Price out of health: how expensive drugs are putting lives at risk

Mariana Alexandrova, 53, lives in Sofia, the capital of Bulgaria. She has type 2 diabetes and her heart is very fragile.

“I take three types of medicines for the heart, two types for diabetes and about four other types of medicines for other diseases,” he told Euronews.

Your medical bills can amount up to the equivalent of 100 a month, in a country where the average monthly salary is less than 1000.

Mariana says that despite being a heavy financial burden, she can afford all the treatments. But as president of a patient organization, she says not everyone is so lucky.

“Patients who are retired, or are just retired, or have a very low salary, often choose to treat only one or two out of every three diseases they suffer from,” he explained. “They often take the cheapest one for diabetes and a medicine or two for high blood pressure. But all the other medicines for diabetic foot, eye, kidney, stomach or neurological disease… they just skip it.”

The problem is widespread in Bulgaria, where 19% of respondents in a recent survey said they cannot afford all the medicines they need.

Patients with diabetes and/or cardiovascular disease appear to be particularly affected.

The head of the cardiology clinic at the National Cardiology Hospital, Borislav Georgiev, says the cost of the drugs is potentially life-threatening.

“The problem is that if the right therapy is not implemented, the patient will not get good healing results. We will have a recurrence of coronary problems, we will have complications, repeated heart attacks, the development of atherosclerosis in other parts of the body, for example, the legs, with peripheral arterial disease, strokes and so on,” explained Borislav.

Specific levels of reimbursement by the national health insurance partially explain the situation, and only the Bulgarian government can act on this. But potential EU-wide measures could also help improve things in Bulgaria and in all member states.

Looking for alternatives: generic drugs

In pursuit of more affordable medicines, the European Commission has proposed to increase competition and make generics and biosimilars more readily available.

Bulgarian health ministry adviser Arkadi Sharkov told Euronews he thinks it is a trail worth exploring.

“Generic preemption and substitution are policies that work well in countries with quality and well-developed antitrust laws,” he revealed.

“Therefore, in Bulgaria, in order to move towards this type of action, it is also necessary to review the so-called vertical integration, i.e. the interconnection between the manufacturer, wholesaler and pharmacy, in order to avoid a monopoly advantage when it comes to the dispensing of medicines from part of the pharmacist”.

But the use of generics in Bulgaria is already more widespread than in other larger and wealthier member states.

Therefore, the European Commission is also proposing to use more non-patent medicines reused for new therapies. The hope is that greater availability of alternative therapies will help bring prices down.

Greater transparency about public funding for drug development could also help make it more affordable, says the European Commission.

Whatever they are, solutions are needed, as time is running out for some patients.

“One of my fellow diabetics is 53 years old. At the moment she can only afford a fraction of the medicines for hypertension and the cheaper ones for diabetes,” explained Mariana Alexandrova.

“Everything else, she also has four or five chronic complications and she’s just missing them; she just can’t afford the meds she needs. She just hopes it doesn’t get worse.”