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Drug makers ask for a 2027 medicines budget in line with demand as they cover a third of NHIF drug spending

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Pharmacy shelves stocked with rows of medicine boxes in soft focus Health
Pharmacy shelves stocked with rows of medicine boxes in soft focus

ARPharM says medicines consumption will rise by nearly 14% in 2026; rebates paid by pharmaceutical companies are expected to exceed €500 million this year, up from €209 million in 2022.

The budget for medicines in 2027 should grow in line with projected consumption, the Association of Research-Based Pharmaceutical Manufacturers in Bulgaria (ARPharM), the Association for the Development of Bulgarian Healthcare and healthcare experts said in a joint position at a discussion in Sofia on 4 November, BTA reported.

Medicines consumption is expected to rise by nearly 14% in 2026 compared with 2025, ARPharM Executive Director Deyan Denev said. Demand for modern treatment is growing faster than the budget of the National Health Insurance Fund (NHIF), so the industry has to cover the shortfall each year. This year, pharmaceutical companies are expected to cover one-third of the NHIF's medicines budget, with the fund paying 67%, Denev said.

"Our minimum request is that if medicines consumption is expected to grow by a certain percentage, the budget should increase by the same percentage," he said. Uncertainty over companies' financial commitments creates risks for reimbursement agreements with the NHIF and for collecting rebates, he added.

Rebates and other payments by pharmaceutical companies to the NHIF were €209 million in 2022, €317 million in 2023, €409 million in 2024 and €450 million in 2025, and are expected to exceed €500 million in 2026, said Arkadi Sharkov, a healthcare economist at the Expert Club for Economics and Politics. He also noted that Bulgaria has one of the highest VAT rates on medicines in the EU.

Petar Petrov, a legal and regulatory affairs expert, said 54% of the new therapies available in the EU have not been launched in Bulgaria because companies would make losses by introducing them. He said prices of medicines on the Positive Drug List, which the NHIF reimburses, are the only ones that have not risen in recent years, and the mandatory rebate starts at 10% and can reach 33%.

Boryana Boteva, chair of the Association for the Development of Bulgarian Healthcare, said the NHIF covers 75% of the cost of therapies for rheumatological conditions and companies have covered the rest for 16 years. If they stop, patients would pay about €150 a month themselves, she said.

Sources