Introduction. Patient access to innovative targeted (TT) and immunotherapies (IT) varies between healthcare payers and it is often related to reimbursement issues. The aim of this article is to analyse the reimbursement and expenditures for TT and IT in a single-payer healthcare system in Bulgaria.

Methods. Data was collected from the expenditure database of the Bulgarian National Health Insurance Fund (NHIF) which is the sole payer responsible for contracting and paying healthcare providers for all services including medicines in the country to gather data on payments for TT and IT for the period 2017 – 2021. We selected the cancers that posed the largest expenditure, namely lung, breast, colorectal, prostate, and melanoma. We evaluated the overall and yearly expenditure per type of therapy and cancer.

Results.

The NHIF reimbursed 15 TT and IT for lung cancer, 10 for breast cancer, 9 for colorectal cancer, 3 for prostate cancer, and 7 for melanoma. Reimbursement for TT and IT for breast cancer accounted for the largest share of the total expenditure for these therapies in the studied period with 29%, followed by lung cancer 26%, prostate cancer 18%, colorectal cancer 14%, and melanoma 13%.

The expenditure trend was increasing particularly in lung cancer by 5-fold, and melanoma and prostate cancer with nearly 2-fold increase. The spending for breast and colorectal cancer remained relatively constant.

Reimbursement coverage for TT and IT in Bulgaria is comparable to other European countries and managed entry agreements based on financial considerations are used to reduce the financial burden and improve access.

Conclusion. The coverage and the rising trend of expenditure of TT and IT in Bulgaria are comparable to that of other EU counties. The NHIF could consider the implementation of value- and indication-based reimbursement to ensure efficient spending of available healthcare funds.