This report presents a review of currentissues in the pharmaceutical sector in Bulgaria, examiningdrug policy, regulation, pricing, formulary selection,distribution, expenditure, and to the extent possible,patterns of use in Bulgaria. Its recommendations areintended to serve as options for reform, by articulatingshort and long term strategies for managing pharmaceuticalexpenditure, improving system sustainability, and drivingvalue for money in Bulgaria, thereby improving efficiency,equity, affordability and ultimately, access to prescriptionmedicines. Although small, the Bulgarian pharmaceuticalmarket is showing strong growth. Medicines comprise not onlya disproportionate share of health care expenditure (38percent of total health expenditure, compared with an EUaverage of around 25 percent), the burden of out of pocket(OOP) costs is also excessive, possibly as high as 81percent of total pharmaceutical expenditure. Of perhapsgreatest concern is that rapid expenditure growth is takingplace without obvious improvements in health outcomes, andat the expense of population equity. Bulgaria does not yethave an integrated national medicines policy, and thepharmaceutical sector is characterized by various highlyprescriptive and at times, arguably inconsistent policylevers. While the regulatory framework has been largelybrought into line with current EU standards, existingmechanisms for listing, pricing and subsidizing medicinesare not ensuring adequate value for money for the NationalHealth Insurance Fund (NHIF), and are contributing toinefficiencies in the health sector. Current pharmaceuticalpolicy settings appear focused on limiting NHIF outlaysrather than prioritizing access and affordability, andafford little financial protection to patients.
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