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Bulgaria’s Blank Cheque For Private Hospitals’ Drug Spending: EU Penalty Alert

The European Commission is heavily fining Bulgaria for ignoring a 2019 infringement procedure that started due to a lack of an obligation for private hospitals to perform public procurement for medicines.

Parliament’s Confirmation And EU Law Breach

On 29 September, the EU executive noted that most members of Bulgaria’s parliament confirmed this ongoing practice, a breach of EU law.

MP from the pro-EU coalition We Continue the Change – Democratic Bulgaria Vasil Pandov stated, “This is an unequivocal violation of EU law, for which there has been an infringement procedure against Bulgaria since 2019. We will pay with our taxes hundreds of thousands of euros (every day).”

This coalition is the main political force empowering the government. In early September, the parliament proposed that the government change the Public Procurement Act to stop the breach.

Rules For Private Hospitals’ Drug Purchases And The Pemetrexed Scandal

Presently, licensed big private hospitals can purchase drugs and treat patients with public money, but unlike public hospitals, they cannot hold tenders and, instead, buy drugs via direct negotiation.

For over four years, these rules caused a public scandal when the ex-manager of the National Health Insurance Institution, Decho Dechev, revealed that private hospitals paid eight times more than state ones for a similar drug (Pemetrexed) to treat oncological diseases, with the price ranging between €65 and €530.

Health Minister’s Proposed Law Change And GERB’s Vote

Dechev presented data revealing that private hospitals purchase more drugs at higher prices than state hospitals; however, the most significant difference often applied to Pemetrexed. As a result, the third government of Boyko Borisov, in power during that era, opposed it and accused it of corruption and lobbying, resulting in a parliamentary scandal.

In 2020, Kiril Ananiev, the health minister of GERB and financier, proclaimed that he would propose a change in the law to qualify private hospitals for making public procurements when using a public resource.

European Commission’s Infringement Procedure Reasons

After three years, the change was not implemented, and in the parliamentary proceedings in late September, GERB once more opposed the obliging private hospitals to tender.

The European Commission started an infringement procedure against Bulgaria, claiming that private hospitals are qualified as state hospitals in using state resources.

Bulgarian law enables private hospitals to prioritize stock drugs due to their higher payment, as well as trading through affiliated companies, declaring higher drug prices, and receiving full reimbursement from the state.

Upcoming Parliament Vote On Price Cap Proposal

Later, in October 2023, the Bulgarian parliament will vote on the government’s proposal to stop hospitals from paying different prices for similar drugs.

Euractiv’s unofficial information stated that this proposal would be rejected because of the opposition of prominent private hospitals and drug suppliers.

The private health sector debates that the imposition of a price cap will result in considerable challenges in the supply of medicines and eventually worsen the issue of the scarcity of rare medicines.

Rejection Of Proposal To Remove Unregistered Drug Purchases

Most members of the parliament also opposed another relevant proposal of the government to disqualify state and private hospitals from buying unregistered drugs without going through public procurement. These drugs are scarce in the Bulgarian market but can treat specific diseases without alternative medications.

These are mainly medicines to treat oncological, rare, and other unregistered diseases in Bulgaria because of the manufacturers’ lack of commercial interest owing to the small size of the local market.

To avoid abandoning the patients in the country without treatment, hospitals now order them as required, without public procurement processes.


The EU fines Bulgaria for not implementing medicine procurement rules in private hospitals. Recent parliamentary confirmation of this practice, despite EU law violations, has worsened the issue. Price disparities, legislative delays, and opposition from private hospitals and suppliers led to a complex healthcare procurement environment in Bulgaria.

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