Medications market in Bulgaria has lately been like a Hollywood action movie in which the state, pharmacists, hospitals, manufacturers and retailers shoot a huge amount of bullets to defend their interests. As a result of a sudden (and unnecessary) legislative chaos nobody, not even the most respected healthcare experts, haven’t got a clue whether the drugs in the country are dropping in price or it their prices jumped irreversibly. All institutions involved in the drug pricing policy compete to present quite contradictory signals causing incurable with any pills headache.
For example, if one trusts the words of the President of the National Council on prices and reimbursement – Prof. Tatiana Benisheva, it turns out that Bulgaria holds the world record for 840 drug prices reduced only within a year.
Prime Minister Oresharski obviously does not accept these statistics at face value, otherwise he would hardly have offered a dramatic package for optimization of the drug policies. They aim to hit hospitals that have generously spent public funds of the healthcare fund, as well as doctors to whom the corporate interest is above the health of their patients. In this context, the Deputy Prime Minister Daniela Bobeva hinted that she is considering the introduction of electronic auctions for drugs. In a European context, however such tricks with the reference prices risk to achieve the opposite effect and anger major manufacturers. They may pull products from the country’s small market, because they can not afford to lose billions in sales in Germany or the UK.
Same detrimental market effects –
deficiency of certain drugs –
as well as protesting and affected patients can be achieved through the kind intervention by the Ministry of Healthcare. It has prepared a new tariff for license fees collected under the Law on Medicinal Products in Human Medicine. If it is adopted, the most common and used drugs that are available for free sale will probably appreciate dramatically. These are soothing pills, influenza and anti-inflammatory pills and preparations which have been kept at the lowest price. The key and most frequently occurring word in the edited document is „increase“. It affects the rates for registration of new drugs that jump to between 500 and 4000 levs. Annual maintenance license fee is proposed to be at 1000 levs instead of the current 250 levs. The rates of assessment of documentation do go up, providing that the one for carrying out clinical trials will be almost doubled. Manufacturers will pay more for inspections to which they are subject, and for all sorts of services related to the pricing and reimbursement of their products. And last but not least, pharmaceutical companies will now pay for training materials for drug safety and to direct advertising messages to healthcare professionals.
According to calculations by Bulgarian Generic Pharmaceutical Association (BGPharmA) under those tariffs the largest domestic manufacturers will be forced
to set aside between 2 and 3 million levs from their budgets
annually on fees. Logically, this will lead to no small price increases of medications. Apart from the most popular cheap drugs, the most seriously affected will be the cures for rare diseases having negligible market turnover. Another possible scenario for manufacturers is to cut jobs. The Bulgarian pharmaceutical companies today employ about10,000 people. The association, whose members are Sopharma, Actavis, Pharmachim Holding, Antibiotic of Razgrad, Balkanpharma, Teva Pharmaceuticals, and other large companies expressed bewilderment from the fact why the government expressed intent to create favorable business environment, while in the same time is increasing the administrative and financial burden on pharmaceutical manufacturers.
The BANKER
