… I used to pay 20–21 leva, now it’s 34–35 leva this month. I take medicines for blood pressure, heart, and diabetes, so the difference is huge.”

Konstantin Kachulev, Chair of the Regional Pharmaceutical Association in Blagoevgrad, added: “There are striking cases where the price of a medicine has doubled or even tripled. We’re talking about medicines that used to cost 5–10 leva, now around 20–25 leva.”

The increase is felt most acutely for medicines partially reimbursed by the NHIF, where patients must cover the remainder.

Kachulev explained: “For example, if a medicine costs 12 leva and the fund pays 10 leva, the patient previously paid 2 leva. If the manufacturer raises the price, and wholesalers and retailers adjust accordingly, the price can reach 25 leva. The fund still pays 10 leva, but the patient now pays 15 leva.”

The Medicines Agency clarified that over-the-counter medicines do not have state-set prices. Manufacturers propose the price, which the state registers but does not fix it.

Konstantin Kachulev, Chair of the Regional Pharmaceutical Association in Blagoevgrad, explained: “We compare prices to see whether the legally permitted markup has been applied and whether it is exceeded, but there is no control over how much the manufacturer actually spends to produce the medicine.”

To determine the reimbursement value of medicines covered by the National Health Insurance Fund, the state compares prices with those in ten other countries and selects the lowest. Nevertheless, many patients are now prioritising essential medications, buying only what is most important for their health.

Stoycho Georgiev said: “90–100 leva for medicines… Very expensive, and it doesn’t even last a month – just 20 pills, taken twice daily. People have to think about substitutes because it’s unaffordable.”

Kachulev added: “Yesterday, a patient returned. He didn’t have enough money. Out of a prescription for three medicines, he chose to buy only the antibiotic. That’s the right decision; it’s the most important medicine.”

To protect citizens from sudden price surges, the Ministry of Health introduced a restriction this year. Companies can request a price increase no earlier than one year after the last approval, and even then the rise is strictly limited—either to the official inflation rate or to the lowest price of the same medicine in reference countries.