Organization of the health system in Bulgaria - focus on payment and affordability of medicines

Aim. The aim of the study is retrospective review and analysis of implemented measures for improving access to patients' therapy in Bulgaria. Materials and methods. The study is based on data from officially published regulations and laws, as well as publications on cost control measures in healthcare and their impact on patients and government spending. Mechanisms of regulatory institutions introduced through laws and regulations are also mentioned in the analysis. Results and discussion. The actions adopted are divided into several groups in order to examine all aspects of medicines affordability - mechanisms for cost control affecting access to medicines, patients' co-payment, and physical availability of medicines. The external reference pricing, Health technology assessment (HTA), discounts and negotiations, regressive scale for price calculation, generics price cap, budget cap and payback mechanism, therapeutic effect monitoring are used for medicines price setting and control. It was found that despite the decrease in drug prices, there is a noticeable increase in government spending, as well as an increase in household spending. The retail pharmacies established in the country are mainly in the large cities. About 32 municipalities could not provide patients' access to medicines. The financial cost implications are substantial and the burden for patients is increasing. Conclusion. Efforts in recent years have focused on reducing costs for both patients and the population as a whole. The study found that the introduction of reference pricing (internal and external), health technology assessment, budget constraints, negotiations, and generic drug policies do not contribute to patient access to therapy. Cost control measures implemented at this stage are not as effective as expected. In addition, it was found that household spending on medicines has been increasing in recent years, and all policy measures taken do not contribute to supporting patients financially.