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).
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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.