Minister Kirilov: 40% of the Healthcare Budget Is Allocated to Medicines; Stronger Security and Control Mechanisms Are Required

Approximately 40% of healthcare funds in Bulgaria are directed toward medicinal products. This was stated by the Minister of Health, Assoc. Prof. Silvi Kirilov, during the 7th National Congress of the Bulgarian Medical Association (BMA) on “Healthcare Policies,” held in the St. St. Constantine and Helena resort. He emphasized that the high share of expenditure on medications creates a risk of imbalances in the drug supply chain—from production to pharmacies—which could lead to negative consequences for patient treatment.

The Minister recalled that as early as 2021, the state established a regulatory framework for maintaining a reserve of key medications in hospitals with state and municipal participation. This ensured stocks of four critical INNs: Heparin, Enoxaparin, Nadroparin, and Dexamethasone. These reserves are a vital element of crisis response readiness, such as for pandemics and natural disasters, and serve as a buffer during supply chain disruptions.

In parallel, the State Agency “State Reserve and War-Time Stocks” also maintains a list of medications for emergency situations, prepared in coordination with several ministries.

In response to the issue of shortages, the SESPA electronic system for monitoring medicines on the Positive Drug List has been operational since 2018. It identifies medications in short supply that are temporarily prohibited from being exported from the country. Updates are forthcoming: calculating needs based on 100% of monthly consumption (instead of 65%) and including all prescription-only medicinal products. It will also become mandatory to enter the verification code for every package.

Data from the Bulgarian Medicines Verification Organisation show that only 50–60% of packages in the country are correctly decommissioned from the system. This is expected to improve following the introduction of mandatory information submission to the National Health Insurance Fund (NHIF).

“Medicines are not an ordinary commodity—they are vital for health and life, which is why states treat them as a strategic resource,” Kirilov stated.

He emphasized that the sustainability of drug supplies requires prevention and diversification. Dependence on a limited number of manufacturers or countries leads to systemic risks; therefore, it is necessary to expand sources and create strategic reserves.

Kirilov also pointed to European initiatives in this direction—the Critical Medicines Act, the EU Stockpiling Strategy, and the Medical Countermeasures Strategy—which aim to strengthen manufacturing capacity and guarantee access to medications within the EU.

“Medicine shortages are not merely a logistical problem, but a serious risk to public health. Strategic and coordinated action is required,” the Minister concluded.