Commission opens infringement procedures against Bulgaria over medicine tenders [Advocacy Lab Content]

The European Commission has opened infringement procedures against Bulgaria for the long-term violation of internal market rules and illegal procedures allowing private hospitals to avoid tendering for medicines.

The Commission has given Bulgaria two months to amend the legislation, which excludes private hospitals from EU public procurement rules, even when they are partially financed with public funds.

If Bulgaria does not meet the deadline, the Commission has the right to bring a case to the Court of Justice of the EU, which could lead to fines for the poorest country in the bloc.

Meeting the deadlines may prove difficult since Bulgaria is not expected to have a normally functioning parliament in the next two months due to an ongoing political crisis.

“The European Commission has every reason to initiate an infringement procedure. Ultimately, the National Health Fund will pay for the drugs, and our taxes will be used to pay fines. This is the reality of a captured state,” said Dr Alexander Simidchiev, (Democratic Bulgaria, EPP) a Parliamentary Committee on Health member.

Bulgaria’s different tender speeds

Even though Sofia agreed in its 2022 correspondence with the European Commission to change its legislation, no significant action was taken.

Moreover, in October 2023, the Bulgarian parliament allowed private hospitals not to conduct public procurement for drugs and consumables, even though they are financed with public money from the National Health Insurance Fund.

In February 2024, the parliament tried to soften the rules and introduced price thresholds for the purchase of drugs from private hospitals to avoid a negative reaction in Brussels, but again failed to introduce mandatory drug tenders for private hospitals.

As Dr Simidchiev told Euractiv, the National Health Fund has been controlled by the players involved through “procedural grips”, and a group of political parties have imposed control over state money for health care.

“The solution is to have mutual control by independent experts and clear rules. because otherwise, it is not clear how the hospitals spend the money,” remarked Simidchiev, a practising pulmonologist at a state hospital.

He said that some private hospitals use subcontractors and manage to avoid conducting public procurement, hence the uneven distribution of the Health Fund resources.

Decade-old “thorn”

For a decade, the NHF paid different prices to public and private hospitals for the same medicines used for the treatment of oncological diseases.

In some cases, private hospitals pay up to ten times more for the same drugs than public hospitals, and in both cases, the cost is reimbursed by the NHF.

State hospitals are obligated to uphold public procurement processes for the purchase of medicines. In contrast, private hospitals can purchase them after direct negotiation with traders, who, in some cases, are related to them.

These rules led to a public scandal four years ago when the former manager of the National Health Insurance Institution, Decho Dechev, announced that private hospitals paid eight times more than state ones for the same cancer drug (Pemetrexed), with the price varying between €65 and €530.

The latest data from the Ministry of Finance shows that the Bulgarian NHF has paid over €1.1 billion to buy drugs from the country’s hospitals, with 37% of this money given to private hospitals. The European Commission opened legal proceedings against Bulgaria for the January 2019 drug tenders.

The Ministry of Health and the Chairman of the Parliamentary Committee on Health, Kostadin Angelov (GERB, EPP), refused to comment to Euractiv.

[By Krassen Nikolov, Antonia Kotseva, Edited by Vasiliki Angouridi, Brian Maguire

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