News and Media

The NHIF will pay 100% the covered medicines not to the pharmacies but to the producer
The general practitioners, who treat patients in remote areas of Bulgaria, will be allowed to sell medicinal products to patients – irrespective of whether the medicines are prescription or not.

This is foreseen in the amendments that the parliamentary health committee will begin to consider, announced its chairman Gen. Stoyan Tonev. The idea is the planned reforms in medicinal policy to take effect from April.

Currently many Rhodopean villages or areas in northwestern and northeastern Bulgaria have no pharmacies for tens of kilometers, so patients manage as they can – either someone goes to the city and fulfills the prescriptions for the sick or each seeks relatives and neighbors for help. “Since many years in Switzerland the general practitioners sell medicines” said General Tonev. And from the NHIF reminded that in Germany this practice was introduces in the eighties of the last century.

The remote GPs practices here are around 400, and in some cases the family doctor is responsible for 400 people, in other – for 800 or more. That is, the change in legislature will relieve hundreds of thousands of sick Bulgarians who live in the mountains, at the borders or in the hamlets far from pharmacies.

“With a new text in the Law on Health Insurance we consider to return back the model in place until 2008, according to which health fund paid 100% of covered medicines not to pharmacies, as it is now, but to their manufacturers or distributors”, said General Tonev.

He explained that the idea is, skipping the surplus charges, the NHIF to realize at least 7-12% savings on the annual amount for medicines, and in the best case – 25%. This year, the Health Insurance Fund will provide nearly BGN 720 million for medicines for home treatment and for cancer medicines. That is, if the amendment becomes fact, the Fund will pay between BGN 50.5 million and BGN 180 million less for entirely free medicines. We are talking about 217 medicines from over 2000 which are in the positive list.

About half a million Bulgarians receive through protocol completely covered medicines which are mainly for treatment of cancer, blood diseases, rare diseases, diabetes, multiple sclerosis and others. “The patients will still get their medicines from the pharmacies and if they refuse to provide the expensive therapy because the NHIF will not pay them, then they may be refused a contract with the fund”, said also General Tonev.

According to the distributors, however, the idea is difficult for realization; many questions and problems arise and a lot of legislative changes are required. For example, how, if the Fund does not pay the pharmacy, the distributor will deliver the medicine without invoicing it, which is a violation of the tax laws, or how the Fund will know to which provider to pay (i.e. a serious reporting and electronic system is required).

Pharmacists challenged the idea: Everyone should work what he/she studied

If the changes become a reality, there is no guarantee that the free medicines will reach the pharmacies. The reason is that the distributors will have interest to deliver them to all pharmacies, as the Fund pays for every delivered 100% covered medicine. Secondly – if the distributor does not have money or has not concluded a contract with the manufacturer of a certain product, the distributor also may not make the delivery. At the moment the Ordinance allows doctors to sell medicines, provided they have RHIF permission. The medicines that are provided by them may be prescription or non-prescription, but without those covered by the Health Insurance Fund, the pharmacists clarified.

Telmisartan, which relates to the group of angiotensin receptor blockers (ARB), is distinguished from other sartans with its optimal pharmacokinetic profile and with some unique pharmacodynamic characteristics.

Thanks to this, telmisartan has favorable gluco-metabolic effects – cardiometabolic sartan, and can be regarded as an antihypertensive agent of choice in patients with the simultaneous presence of arterial hypertension (AH) and metabolic syndrome and/or impaired glucose tolerance, or diabetes type 2 (DT2).

The metabolic syndrome, which is associated with insulin resistance, is a combination of common cardiovascular risk factors such as hypertension, impaired glucose homeostasis, visceral obesity and atherogenic dyslipidaemia in the same individual.

The lack of universally accepted definition hinders the collection of accurate epidemiological data, but it is assumed that 10-25% of the population in the developed countries fulfill the criteria for this disease.

The reasons for this very high rate of prevalence are probably the widespread availability and easy access to high calorie (high in fat and refined carbohydrates) foods and a sedentary lifestyle. The presence of metabolic syndrome, in turn, implies a two to four-fold higher risk for cardiovascular morbidity and mortality, and five to nine-fold increase in the risk of developing DT2

Why choose exactly telmisartan in the presence of metabolic syndrome?
The main aim in the treatment of patients with metabolic syndrome is to reduce insulin resistance, and thus to prevent the occurrence of DT2 and adverse cardiovascular events.

The renin-angiotensin-aldosterone system (RAAS) plays a key role in the pathogenesis of insulin resistance and cardiovascular complications in patients with or without the presence of DT2. Therefore, blocking the RAS with angiotensin-converting enzyme inhibitors (ACEi) or with ARB is the basis of modern therapy in this population.

Telmisartan is the only sartan that has the unique effect of partial agonist of peroxisome proliferator activated receptor-gamma (PPAR-gamma). This receptor affects gene expression related to carbohydrate metabolism.

For its agonists, pioglitazone and rosiglitazone, It is proven that its agonists, pioglitazone and rosiglitazone, improve the insulin resistance in patients with DT2. Accumulated is also significant amount of evidence that activators of PPAR-gamma have anti-inflammatory, antiproliferative and antioxidative effects on vascular cells, thus reducing the risk of developing atherosclerosis.

The results of some preclinical and clinical studies have shown that administration of telmisartan can improve the carbohydrate and lipid metabolism (due to insulin sensibilisation effect) without exhibiting undesirable side effects associated with taking full PPAR-gamma agonists.

Furthermore, telmisartan has longer lasting antihypertensive effect compared with the other ARB, which is probably due to the longest half-life the medicament (almost 24 hours) and the highest affinity for the type 1 angiotensin II receptor.
Telmisartan also has the highest lipophilicity compared to other sartans that provides the largest volume of distribution and facilitate its penetration in various organs and tissues.

The superiority of telmisartan over other sartans in terms of 24-hour BP control, especially in the early morning hours is proven. The described here unique qualities make telmisartan the recommended sartan, especially in cases where AH is accompanied by metabolic syndrome or DT2.

Tchaikapharma High Quality Medicines Inc. now produces telmisartan under the trade name Telsart.

Telsart is on the list of NHIF with the following code and price:

Telsart 80 mg x 28 tabl. – CG021

Price of free sale – BGN 5.64

Reimbursement – BGN 2.64

Additional payment by the patient – BGN 3.00

Telsart has lowest price compared to all other competitors on the market – the additional payments under NHIF is only BGN 3.00 For other telmisartans the patient has to pay from BGN 5.15 to BGN 8.25. Calculated on the number of tablets Telsart again has the lowest price – BGN 0.11 per tablet.

For further information on Telsart please check here:
Телсарт

Tchaikapharma High Quality Medicines Inc. received Marketing Authorization for Pizona – a new medicine for diabetes.

Tchaikapharma High Quality Medicines Inc. received new Marketing Authorization for the medicinal product Pizona 15 mg, Pizona 30 mg and Pizona 45 mg tablets subject to medical prescription.

Pizona contains the active substance pioglitazone and is an anti-diabetic medicine used to treat type 2 (non-insulin dependent) diabetes mellitus. This is the diabetes, which usually occurs in adults.

Pizona helps control the level of blood sugar in type 2 diabetes by helping the body better use the insulin it produces. The attending physician checks whether Pizona is producing the desired effect within 3 to 6 months after initiation of the therapy.

Pizona tablets may be used alone or in combination with metformin and/or sulfonylurea derivatives, which are also oral antidiabetics. The medicament may also be used in combination with insulin.

The team of “Tchaikapharma High Quality Medicines” wishes you warm and happy Christmas and New Year holidays!

Smartphones and special devices that transmit data via Bluetooth will remind elderly patients over 65 years when to drink their medications, when it is time to measure their blood pressure, pulse or when to go for a check-up.

This is a plan of the European Commission, supported by the Sofia Mayor Yordanka Fandakova, by the Sofia Municipality and district “Triaditza”. The pilot plan includes 100 retirees with at least one chronic disease, said the manager of the program Dr. Stoycho Katsarov from the Center for Protection of the Rights in Healthcare. “The goal is better health, safety and independent living for Bulgarians over 65 years,” added Dr. Katzarov. The analysis of the results will be used by the European Commission to develop a European policy for integrated health and social care.

The selected in Bulgaria patients satisfy the conditions to not be accommodated in a rest home, to be a receiver of at least of one social care service like a social or personal assistant, patronage, to be at risk of isolation and to not suffer from severe mental disorders. The smartphones and devices they have been given will not only monitor their life indicators, but also their body weight, the environment temperature, and their locomotor activity.

“All the data will be collected in a database, and it will register the medical and social care services received by the senior (meaning the diagnoses, the therapies, and the check ups),”- said Dr. Katzarov.

The expert said that an all-day call center will be built for a permanent connection with the project participants. It will include GPs and social workers. “The project is for the period of three years, and it was launched on the 1^st of February this year, but the monitoring of patients starts on the 1^st of February 2015,” – said Dr. Katzarov.

The cost of the initiative is € 5,000,000. Bulgaria receives € 500 000 and 250 000 of them – is non-repayable. “Once the program is completed, we can determine what kind of services seniors require, what are the problems they most often encounter. And our health and social services will know in which direction to focus their efforts and what is the required care, which we now lack that has to be provided,”- said the doctor. According to the EC this is the only way we can effectively manage the demographic changes and lifestyles in Europe and to focus on the lives of the elderly.