In the week when the budget is adopted on second reading and the NHIF decides to spend the funds from the reserve, the Initiative Committee of master pharmacists warns that if the state does not provide funds for drugs in time by the end of the year, patients will be left without treatment, and family pharmacies - without the opportunity to continue working normally.
The problem is easy to understand: the state delays payments to pharmacies for already dispensed drugs, and without these funds, pharmacies cannot purchase new ones from distributors. It is currently unclear whether funds have been provided from the reserve to provide drugs for outpatient care. Another unresolved problem from the new budget is the low added value for pharmacy activities. For years, pharmacy owners have been talking about the unfair policy of zero markup when dispensing expensive therapies: for example, currently in the Regulation on Pricing for medicines from 30 to 50,000 leva, the pharmacy receives the legally limited markup of 30 leva. We ask: what business operates with such parameters? Why is access to medicines at stake? Why has there been no understanding for years about the role of the family pharmacy in the healthcare system? Isn't there a need for pharmacies and private initiative in this sector?
„It is absurd for a pharmacy, which is a commercial company, in addition to a healthcare institution, to purchase and dispense medicine for thousands of leva or euros from next year and receive a markup of up to 30 leva or 15 euros. It is not normal for the Fund not to provide in its budget funds for payments with these companies for the medicines sold and even for there to be no interest included in the contract in case of delay in their payment. These pharmacies are the backbone of the country's drug supply. Their commercial initiative has proven its effectiveness over the years and is the only channel for access to medicines. If these sites are not secured, they will not sign the new contract, and this will limit access, which is already compromised due to the poor conditions,“ stated Adelina Lyubenova, Chairwoman of the Initiative Committee of Master Pharmacists, Pharmacy Owners.
In this difficult environment, family pharmacies continue to operate and serve patients. They will not protest like all the dissatisfied ones today, but they firmly state that without a guarantee of timely payment, the drug supply chain under the Cash Register will be blocked. In order to get new medicines, private pharmacies must first pay for the old ones, and if the state does not pay - they cannot provide stock. The situation is the worst in populated areas, where there are often only one or two pharmacies.
Additional tension is also created by the constant shortage of medicines - nearly 300 medicines have been in limited quantities for years and hundreds of patients remain without adequate and timely treatment. According to the ICMF, “there is no awareness and no legal changes have been taken to stop the leakage of medicines imported for Bulgarian patients“.
Ivan Dimitrov from the Patients Forum adds: “When people cannot get their medicines, they start looking for them in other countries. This is unacceptable.“
The initiative committee insists that pharmacy owners be included in the negotiations for the new framework contract with the NHIF and that their proposals be discussed.
If the goal of the fund is to ensure fair access to medicines at an affordable price, let the contract with retailers be cleared of administrative burdens and restrictions for those wishing to work with it. Let pharmacies be encouraged to maintain the full range of medicines and, without financial risk, be able to focus on consultation and the efficacy of prescribed therapies. The new contract with the NHIF should not require mandatory membership in the professional organization, accumulated points from continuing education and any other criteria that burden the negotiation process. The excessively high fines, reaching up to 8,000 leva, are also inadequate and are turning many family pharmacies away from the contract.
“We want the new contract to focus on the patient and protect the family business“, emphasizes Adelina Lyubenova.
The demands of the family pharmacies include: the state to pay for all dispensed medicines on time; to allocate funds from the reserve to guarantee continuous access until the end of the year; to ensure stability in the supply chain; to include pharmacy owners in the negotiations for the new framework contract; to reduce the administrative burden, which does not improve the quality of the service; to end the practice of disproportionately high sanctions.
“Pharmacies are the last door to people's health. If it closes - there will be no one to open it“, states the Initiative Committee of Master Pharmacists.