OBJECTIVES: Pandemic periods deteriorate the access to medicines and increase the cost for patients and society. We aimed to analyze the changes of antidiabetic medicines consumption and cost for patients' and third-party payer during pandemia in Bulgaria.

METHODS: A retrospective, observational analysis of 23 International Nonproprietary Names (INNs) included in Positive Drug List (PDL) during the period 2020- 2022. Reimbursed medicines and cost were collected from officially available sources (National Health Insurance Fund). Utilization was calculated per INN, as well as changes in reimbursement expenditures during pandemic period (2020 – 2022) in absolute and relative units. Patient co-payment was also taken into consideration.

RESULTS: Cost for third party payer increased significantly from 25,714,735 to 32,379,502 Euro. Two new INNs were included in the Positive Drug List (PDL) Saxagliptin/ Dapagliflozin and Semaglutide. The highest public spending was for Gliclazide (3.6 to 3.9 mil Euro), Metformin (2.9 to 2.8 mil Euro), and Empagliflozin/ Metformin (3.3 to 4.7 mil Euro). The patients' co-payment remains significant -from 21,095,428 to 25,758,648 Euro, depending on prescribed trademarks and retail prices of medicines. The highest co-payment is found for Dapagliflozin and Metformin 3 and 4.8 mil Euro. The overall society expenditures for medicines accounted for 47 in 2020 and 58mil Euro in 2022.

CONCLUSIONS: Patients and society experienced heavy cost burden for type II diabetes medicines therapy during pandemic period and almost share expenditures proportionally. Policy measures for regular supply and decreasing co-payment are needed to avoid high cost burden for patients.