Outgoing Bulgarian health minister Petar Moskov will leave a legacy of unfinished cost-containment initiatives, although he has also scored some significant wins during his term of office.
Implications | The introduction of mandatory discounts on many reimbursed medicines, and a system of health technology assessment (HTA), are among outgoing Bulgarian health minister Petar Moskov's main achievements in the area of pharmaceutical policy. |
Outlook | Moskov's combative approach towards the pharmaceutical industry means that he is unlikely to be greatly missed in pharma circles – although the future of pharmaceutical policy looks distinctly uncertain; in particular, it is unclear whether the government elected in the snap elections, expected in April, will want to make quick progress with the planned launch of cross-border procurement of expensive medicines with Romania. |
Petar Moskov, Bulgaria's health minister and part of the outgoing coalition government expected to be replaced soon by an interim administration, has made some important achievements in his period in office, which started in November 2014. A divisive figure for the pharmaceutical industry, Moskov has led the introduction of mandatory discounts for some medicines on the positive drug list (PDL), as well as a system of health technology assessment (HTA). His reforms also include the introduction of full reimbursement (to the value of the reference price) for medicines to treat essential hypertension, starting from the beginning of 2017.
Moskov has also seen important elements of his cost-containment strategy for pharmaceutical care fail. Most recently, it has been confirmed that the plan to introduce a "price corridor" for reimbursed medicines, to limit the level of co-payments patients pay for particular drugs, has been cancelled (see Bulgaria: 30 December 2016: Bulgarian government cancels proposed price corridor for reimbursed drugs ). In addition, Bulgarian medical news source zdrave.net reported that the cancellation of the major centralised electronic tender for hospital drugs has been confirmed by the Ministry of Health (MoH; see Bulgaria: 29 December 2016: Bulgaria's outgoing health minister expects new government to cancel electronic tender for hospital drugs). In the case of the hospital-drugs tender, the cancellation comes after a high-level intervention by pharmaceutical associations and the American Chamber of Commerce (see Bulgaria: 22 December 2016: Bulgarian pharmaceutical associations, US Chamber of Commerce call for review of USD636-mil. e-tender for hospital drugs ).
Bulgarian medial news source hospital.bg reported the statements of the director of the Association of the Research-based Pharmaceutical Manufacturers in Bulgaria (ARPharM), Deyan Denev, and the chairman of the board of the Bulgarian Generic Pharmaceutical Association (BGPharmA), Nikolai Hadjidonchev, that although the idea of the electronic tender was good, it was not well thought out. According to the source, Denev reportedly said that the mandatory discount system "works" and is "accepted by producers", enabling the National Health Insurance Fund (NZOK) to increase the number of patients treated. Denev added that in 2015, the total amount saved by the Bulgarian MoH because of the mandatory discounts was BGN45 million (USD24.1 million), and that the total in 2016 is expected to increase to BGN90 million. According to Denev, the increasing amount paid by pharmaceutical companies makes the consistently inadequate NZOK drug-reimbursement budget unacceptable. In his view, it is natural that the expenses for drug reimbursement in Bulgaria should increase, considering the ageing population and increasing incidence of particular conditions, as well as the launching of more effective medicines, combined with enhanced expectations of life expectancy and quality.
According to zdrave.net, Moskov predicted that in 2017, the amount saved because of mandatory discounts will be BGN137 million. In typically combative mood, Moskov reportedly defended the electronic tender for hospital medicines, arguing that it would mean that procurement would be "clean" and "transparent", and not carried out in "dark rooms" in which hospital managers make deals with the management of companies. Moskov added that although Bulgaria has progressed from a communist society, in which the ruling party did not have the interests of the people at heart, the same people who had power and influence during the communist times "became country managers of large pharmaceutical companies", as well as other industries.
Outlook and implications
Increasing expenditure on originator medicines has been the main factor in the growth of Bulgaria's pharmaceutical market in recent years – a growth of 7.6% year on year (y/y) in the overall market in 2015 followed the 8.2% y/y growth in 2014, according to QuintilesIMS. While also focusing on major reform initiatives in the wider healthcare sector, particularly primary healthcare, Moskov's main legacy will be his determined and combative approach to the pharmaceutical industry, and he can count a number of important successes in his attempts to wrestle with the problem of a "natural" growth in pharmaceutical spending and a very limited budget.
Regarding one of Moskov's most high-profile cost-containment initiatives – the proposed establishment of cross-border procurement, initially with Romania but potentially with other Central and Southeast European nations, it is unclear whether the political change in Bulgaria will mean the end of this venture (see Bulgaria – Romania: 11 November 2016: Bulgarian and Romanian health ministers sign official agreement on cross-border price negotiation and procurement of high-cost drugs ). On the one hand, very little has changed in the fundamental circumstances giving rise to the initiative; on the other hand, the likely change of government after the snap elections expected in April and the upheavals associated with this will at least mean that this cross-border plan is almost certain to be off the agenda for some time.