An audit is being conducted in 7 state hospitals - four in Sofia and three in the province, due to the prices of expensive medicines that are outside the Positive List.
In some cases, the differences in the price for the same medication are striking and amount to several thousand leva.
This was announced by the acting Deputy Minister of Health Vladimir Afenliev at a press conference on the topic: “How expensive are expensive medicines in medical institutions?“, at which he reported on the results of inspections carried out by the department.
He specified that these are medicines that are outside the Positive List of Medicines and are purchased directly by hospitals for a specific patient. "In most cases, these are rare and very serious diseases", he explained.
An interesting fact is that only state hospitals, which are seven in total, deal with this type of purchasing of medications. He also gave an example of atypical financial activity in these medical institutions, using the same medicine for comparison. "Medicine A was purchased in one hospital for 46,000 leva, and in another - for 424.70 leva. In a third - for 150,402 leva. Similarly - in one hospital for 23,018 leva, and in another for 64,375 leva. Medicine C was purchased in one hospital for 8,000 leva, and in another - for 36,000 leva. Here we are talking about the exact same medicine - trade name, type of packaging, concentration. For medicinal product D, the difference is from 18,000 to 44,000 leva. For medicinal product E - from 15,000 to 40,000 leva", reported Afenliev.
The inspectors also came across other striking examples - two state hospitals in Sofia purchased a medicine for 1,400-1,600 leva. Another state hospital in Plovdiv purchased it for 10,800 leva. " In another case, a medicine from two state hospitals in Sofia was purchased for 2,300-2,400 leva. A state hospital in Plovdiv purchased it for 15,210 leva. One of the most striking cases is a medicine that was purchased in Sofia for 517 leva, and in Plovdiv – for 8,500 leva", the Deputy Minister of Health pointed out.
"At first glance, when we analyzed the information on the issue and the documentation, it seems that the order has been followed and the purchase of the medicinal products seems legal", he emphasized. "However, in order to see why there are these anomalies in the prices, an audit is already being carried out on the subject in these state hospitals", Afenliev said.
Since these medicines are not on the Positive List, they do not have a registered official price, the Deputy Minister explained. However, most of them are registered in the European Union. There are two types of such medicines - some are completely unregistered, and the others are registered in the European Union, but without a set price in Bulgaria.
Afenliev recalled the procedure for paying for these medicines: "Financing is carried out through a transfer from the Ministry of Health to the NHIF. There is a special line in the NHIF budget for such transfers, where this mechanism is described. This concerns treatment of persons under 18 years of age, for activities outside the scope of compulsory health insurance. NHIF pays directly to medical institutions after receiving the relevant transfer. Medical institutions make a selection in accordance with the legislation. A commission of three doctors proposes the purchase of a specific medicine for a specific patient. Then, the medical institution, in accordance with a certain procedure according to the regulations, negotiates with a supplier or manufacturer. Upon finalization of the procedure and administration of the medicine, the hospital provides an invoice to NHIF, which pays for the product with funds from the transfer".
According to the Deputy Minister of Health, there has been a significant increase in the number of orders issued for approval of the payment of these medicines for 2025 compared to 2024. "This can also be considered a positive indicator - more patients have gained access to treatment", he emphasized. But he pointed out that there is also growth in financial terms - which, however, is also due to the fact that some medications have become more expensive.
Of all applications submitted to the NHIF for treatment, 55.7% of the costs for 2025 relate to these medications. That is, over 50% of the funds are directed to the so-called expensive, but unregistered medications.
"The problem that we identified after a thorough analysis - based on information from the NHIF and from all hospitals that have applied for such medications - is the lack of sufficient transparency in the spending of funds. There is no detailed reporting by the NHIF to the Ministry of Health. We are not saying that reporting does not exist, but according to the financial directorate of the Ministry of Health, it should be significantly more detailed and structured according to the direction of the expenses. At the moment, it is not clear from these reports which medication, for which patient, and what amount was paid, which is why we have requested changes in this process," explained Afenliev.
The team of the Ministry of Health, together with the Ministry of Finance, intends to introduce changes in the procedure for financing expensive medicines and their pricing. "Because from everything said so far, the main conclusion is that in one year – 2025, and probably in previous years as well, the state has paid many times more for the same medicines. This means that at normal or the lowest prices used, financial resources should be freed up so that more patients can access treatment or this resource can be directed to other necessary activities," Afenliev emphasized.