Glycated hemoglobin thresholds for endocrinologist referrals to be lowered

The glycated hemoglobin value used as a criterion for referring diabetic patients for a consultation with a specialist endocrinologist will be lowered. This is envisioned in the draft amendment to Ordinance No. 9, according to the published motives.

Currently, patients are referred when HbA1c is above 8%, which, according to the Ministry of Health, leads to insufficient disease control and an increased risk of complications. It is proposed that a consultation with an endocrinologist be conducted at HbA1c ≥ 7.5%, aiming for earlier intervention and improved metabolic control.

The project also envisages the creation of two new outpatient nuclear medicine procedures for radionuclide therapy with theranostic radiopharmaceuticals for patients with prostate carcinoma and neuroendocrine tumors. The drugs Pluvicto and Lutathera, already included in the Positive Drug List, will be covered by the NHIF, requiring an outpatient procedure to monitor the therapeutic effect.

A number of other changes in the NHIF activity package are also planned, including:

• adding activities for targeted immunizations in primary and specialized outpatient medical care;
• inclusion of new specialized activities in the field of maxillofacial surgery;
• introduction of “prevention of sexually transmitted infections” activities in obstetrics and gynecology;
• expansion of clinical microbiology testing;
• creation of new clinical procedures for pediatric intensive care;
• a new clinical pathway for transient ischemic attack, proposed by the Bulgarian Society of Neurology.

In the field of radiotherapy, clinical pathways are being updated; the outdated clinical pathway for three-dimensional telegammatherapy is being removed, and names are being adapted to modern technologies.

The full text of the draft ordinance and the motives for it can be viewed here.