Impact Of Reimbursement Policy On Medicines Expenditures And Copayment: The Case of Cardiovascular Medicines In Bulgaria
Author(s)
Zornitsa Mitkova1, Violeta Angelova, student2, Antonia Tsvetkova, student2, Zoya Stamova, student2, Manoela Manova, PhD3, Guenka Ivanova Petrova, ScD, PharmD, PhD4.
1Associate Professor, Medical University - Sofia, Bulgaria, Sofia, Bulgaria, 2Medical University - Sofia, Bulgaria, Sofia, Bulgaria, 3Faculty of pharmacy, Medical University, Sofia, Bulgaria, 4Medical University of Sofia, Faculty of Pharmacy, Sofia, Bulgaria.
1Associate Professor, Medical University - Sofia, Bulgaria, Sofia, Bulgaria, 2Medical University - Sofia, Bulgaria, Sofia, Bulgaria, 3Faculty of pharmacy, Medical University, Sofia, Bulgaria, 4Medical University of Sofia, Faculty of Pharmacy, Sofia, Bulgaria.
OBJECTIVES: Reimbursement policy for CVMs in Bulgaria was changed by introducing full coverage since 01.04.2024 in Bulgaria. Health insurance fund reimburses 100% at the reference price (the lowest price per defined daily dose) so co-payment for higher priced medicines remains. That’s why we aimed to assess the impact of changes in reimbursement policy on public expenditure and co-payment.
METHODS: Prices and reimbursed expenditures of CVMs before and after introduction of full coverage were extracted from official sources. Changes in utilization were calculated in defined daily doses per 1000/inhabitants per day during 2022 - 2024. Pharmacotherapeutic groups of ACE-inhibitors, Angiotensin II receptor blockers (ARBs), β-blockers, and Ca- channel blockers were included in the analysis.
RESULTS: The total reimbursed expenditure grows with 7.3million Euro for one year. The total CVMs utilization in 2023 is lower than 2022 (134.5 and 155.15 DDD/1000 inh/day respectively), whereas in 2024 it is significantly higher than those in 2023 (153.37 DDD/1000 inh/day). The highest rate was found in the group of ARBs. Utilization in DDD/1000/inh/day for ARBs changed from 36.38 in 2024 to 33.3 DDD/ 1000 inh/day in 2022. The new policy resulted in a reduction in the co-payment, but only the reference product is free of co-payment. The decrease was found in the groups of ACE-inhibitors (about 1.6 Euro per package) and ARBs (average 3 Euro per package).
CONCLUSIONS: Increase in reimbursed percent logically let to increase in expenditure and utilization of CVMs most notable for the group of ARBs. Longer time period needs to be created and analyzed the stable tendency.
METHODS: Prices and reimbursed expenditures of CVMs before and after introduction of full coverage were extracted from official sources. Changes in utilization were calculated in defined daily doses per 1000/inhabitants per day during 2022 - 2024. Pharmacotherapeutic groups of ACE-inhibitors, Angiotensin II receptor blockers (ARBs), β-blockers, and Ca- channel blockers were included in the analysis.
RESULTS: The total reimbursed expenditure grows with 7.3million Euro for one year. The total CVMs utilization in 2023 is lower than 2022 (134.5 and 155.15 DDD/1000 inh/day respectively), whereas in 2024 it is significantly higher than those in 2023 (153.37 DDD/1000 inh/day). The highest rate was found in the group of ARBs. Utilization in DDD/1000/inh/day for ARBs changed from 36.38 in 2024 to 33.3 DDD/ 1000 inh/day in 2022. The new policy resulted in a reduction in the co-payment, but only the reference product is free of co-payment. The decrease was found in the groups of ACE-inhibitors (about 1.6 Euro per package) and ARBs (average 3 Euro per package).
CONCLUSIONS: Increase in reimbursed percent logically let to increase in expenditure and utilization of CVMs most notable for the group of ARBs. Longer time period needs to be created and analyzed the stable tendency.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HPR116
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Reimbursement & Access Policy
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)