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Reimbursement Mechanism in Bulgaria

Nikoleta Grigorova. Reimbursement Mechanism in Bulgaria. The perfect storm is everywhere. Changing environment. Heavy administration. Delayed Access. Patients. Lack of Transparency. Low awareness. Low budgets/ High copayment. The perfect storm – BG edition!.

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Reimbursement Mechanism in Bulgaria

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  1. Nikoleta Grigorova Reimbursement Mechanism in Bulgaria

  2. The perfect storm is everywhere Changing environment Heavy administration Delayed Access Patients Lack of Transparency Low awareness Low budgets/ High copayment

  3. The perfect storm – BG edition! • fragmented in separated organizations and diseases; • making spontaneous actions preceding the dialog with the institutions; • ignorance of the legislation; • lack of national representation (necessary for inclusion in the decision making).

  4. The perfect storm – BG edition! • In the 2004 year, the first patient’s umbrella “Confederation of Health Protection” was created; • In the year 2010 the new Government administration confirms the national representation; • All members of the Confederation were involved in the process of reimbursement; • Adoption of new reimbursement regulation was made for new position of PA with new controlling function, for to being legal.

  5. Reimbursement process Step 4 230 – 620 days Pricing & Reimbursement 60-90 days Reimbursement list NHIF Step 3 120-480 days Positive Drug List (PDL) PDLC /Council of Ministers (CM) Step 2 • NHIF Commissions + experts – physicians • Percentage based reimbursement • New reimbursement criteria for the first time stipulated in • Regulation 50 days Price-MoH Step 1 • Drugs covered by public funding (NHIF, MOH, hospitals) • Prepared by PDL Commission – MOH, CM • Appeal procedure at MOH • Adopted with ordinance of the Council of Ministers 210 days MA Drug Agency • Lowest price in • the Council of Europe

  6. Institutions involved in reimbursement MoH – the national health policy maker Priorities in expensive drugs for oncology and hemodialysis The solely European country, which makes not only general health policy, but lead tenders for expensive drugs Working on the Positive Drug List Committee NHIF – monopolistic payer in the primary care Heavy administration of reimbursement Monopolist on the market Constant budget deficit, no effective controlling mechanism Current problems with the hospital funding Reimbursement in %

  7. Institutions involved in reimbursement

  8. NGOs Member of Coalition in the controlling Board of NHIF (Association of Bulgarians with Bronchial Asthma) Member of Coalition in the Transparency Commission (supervise the decisions of the Positive Drug list) Member of Coalition in Audit Committee to Regulation 34 to the Ministry of health Member of Coalition - observer to the weekly sessions of the Health Committee to the Parliament Member of CHP in Audit Committee to Regulation for expensive drugs to the Ministry of health

  9. Copayment in % of “patient’s pocket” for drugs in relation with reimbursedones in EU

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