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According to Minister Moskov, when one has a facility in the big city where people have assets, one has to take responsibility for the system as well. According to the guild, the solution is to permit subsidiaries

Administratively forcible is the method imposed by the state that out of the 4 pharmacies, which an owner is entitled to have, one necessarily has to be located in a small village, the second one – to work round the clock and the other two – whatever the owner considers.

This is what was stated by Nikolay Kostov, chairman of the Association of Pharmacies Owners, in connection with the forthcoming reforms in the Drug Law by the Health Minister Dr. Petar Moskov, which would be the next one to be “repaired”. Kostov predicted that if the idea was implemented, the owners would go around it. For example, a natural or legal person would open up to 2 pharmacies in the cities wherever they decide, and this way the requirement for the other two would be avoided.

The Minister launched his proposal in February this year and then he said:” when one opens a pharmacy in the big city where people have assets, and it is effective, one has to take responsibility for the system, even if this is not a market method”.”Even during post-socialist times there was no such regulation! The opening of pharmacies is encouraged in small towns everywhere in the EU, but only where this is possible. In some places it is a lost cause,” said Kostov.

According to research, in order for a pharmacy to exist in the EU, there should be at least 1200 inhabitants, while in some places a pharmacy serves 15 000. Another determining factor is overcharge. The more it is “suppressed”, the more patients are needed in order for the facility to not go bankrupt. “In our case, although higher overcharge is permitted, it is usually 10-13 to 14%. Of course, if it is 30%, then the pharmacy can function even in a village with 800 people,” said Kostov. He added that people from smaller places have a different income and consumption than in cities. And if the village has no doctor, it is absurd to open a pharmacy, because no one can prescribe medication. And if the patient goes to a big city to see a doctor, it is logical he would to buy his drugs there as well.

Kostov recalled that years ago the state and the municipalities were allowed to open pharmacies, but they all were privatized, as they had debts. “So the state abdicated from this type of activity, and now wants to move it over to us”, he added. While the idea may seem social, it was “wild populism” that protects only the interests of the occupational group.  According to the Association of Pharmacies Owners a solution would be to allow the pharmacies in major cities to have branches in small villages which would work 1-2 times a week for several hours, and not only with a master pharmacist, but with an assistant pharmacist as well.

Doctors specializing in Medicine will have a right to a contract with the NHIF was decided by the MPs yesterday, when they accepted the amendments to the Law on Medical Institutions. This way they made the promise of the Health Minister Petar Moskov, which he made to the doctors in the campaign “Young Medic”, become a fact.

Specializing doctors currently do not have the right to work with the Fund and this is the reason why hospitals find it difficult to provide the necessary funds to ensure they have good salaries. However, this will change with the changes and clinics will want to recruit young physicians on staff. Furthermore, the MPs adopted the opportunity for emergency doctors to work more flexible shifts, and in the areas where there are no clinics, physicians are required be on duty at least 10 hours a week.

The Health Insurance Fund will finance hospitals only according to the needs of the population

The Health Insurance Fund will not finance all newfound hospitals and will base its decisions on the National Health Card, which will have an obligatory nature. It will list the needs of the regional population. This was the bottom-line decision of the Parliament when adopting the amendments to the Law on Medical Institutions.

GERB listened to the promise of Prime Minister Borisov to provide support for the health reform of Minister Petar Moskov. The most important changes which concern the funding of hospitals will be solved with the regulations and methodologies of the Health Ministry. It will depend on the Health Minister whether the NHIF will refuse hospital contracts and which hospitals will that be, and whether the government and private hospitals will be forced to unite and for what. Currently Bulgaria has twice as many hospital beds as the EU, and according to the statistics, every fourth Bulgarian is hospitalized once a year, and in practice such people are subjected to treatment not necessarily or even needlessly.

The National Health Card will have an obligatory nature. It will describe by districts the population medical attention needs. How treatment needs in specialties and hospitals will be determined will be recorded in the methodology of the Health Ministry. The Fund will not finance all institutions in the regions where there are more hospitals than population needs. The criteria by which the NHIF will decide with whom to form a contract and who will remain without funding, will be described in an ordinance. Minister Moscow claims that hospitals that provide comprehensive treatment and do not focus only on well-funded activities by the NHIF will receive priority funding.

The law provides that the treatment which paid by the NHIF is divided into two packages – Basic and Additional. For the diseases of the Basic package, a comprehensive treatment of which will be provided, the Health Fund will only enter into contracts with hospitals or groups of hospitals that can provide this. Minister Moskov explained that his idea of comprehensive care will be enacted into an ordinance for cancer, the most common cardiovascular diseases and for some rare diseases starting next year. The aim is to have comprehensive care provide for the whole Basic package within the next 3 years.

The proposal of the Health Minister was the care in question to be provided in one place, i.e. either in a hospital or a group of hospitals. But the majority adopted a softer text according to which hospitals will able to enter into contracts with each other to receive funding from the NHIF for complex care, without merging.

The idea is, for example, in cancer patient treatment to have at any stage a guarantee for surgery, chemotherapy and radiotherapy, and not to receive surgical treatment in one hospital, and infusions – in another, where the person arranges the stay by himself. The NHIF would not pay all hospitals for the reported treatment covering 3 clinical pathways, and would enter into a single contract for all the treatment needed in one. That is, either all pathways would be paid for, or none. Hospitals would have to arrive at an understanding whether to group into holding companies or unions under the Trade Act, or to enter into contracts among themselves and decide who would receive how much funding.

The opposition is concerned that if the state, municipal and private hospitals begin to make associations this would lead to siphoning money. But according to Moskov, the idea is that hospitals, dealing only with chemotherapy, for example, would not be able to receive money directly from the Fund, as well as that consolidating would help downsize the administration.

The idea which caused protests in the summer – that oncology, psychiatric and skin outpatient facilities should merge with the other hospitals – was dropped once and for all. Hospital accreditation will be required in order to land a contract with the NHIF, as it is now, and directors of hospitals are still required to have a qualification in Health Management.

What will the packages contain?

By the 15^th of September it should become clear what the Basic package would contain and what the Additional one would contain, said Deputy Health Minister Vanyo Sharkov. The diseases from the Basic package would be the main priority and, according to the promises of Moskov, there would be 100% guaranteed funding for them, while those from the Additional will receive less money than now and the treatment would have to wait. The Basic package would include child and maternal health, strokes, cardiology, cardiac surgery and interventional cardiology, traumatology and neurosurgery. Regarding the Additional package what is clear for the time being is that it would contain the “pimples” in the words of Sharkov – i.e. the non-essential diseases. Most one-day eye surgery would be transferred from hospital to outpatient care. The Basic package was also not defined in a law, and the determining of its contents was left entirely to the Ministry of Health.

For the first time the Republic of Bulgaria, as a Member State of the EU, will be the reference country in the decentralized procedure (DCP) for Marketing Authorisation for a medicinal products with applicant Tchaikapharma High Quality Medicines Inc., Bulgaria. The concerned parties in the procedure are Austria, Greece, Portugal, Romania, Slovakia and the Czech Republic.

As a reference party to the procedure the BDA will assess the dossier for Marketing Authorisation for medicinal products (fixed combination) with active ingredients ramipril and amlodipine. A team of the BDA will prepare evaluation reports, including questions to the applicant at any stage of the procedure. The evaluation will be consistent with the requirements of current Pharmacopoeia (Ph.Eur.), the Guidelines of the International Committee on Harmonization (ICH) and European guidelines on quality, safety and efficacy of medicinal products.

Bulgarian Drug Agency issued a new Marketing Authorisation to Tchaikapharma High Quality Medicines Inc. for the medicinal product for treatment of diabetes mellitus Aroba 100 mg tablets.

Aroba contains the active substance acarbose, and belongs to the group of medicines called alpha-glucosidase inhibitors. It is used as supplement treatment concomitantly with diet in patients with diabetes and for the prevention of type 2 diabetes in patients with demonstrated impaired glucose tolerance. The dosage should be individualized for each patient by the doctor as the efficacy and tolerability vary from individual to individual.

ATC code: A10BF 01

More information about Aroba can be found here.