Bridging Systemic Access Gaps for Cancer Medicines: A Policy Perspective From the Republic of Moldova
Author(s)
Elena Chitan, MPH, PharmD1, Constantin Nedelea, PharmD2, Liliana Dogotari, PhD, PharmD1, Adrian Cojocaru, student, Student3, Stela Adauji, Dr. habil., MPH, PharmD1.
1Department of Social Pharmacy "Vasile Procopisin", "N. Testemitanu" State University of Medicine and Pharmacy, Chisinau, Moldova, Republic of, 2Medicines, Goods, and Services Procurement Division, Center for Centralized Public Procurement in Health, Chisinau, Moldova, Republic of, 3"N. Testemitanu" State University of Medicine and Pharmacy, Chisinau, Moldova, Republic of.
1Department of Social Pharmacy "Vasile Procopisin", "N. Testemitanu" State University of Medicine and Pharmacy, Chisinau, Moldova, Republic of, 2Medicines, Goods, and Services Procurement Division, Center for Centralized Public Procurement in Health, Chisinau, Moldova, Republic of, 3"N. Testemitanu" State University of Medicine and Pharmacy, Chisinau, Moldova, Republic of.
OBJECTIVES: Cancer remains a leading cause of morbidity and mortality in the Republic of Moldova, yet access to essential oncology medicines is hindered by systemic barriers. This study assessed access gaps and policy misalignment, focusing on procurement bottlenecks, reimbursement limitations, and the emerging use of health technology assessment (HTA) as a value-based policy tool.
METHODS: A structured policy analysis was conducted, including desk review of national legislation, pricing and reimbursement regulations, and procurement procedures. National data (2023-2025) on procurement outcomes, reimbursement decisions, and medicine expenditure were analyzed. Consultations with policymakers and patient representatives provided qualitative insights.
RESULTS: Between 2019 and 2024, Moldova’s public spending on oncology medicines more than doubled, from USD 6.89 million to over USD 16.6 million, driven by increased demand, expanding treatment indications, and higher medicine prices. Procurement data for 2023-2025 revealed systemic bottlenecks, including repeated tender failures and absence of supplier bids for several essential oncology medicines: Asparaginasum, Chlorambucilum, Vinblastinum, and Vincristinum resulting in unstable or absent availability. The fragmentation of access pathways is reflected in reimbursement trends. Many high-cost oncology medicines remain financed through supplementary mechanisms, including institutional budgets and special-purpose funds, lacking transparent prioritization criteria. The 2023-2025 reimbursement application data further highlight systemic barriers: of 11 oncology medicine submissions over three years, only 4 (36%) received approval, with no approvals granted in 2025. Two 2025 applications for high-cost oncology medicines remain under full HTA evaluation, the first formal application of HTA in Moldova’s oncology sector. While a procurement mechanism is in place, its scope is restricted to price-based contracting, without the application of advanced tools such as managed entry agreements, cost-volume arrangements, outcome-based models. This limits country ability to implement value-based purchasing strategies for medicines.
CONCLUSIONS: Closing access gaps for oncology medicines requires system-level HTA integration, strengthened procurement, and transparent, value-based resource allocation to ensure sustainable, equitable access.
METHODS: A structured policy analysis was conducted, including desk review of national legislation, pricing and reimbursement regulations, and procurement procedures. National data (2023-2025) on procurement outcomes, reimbursement decisions, and medicine expenditure were analyzed. Consultations with policymakers and patient representatives provided qualitative insights.
RESULTS: Between 2019 and 2024, Moldova’s public spending on oncology medicines more than doubled, from USD 6.89 million to over USD 16.6 million, driven by increased demand, expanding treatment indications, and higher medicine prices. Procurement data for 2023-2025 revealed systemic bottlenecks, including repeated tender failures and absence of supplier bids for several essential oncology medicines: Asparaginasum, Chlorambucilum, Vinblastinum, and Vincristinum resulting in unstable or absent availability. The fragmentation of access pathways is reflected in reimbursement trends. Many high-cost oncology medicines remain financed through supplementary mechanisms, including institutional budgets and special-purpose funds, lacking transparent prioritization criteria. The 2023-2025 reimbursement application data further highlight systemic barriers: of 11 oncology medicine submissions over three years, only 4 (36%) received approval, with no approvals granted in 2025. Two 2025 applications for high-cost oncology medicines remain under full HTA evaluation, the first formal application of HTA in Moldova’s oncology sector. While a procurement mechanism is in place, its scope is restricted to price-based contracting, without the application of advanced tools such as managed entry agreements, cost-volume arrangements, outcome-based models. This limits country ability to implement value-based purchasing strategies for medicines.
CONCLUSIONS: Closing access gaps for oncology medicines requires system-level HTA integration, strengthened procurement, and transparent, value-based resource allocation to ensure sustainable, equitable access.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD15
Topic
Health Service Delivery & Process of Care, Health Technology Assessment, Patient-Centered Research
Disease
Biologics & Biosimilars, Oncology, Pediatrics, Rare & Orphan Diseases