Банкеръ Weekly



Pharmacies should make an 8% discount of the price of drugs in order to be allowed to sign an agreement with the National Healthcare Insurance Fund (NHIF), the Managing Board of the fund decided on January 17. Initially, pharmacy owners were required to drop prices by 10%, then a 6% discount was said to have been settled. The discount will not be valid for the fund only, but also for the patients. The eight per cent will be distributed in proportion with the amounts paid by the patients and the NHIF. If the fund covers 50% of the price of a drug, both the patient and itself will be given a 4% discount. In case that it covers 75%, it will get a 6% discount. However, neither the pharmacy owners nor the distributors understand the scheme and they all doubt that this will be the final decision.A meeting with manufacturers, wholesalers, and pharmacy owners was organized before the session of the Supervisory Board on January 17. However, neither the main distributors nor their branch chamber were invited to participate in the discussion about the contract terms, the chamber chairman Vladimir Naidenov told the BANKER weekly. He added that most pharmacies are not going to agree with the new terms, because nobody offers guarantees that the wholesalers will make the settled discounts.The NHIF experts are sure that the 8% reduction will not have a disastrous effect on the financial condition of the pharmacies. Still, pharmacy owners hold the opposite view. They underline that distributors do not offer them constant discounts and if they agree with the new terms, they will likely face bankruptcy. They explained that the price reduction only concerns a group of drugs. According to Vladimir Naidenov, the drug value is determined by the economic situation and even by the fuels prices. In order to cover the money he spends on delivering drugs to the pharmacies, a distributor adds at least 6.2% surplus charge.It is constantly repeated these days that the fund is not a commercial company and cannot set conditions to the pharmacy owners when signing an agreement. And eventually, consumers will be the ones to lose again. Nobody takes into account that before reaching the pharmacy, a patient has already paid at least BGN2.50, Vladimir Naidenov commented. A lev has gone for implementation of the prescription and another lev and a half for visiting the GP who prescribed the medicines. Considering all that, the percentage of the price reduction for the consumer is insignificant.Apart from the obligatory discount, a number of other senseless requirements have been set. To illustrate that, distributors point at the 2004 Ordinance No 41 of the Council of Ministers which obliges them to put one more sticker on drug packings from February 1. The sticker will reveal who are the dealers who distributed the medicine on its way from the manufacturer to the pharmacy. The fact that the sticker might hide important information about how the drug is used seems not so disturbing. Another problem is that the printing houses do not have the necessary inks yet. That is why stickers will hardly be printed in time and then sanctions will be imposed, the wholesalers branch chamber complains.Anyway, the fund has not profited by its monopoly entirely yet. That may happen when a standard is introduced saying for how many people there should be a pharmacy cooperating with the NHIF. If the practice of more developed countries is adopted (where a pharmacy of the kind exists for 10,000 people), the 4,500 pharmacies existing in Bulgaria at present will be reduced to 2,000. Then they will be forced to work at the lowest surplus charge, making profit mainly from the turnover, and the fight for space will get even more furious. Right now, that fight concentrates on who should distribute drugs worth BGN245MN. This is the amount allocated by the NHIF budget for payment of home treatment drugs.

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