Bulgaria agrees to pay pharmacists higher fees, avoiding protest threat [Advocacy Lab Content]

The Bulgarian government has averted large-scale pharmacy protests, agreeing to pay higher fees to pharmacies supplying patients with free medicines. Protests were threatened over government plans to cut already low fees.

Some pharmacies in big cities even started warning protests, stopping work for two hours a day. This forced the state to enter into emergency negotiations with the pharmacy associations and quickly reached an agreement to increase the fees.

“We are satisfied with the agreement. This guarantees sustainability and predictability of the funds of the health insurance fund,” said Dimitar Marinov, chairman of the trade union of pharmacists.

However, pharmacies are still waiting to see if the agreement reached will be implemented by the state health fund.

Pharmacists react to fee cuts

Last week, Bulgarian pharmacists announced protests following the government’s decision to reduce fees allocated to pharmacies for filling prescriptions of state-funded medicine.

The state fee covers order costs from pharmaceutical warehouses, staff salaries, accounting and other expenses. Pharmacies claim that this amount is already insufficient, and a new reduction will lead to a severe crisis in the sector.

Dimitrina Staykova from the Bulgarian Pharmaceutical Union told Euractiv that many pharmacies would be threatened with bankruptcy if the government did not abandon its plans. She warned that tensions could escalate, making it difficult for patients to access vital medicines.

Free medicines

Currently, the Bulgarian government pays pharmacies between 2.5 and three euros to fill a prescription with a maximum of three drugs financed by the state’s National Health Insurance Fund.

Tensions were triggered by the government’s initial decision to make 1,400 prescription drugs available without cost to the patients, starting last April.

Most are relatively inexpensive medicines for the prevention of cardiovascular diseases, especially for blood pressure control. However, this increased the expenditure of the state not only for the medication but also for the fees paid to pharmacies to supply patients with free drugs.

“When these drugs are free, the pharmacy is deprived of the possibility to make a surcharge and of its economic meaning of existence”, pharmacists explained to Euractiv.

Reduced surcharge

In June, the Health Ministry announced it wanted to reduce its fee costs by repealing the single payment for single prescriptions. Instead, the state announced that it would pay between 2.5 and three euros for all drugs per patient per month.

Pharmacies strongly protested the decision, stating that this funding was not enough to cover the cost of providing these drugs.

“Some patients need very expensive drugs that cost between 5,000 and 15,000 euros per month. The pharmacy pays them in advance to order them, the pharmacist deals with all the bureaucracy, and the drugs are sold without profit.”

“And finally, the state pays the pharmacy a 2.5 to three euro fee for providing the medicine, which costs 15,000 euros,” Staykova told Euractiv, adding that “Sometimes there is a risk of errors in the documents, and the amount of 15,000 euros is not even reimbursed.”

As she explains, the 2.5 euro fee itself is then taxed by the state with 20% VAT, although Bulgarian law exempts medical activities from the tax.

Risk of bankruptcies

According to the statistics provided to Euractiv by the Bulgarian Pharmaceutical Union, about 75% of pharmacies in small towns’ financial resources are generated by the fees paid by the state for supplying patients with free medicines.

The reduction in fees puts them at risk of bankruptcy because they are unable to recoup their costs by selling nutritional supplements and beauty products like pharmacies in big cities.

The bankruptcy of more pharmacies in small towns will deepen the problems in Bulgarian healthcare. In March 2024, the Ministry of Health announced an initiative to install vending machines for medicines in small towns, but they cannot solve all the problems of not having enough pharmacies. Vending machines cannot sell prescription drugs.

“Pharmacies in Bulgaria are deprived of economic logic to exist because they cannot put a premium on a huge part of the products they sell. We have a dignified right to exist. The state fee should be calculated according to the value of the drugs,” Dimitrina Staykova added.

Higher fees

After one week of high tensions, the government agreed to pay pharmacies a fee of 15% of the value of the reimbursed medicine, but the fee cannot exceed 13 euros.

This is a significant increase over current fees but will significantly increase the cost of the state budget, which is due to be updated before the end of the year.

[By Krassen Nikolov, Edited by Vasiliki Angouridi, Brian Maguire | Euractiv’s Advocacy Lab]

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