Description: Final Report with Recommendations for Reforming Bulgaria’s Pharmaceutical Sector

Final Report with Recommendations for Reforming Bulgaria’s Pharmaceutical Sector

This report presents a review of current issues in the pharmaceutical sector in Bulgaria, examining drug policy, regulation, pricing, formulary selection, distribution, expenditure, and to the extent possible, patterns of use in Bulgaria. Its recom...

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Bibliographic Details
Main Author:	World Bank
Language:	English en_US
Published:	Washington, DC 2015
Subjects:	PHARMACY CLINICAL GUIDELINES RISKS RETAILING RETAIL PRICE DOSAGE FORMS SUBSTITUTION CHRONIC DISEASES DISPENSING FEES ACCOUNTING FEEDBACK FINANCING STOCK PHARMACISTS PACKAGING SALES PREVENTION LAWS ACTIVITIES SUPPLIER ADHERENCE TO TREATMENT HEALTH INSURANCE MONITORING DRUGS HEALTH CARE DRUG PRICES HEALTH DRUG FORMULARIES DISTRIBUTION PRICING WHOLESALE PRICE BREAST CANCER PRICE BENCHMARKS RETAIL TRADE PRESCRIPTIONS CORRUPTION CRIME HYPERTENSION DISCLOSURE PRICE COMPETITION INFLATION PHARMACEUTICAL RETAIL INTERFERON PHARMACEUTICAL POLICY RANDOMIZED CONTROLLED TRIALS PHARMACIES COMMUNICATIONS COST EFFECTIVENESS MARKET SEGMENT WHOLESALER DIABETES ADVERTISING MARKET ENTRY PRICING MECHANISMS BRANDS PATIENT PATIENTS PHARMACEUTICAL MANUFACTURERS LEUKEMIA REBATES REBATE PRODUCTS MEDICATION NURSES RATIONAL DRUG USE PHARMACEUTICAL INDUSTRY HEALTH MANAGEMENT OBSERVATION MARKETING WHOLESALING INDICATORS BRAND PREFERENCES PRODUCT GROSS DOMESTIC PRODUCT PRICING POLICIES GMP BRAND EFFICIENCY NARCOTICS EXPENDITURE PHARMAC SUBSTITUTE BENCHMARK PRICING PROCUREMENT PRICE ADJUSTMENTS TURNOVER PRICE COMPARISONS VALUE PROSTATE CANCER MEDICINE PHARMACEUTICALS BUDGETS SOCIAL POLICY DEMAND HEALTH OUTCOMES PHARMACEUTICAL EXPENDITURE REPORTS ISONIAZID DRUG EVALUATION INSULIN PRICE CHANGES EXPENDITURES DECISION MAKING THERAPIES CHEMOTHERAPY OPPORTUNITY COSTS PHARMACEUTICAL PRICING COLD CHAIN NUTRITION MARKET RETAIL PRICES EXTERNAL REFERENCE PRICING SUPPLY CHAIN QUALITY OF LIFE MARKET COMPETITION INTERNET TENDERING GLAUCOMA DISTRIBUTION OF PHARMACEUTICALS VACCINES HEALTH CARE PROFESSIONALS PHYSICIANS COMMUNICABLE DISEASES MARKET SHARE CLINICAL TRIALS CLINICIANS LIVER CANCER PHARMACEUTICAL SECTOR EVALUATION GENERAL PRACTITIONERS DRUG SELECTION SUPPLY PURCHASING RESPIRATORY DISEASES MARKET POWER METHADONE TREATMENT GUIDELINES WAREHOUSES GOOD PRESCRIBING STRATEGY WHOLESALERS TRANSFER PRICES FEES PHARMACEUTICAL MANAGEMENT REGISTRATION SUPPLIERS MEDICINES PRICE CONTROLS HOSPITALS HEALTH SERVICES IMPLEMENTATION PRICES PHARMACEUTICAL PRICING POLICIES GENERIC PRODUCTS COMPETITION
Online Access:	http://documents.worldbank.org/curated/en/2015/11/25465740/final-report-recommendations-reforming-bulgaria’s-pharmaceutical-sector http://hdl.handle.net/10986/23248

Description
Summary:	This report presents a review of current issues in the pharmaceutical sector in Bulgaria, examining drug policy, regulation, pricing, formulary selection, distribution, expenditure, and to the extent possible, patterns of use in Bulgaria. Its recommendations are intended to serve as options for reform, by articulating short and long term strategies for managing pharmaceutical expenditure, improving system sustainability, and driving value for money in Bulgaria, thereby improving efficiency, equity, affordability and ultimately, access to prescription medicines. Although small, the Bulgarian pharmaceutical market is showing strong growth. Medicines comprise not only a disproportionate share of health care expenditure (38 percent of total health expenditure, compared with an EU average of around 25 percent), the burden of out of pocket (OOP) costs is also excessive, possibly as high as 81 percent of total pharmaceutical expenditure. Of perhaps greatest concern is that rapid expenditure growth is taking place without obvious improvements in health outcomes, and at the expense of population equity. Bulgaria does not yet have an integrated national medicines policy, and the pharmaceutical sector is characterized by various highly prescriptive and at times, arguably inconsistent policy levers. While the regulatory framework has been largely brought into line with current EU standards, existing mechanisms for listing, pricing and subsidizing medicines are not ensuring adequate value for money for the National Health Insurance Fund (NHIF), and are contributing to inefficiencies in the health sector. Current pharmaceutical policy settings appear focused on limiting NHIF outlays rather than prioritizing access and affordability, and afford little financial protection to patients.

Final Report with Recommendations for Reforming Bulgaria’s Pharmaceutical Sector

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