The Health Insurance Fund should buy oncology drugs the same way it buys all other drugs. Then no one needs to hold tenders. This was said in the program “This Morning“ on bTV by Dr. Stoycho Katsarov, former Minister of Health and representative of patient organizations on the Supervisory Board of the National Health Insurance Fund.
The same drugs are at drastically different prices in different hospitals. An investigation by bTV 6 years ago showed these serious differences in the ordering of the same drugs. However, nothing has changed so far, and at this point, the government is proposing legislative changes to introduce regulation.
“Having centralized tenders in the Ministry of Health, and having private hospitals also hold tenders, are two things that are incompatible. Either you hold a tender in the Ministry of Health, or every hospital holds tenders“, the former Minister of Health commented on the media
According to him, the proposal that has been submitted to the National Assembly is for all hospitals, including private ones, to hold tenders for oncology drugs. “I have been sticking to my position since 2010, when this anomaly with oncology drugs was introduced, that not only private hospitals, but also state and municipal hospitals should not hold tenders for oncology drugs, but they should be reimbursed by the Health Insurance Fund in the same way that it reimburses all other drugs“.
“Have you heard of tenders for insulin, or for drugs for hypertension, or for lung diseases, for asthma? You haven't. The Health Insurance Fund has a procedure for negotiating prices and discounts with manufacturers. It does not hold tenders, but pays for the drugs and this procedure, although with some remarks, works well“, he pointed out.
According to Dr. Katsarov, there is no problem with it being applied to oncology drugs. “Then neither the hospitals nor the Ministry of Health will have to hold tenders. This is the best solution“.
According to Health Minister Katya Ivkova, the best solution is to hold tenders at the Ministry of Health level. According to her, a much better price can be negotiated in this way.
“In fact, experience shows the opposite. In September last year, such a framework agreement was held at the Ministry of Health and the prices achieved are higher than the prices that the Health Fund was paying for the same medicines until then. This is one of the reasons for the large differences in the payment of individual medicines“, said Stoycho Katsarov.
According to him, the only way to solve this problem properly is for the Health Fund to buy them the same way it buys all other medicines. “Then no one needs to hold tenders“.
“The Ministry of Health is holding a competition for framework agreements. It does not promise to purchase medicines. It does not promise you that it will buy a certain amount of medicines from your company, but asks you to indicate a price“, he commented.
“Since, unlike public procurement, you do not have a guaranteed market for a certain quantity, you will give a high price. This is the reason. It is absolutely natural“, explained Dr. Katsarov.
But in his words, what the Ministry of Health is doing is completely unnecessary if the Health Fund applies the mechanism for oncology medicines, the same as it does for all other medicines.
“The flaw is that one pays and another buys. And he can buy at whatever price he wants. The European experience in the reimbursement of medicines is exactly the one that our Health Insurance Fund applies to other medicines - without holding auctions“, commented Dr. Katsarov.
“There is a procedure for forming a price. There is a procedure for negotiating discounts. We have them too. They are not perfect, but we have them and they work. This is the good model and it does not require anyone to hold auctions“, he added.