Bulgaria's cheap drugs

"If I fall ill with cancer again, only God can help me," says Daria Dimitrova. She doesn't say it because she is deeply religious, but from despair. The memories of the hard fight for survival that she went through five years ago are so painful for the 54-year-old Bulgarian that she would like to delete them from her mind. And she was actually lucky – at the time, the self-employed architect was able to pay 2,400 leva (1,200 euros) for her therapy out of her own pocket. The chemotherapy medications and several of the medical tests were not paid for by the health fund. Today, she would not be able to fork out this amount.

The Bulgarian National Health Insurance Fund now at least pays the cost of generic medicines. But the fund's spending on pharmaceuticals is currently rising very fast. In 2015 alone, it paid out the equivalent of some 450 million euros ($504 million) more than the year before. The expenses for cancer drugs even doubled between 2012 and 2014. So the fund has to save where it can. At the end of last year, the Bulgarian health minister, Petar Moskov, even gave the pharmaceutical manufacturers an ultimatum: either they offered higher rebates, or their products would be taken off the list of refundable medications.

State miscalculations

But this backfired. "Of the more than 3,000 medications that used to be completely or partly refunded, almost a third have been dropped since the start of 2016," Dr. Stoycho Katsarov, the chairman of the Center for the Protection of Rights in Health Care, told DW. He said cancer sufferers were worst affected, as there was no alternative for at least two of the 12 cancer medications that have been removed from the list. Patients even have to pay for antibiotics completely out of their own pockets, along with many painkillers, cardiovascular and psychotropic drugs.

This is despite the fact that the health funds in Bulgaria, or Romania, negotiate the cheapest prices for medicines in the entire EU. Paradoxically, this is not always to the patients' advantage. When the difference in prices between the poorer and the richer European states continues to grow, it has tangible consequences: Many producers lose any interest they may once have had in offering their products to cheap markets such as Bulgaria or Greece.

Small profits = delivery problems

While new medications come onto the market quickly in high-price countries such as Sweden, Switzerland, Germany or Finland, their introduction to less lucrative markets such as Bulgaria, Poland, Romania or the Baltic states is often delayed. As a rule, several years go by before the pharmaceuticals are even imported by the health fund. Until then, patients have to come up with other ideas, such as buying them abroad or finding sponsors.

But even in the case of established, but low-profit-yielding drugs, there are often delivery problems in poorer countries, because they are deliberately neglected by the manufacturers. For example, Bulgarian drugstores have been without "Diazepam" suppositories for years. "They cost only a few cents, but are the best way to stop babies' and children's epileptic fits quickly and effectively,” the head of the neurological department of the children's hospital in Sofia, Prof. Ivan Litvinenko, tells DW.

Outdated medications, lowered chances of survival

To make the situation worse, Bulgaria's health fund only refunds the cheapest drug from a group of medications - usually, a cheap copy of an original that is often already seen as outdated in the West. The reason is a regulation that was put in place by the pharmaceutical companies: The cheaper generic drugs are only allowed to be put on the market ten years after a new original medication has appeared, i.e. after the license expired, according to Dr. Katsarov. But if people want to obtain the original medication, they have to buy it themselves.

The disparities between East and West in the supply of medications have tangible consequences - and not only financial ones: A new study by the European Cancer Patient Coalition shows that survival rates of cancer patients in eastern Europe are about 40 percent lower than in western Europe.