June 30, 2009, Sofia. The Association of Research-based Pharmaceutical Manufacturers in Bulgaria (ARPharM) conducted a series of pre-election meetings with representatives of the main political parties.

The meetings took place following official letters sent by ARPharM last week for   meetings between the chairpersons of the pre-election headquarters, the political representatives of the parties, engaged in Healthcare, and the managing board of the Association. At the meetings, the Association tabled the main challenges regarding pharmaceutical policy in Bulgaria and the political debate on it. In the present political campaign, healthcare is one of the main topics of political discussion. This is conditioned by the fact that the problems connected to the confidence in the healthcare system of Bulgarian citizens, continues to be among the leading problems coming up in all sociological researches. There are 3 myths that have to be dethroned  so that the pharmaceutical policy could achieve positive and efficient results and provide better access to medicines  for patients in Bulgaria . The promises of politicians to people must reflect in a real way the current status because populism is damaging to both sides. During the meetings, people from the Association gave as an example the following statements, which have to be carefully reviewed by the government, both the future and the current one:

Prices of medicines are too high

Manufacturer’s prices of medicines in Bulgaria are regulated by a special commission which watches that they are not higher than the lowest price in 8 countries in Europe. The entire information is published in the Internet and the process is absolutely transparent. Thus, it is guaranteed that the medicines in our country, on the level of manufacturing, are the cheapest in all Europe and everyone can make sure of this by visiting the Internet web site of Ministry of Health. According to a research of Eurostat, Bulgaria is among the five countries that have the lowest prices of medicines in Europe, despite the high VAT tax.

The cases in which a particular medicine has a higher price in Bulgaria than in Romania or Greece, is mostly due to the fact that, after registering the lowest price of manufacturer, the commission adds 20% of VAT. And in the 8 referent-countries, the commissions add 0% to 9%.

The registration of the lowest production price already has the opposite effect as it leads to withdrawal of drugs from Bulgaria or it turns the exception into a rule for entire groups of medicines and thus forces patients to pay more for drugs out of their own pocket.In Bulgaria both public and out-of-pocket expenditure on pharmaceuticals is high 

The total expenditure on pharmaceuticals for the year 2008 in Bulgaria – both public and out-of-pocket – amounts to 1.6 billion Bulgarian leva, or in other words – BGN 208.00 per capita. For the same year, Bulgarians have smoked cigarettes for the sum of 2.1 milliard Bulgarian leva, or BGN 273.00 per capita. In comparison, in other countries like Greece for example, people who live 5 to 8 years more than Bulgarians, have taken medicines in the year 2008 for the sum of 11 billion Bulgarian leva, which bearing in mind the population of 10.7 million  people  in Greece, means BGN 1028.00 per capita. This is four times more than Bulgaria! The expenses of Bulgarians for medicines will continue to rise because the nation is ageing, morbidity rate is rising, and more and more efficient medicines are discovered. The faster the governing power accepts this truth, the more successful will their governing be. Their task is to control the growth, to distribute expenses to diseases of higher priority; but if now there are promises that expenses shall be decreased, this just means that patients will pay for their drugs by themselves in the future, without any help by the state. The state spends too much money to help ailing people get medicines

The truth is exactly the opposite – the state spends extremely low amount of money for medicines. For the year 2008, 1.6 billion Bulgarian leva have been spent in Bulgaria for medicines, out of which the state has paid BGN 540 million, or only 34%. The remaining 66% have been paid by patients themselves. Again, to compare with Greece – out of these BGN 11 billion, the state has covered BGN 10 billion, or more than 90%. The health budget in Bulgaria for the year 2008 is nearly BGN 3 billion. The expenses of the state for medicines are BGN 540 million, or 18%. In the entire Eastern Europe, states spend from 20% to 25% for medicines. Less money for drugs in the state budget means more patients in hospitals where treatment is timer more expensive than if they are at home. 

If the next government accepts this truth, they can reach very good results – increase in the public resources for drugs, direction of these resources to priority areas as for example socially significant diseases, child healthcare, immunizations and prevention, and indeed to significantly help Bulgarian patients receive modern pharmaceutical treatment. The solution of all of these matters depends also on the limitation of overregulation on the prices of drugs and introduction of clear priorities for medicinal policy and concrete measures for their implementation.The representatives of ARPharM discussed these matters with the representatives of the main political powers in accordance with the pre-election campaigns of the parties. The Association hopes that this will lead to future activities which will optimize the distribution of public resources for health and will ensure that patients shall receive the necessary help on part of the state when they need pharmaceutical treatment.