Significant disparities in the prices paid for medicines used to treat children with rare diseases have been uncovered in Bulgaria, following an inspection by the Ministry of Health in seven state hospitals.
In one case, a hospital in the capital, Sofia, purchased a medicine for 517 leva, while a hospital in Plovdiv paid 8,500 leva for the same product.
The medicines in question are not reimbursed by the National Health Insurance Fund and are ordered individually for specific patients by hospitals, with costs covered by the state budget. According to the ministry, more than 143 million leva were spent last year on medicines for children with rare diseases that are not covered by public health insurance.
Deputy Health Minister Vladimir Afenliev said that over 50% of the expenditure relates to these high-cost, unregistered medicines, warning of a significant lack of transparency in how the funds are spent.
He noted that it is currently not possible to track how much is paid for a specific medicine for a specific patient. “It appears that the procedure for purchasing medicinal products is being followed,” he added.
The medicines were ordered by seven state hospitals — four in Sofia, and one each in Plovdiv, Varna and Pleven.
Deputy Health Minister Vladimir Afenliev said: “Medicinal product A was purchased by one hospital for 46,424.70 leva, while another acquired it for 150,402 leva. We are talking about exactly the same medicine — identical trade name, packaging and concentration.”
Two state hospitals and a medical facility in Plovdiv have purchased the same medicine at vastly different prices.
In another of the most striking cases, Afenliev noted: “A medication bought in Sofia for 517 leva was purchased in Plovdiv for 8,500 leva. It appears that the procedure has been followed, and the procurement of the medicinal products seems to be lawful.”
An audit has been ordered in the seven hospitals.
Deputy Health Minister Vladimir Afenliev said: “The Ministry of Health is not an investigative body, but if the audits reveal such data and indications, there are other competent authorities.”
The ministry will propose legislative amendments to regulate the prices of unregistered medicines. Hospital pharmacies are expected to report them through the National Health Information System.
The caretaker Health Minister also said in an interview for “The Day Begins” that he supports the Bulgarian Medical Association’s request for a 25% increase in the prices of medical services.
Mikhail Okoliyiski, caretaker Health Minister, said: “We see that prices are increasing, medical devices, in general all activities in the healthcare sector are increasing in cost, so this should be updated at the earliest appropriate moment.”
The Ministry of Finance stated that under the current extended budget law, such an update is not possible.
Stanislav Mikhailov, Deputy Finance Minister and Chair of the National Health Insurance Fund Supervisory Board, said: “Immediately after the elections, we expect a regular government to be formed and a budget procedure to begin. At the end of that budget process, the NHIF supervisory board will be able to sit down and negotiate with the Medical Association.”
The deputy minister added that healthcare funding is increasing, but stressed the need for more efficient use of resources.
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