Pavel Kolev: "We are not catching up with the future - we are already in it"

Pavel Kolev graduated from the Medical University – Sofia with a Master’s degree in Pharmacy and has over twenty-five years of professional experience in the pharmaceutical industry.

His career at AbbVie began in 2012, and over the years he has held leadership roles in the Bulgarian affiliate, as well as in the Eastern Europe, Middle East, and Africa region. In 2020, Pavel Kolev joined the company’s global marketing team and later served as Director of the Immunology business unit in Russia. Since the summer of 2022, he has returned as the General Manager of AbbVie Bulgaria.

Pavel Kolev has been a member of the Board of Directors of the Association of Research-Based Pharmaceutical Manufacturers in Bulgaria (ARPharM) since May 2023. A year later, he was elected Deputy Chairman, and on May 14, 2025, he was elected by majority as Chairman of the Board of the Association.

SECTION 1: THE GREAT TRANSFORMATIONS – SCIENTIFIC PROGRESS, ETHICAL STANDARDS, PUBLIC MISSION

We live in times where science and technology are fundamentally transforming our understanding of health. How will these changes reshape the pharmaceutical industry over the next decade?

Pavel Kolev: We live in a time when science is not just advancing – it is transforming the very model of medicine. Genomics, next-generation biological therapies, data integration, and artificial intelligence – the pace is unprecedented. We often do not realize that we are not catching up with the future. We are already in it. The faster we accept this fact and adapt, the more successfully we will participate in the global transformation.

Over the next decade, science will change the pharmaceutical industry beyond recognition. The boundaries between biology, data, and technology are beginning to blur, paving the way for solutions that until recently sounded like science fiction. We are talking about a world where diseases will be identified before symptoms appear, therapies will be personalized in real-time according to the patient’s biological profile, and artificial intelligence will assist scientists in discovering new molecules at a pace that the human brain alone could not reach. The pharmaceutical industry is gradually evolving from a drug manufacturer into a source of complex health strategies based on biotechnology, digital biomarkers, and integrated therapeutic platforms. The focus will shift increasingly from treatment to disease prevention.

Of course, this change also requires a new type of leadership – one that thinks systemically, balances scientific, regulatory, and social aspects, prioritizes long-term vision over short-term gains, understands the ethical boundaries of technology, and turns data into solutions with real long-term value for patients.

In the face of intensifying economic, political, and social pressure, how will the pharmaceutical industry preserve its ethical core? Where is the line between scientific progress and moral responsibility?

Pavel Kolev: The ethical core of the pharmaceutical industry has always been at the heart of the trust we build with the medical community, institutions, and society for the sake of patients. This is not something we activate under pressure – it is the foundation upon which we have built the sector. And the stronger the economic, political, and social challenges, the more important it is for this foundation to remain stable. The line between scientific progress and moral responsibility is clear: science opens doors, but morality determines how and when we cross them. Progress only makes sense if it serves people, if it improves their lives in a transparent and sustainable way. In times when we talk about the growing role of artificial intelligence in the development of science, the need to invest in humanity becomes even more urgent. Technology can analyze, predict, and optimize, but it cannot replace human judgment, empathy, responsibility, and moral choice. I believe that science and morality are not opposing forces. They must evolve together. When scientific progress is guided by ethical principles and humanity, it becomes true value for patients and society. And that is the most essential mission of our industry – to preserve trust while driving progress in a responsible, transparent, and human way.

You often emphasize the role of health as a factor for economic growth. How can we shape a social environment where health is perceived as strategic capital and a long-term investment rather than just an expense?

Pavel Kolev: The link between health and economic development is becoming increasingly obvious, especially in the context of the demographic crisis in Bulgaria. We are talking not only about a declining population but also about a significantly shrinking share of economically active people. The combination of an aging population, high chronic morbidity, and the emigration of young specialists creates a double challenge: on one hand, lower revenues in the economy, and on the other – higher needs for health investments. Against this backdrop, Bulgaria continues to invest one of the lowest shares of GDP in health, we have the highest levels of out-of-pocket payments in the healthcare system, and we remain at the bottom of European rankings for preventable mortality and life expectancy. This is a signal we cannot ignore. If we want to reverse the trend, we must change the philosophy through which we view healthcare: health is not an expense, but strategic capital and a key investment in the nation’s resilience.

How can we achieve this change?

First – prevention, early diagnosis, and timely access to modern treatment. These are the three most effective tools for reducing the burden of disease and for long-term maintenance of good health.

Second – transparency and predictability in the financing of the system. Investments in healthcare must be aligned with the real health needs of the population to move from reactive management to strategic planning. Currently, health budgets are determined based on the lowest health insurance contribution in Europe (8%), combined with low collection rates and a lack of transparency regarding the financing of civil servants and socially vulnerable groups. The result is limited financial resources that do not allow for the sustainable development of modern, effective, and contemporary healthcare that society expects. Furthermore, budgets are allocated not according to current medical needs, but based on available funds and historical distribution from previous years. This leads to a hidden deficit in the system, creates distortions, and hinders predictability, and a predictable environment is key to attracting more significant investments and innovations.

Third – integrated policies and sustainable partnerships. Neither the state, nor the industry, nor the medical community can manage alone. Common solutions are needed – from creating registries and digital tools to integrating innovative therapies and new approaches in the treatment of chronic diseases.

Fourth – educational initiatives and incentives for healthy behavior. Active communication is needed regarding the role of health as a factor for economic growth and specific incentives aimed at employers and citizens. The benefit is mutual: better quality of life and higher productivity.

SECTION 2: EUROZONE, BUDGETARY MECHANISMS, REGULATIONS AND SYSTEM SUSTAINABILITY – RISKS AND OPPORTUNITIES

Bulgaria’s entry into the eurozone is more than a financial step – it is a new framework of trust. What will be the real consequences for patients and how will their access to modern treatment change?

Pavel Kolev: Bulgaria’s entry into the eurozone is a strong signal of integration with European standards – transparency, predictability, and sustainability. These principles are critical for modern healthcare and for equal access to treatment. For patients, the potential is significant. The eurozone can provide more stable financing, easier integration of European mechanisms, and higher standards for the quality of treatment. However, this will not happen automatically. To accelerate the introduction of innovations, real structural reforms and a predictable environment that allows for long-term solutions are needed. There should be no compromises with access to innovation.

The eurozone should be a driver for a more efficient system – with modernized, electronic, and faster evaluation procedures. Economic stability is not an end in itself, but a means to build a sustainable, predictable, and patient-oriented health system.

Do you expect an increase in pressure on drug prices in our country, and what would prevent the risk of limiting access to innovative therapies?

Pavel Kolev: Pressure on drug prices in our country is a constant trend. This is due to both strict budget constraints and the regulatory framework. Bulgaria applies the lowest price rule, determined based on 10 reference European countries. Thus, in practice, we have some of the lowest drug prices in Europe. Added to this is the regular price revision procedure under the control of the National Council on Prices and Reimbursement of Medicinal Products (NCPRP). At the same time, Bulgaria remains the country in Europe with one of the highest levels of VAT on medicines (20%). This increases the final financial burden on patients and puts additional pressure on accessibility, despite the fact that manufacturer prices are among the lowest on the continent. This factor often remains outside the public debate but is key to the real price people pay.

In addition, in recent years, pressure has intensified from the so-called Mechanism for Predictability and Sustainability of the NHIF Budget. The problem is that the NHIF budget does not reflect real health needs, thus accumulating a growing deficit that is fully compensated by the industry. For 2025, the amount that companies will have to return to the NHIF is expected to exceed 900 million BGN, or over 30% of actual drug consumption. In other words, this means that the NHIF reimburses the therapies that Bulgarian doctors prescribe until August, and for the rest of the year, these therapies are provided entirely by the industry. In the budget proposal for 2026, this imbalance between patient needs and public funding will continue to grow. In certain cases, the NHIF effectively seizes the entire revenue from the growth in medication use, which can lead to absurd situations – a company delivering a drug practically for free or even at a negative price.

If this trend deepens, access to innovative therapies in Bulgaria is at serious risk. The entry of new treatments will slow down, patients will wait for years, and the pressure on the system and chronic diseases will increase.

I believe that through constructive dialogue with institutions, we can find a sustainable financing model that is both predictable for the state and fair to the real health needs of the people.

If Bulgaria misses the moment for strategic reforms, what will be the consequences of insufficient funding for the health system?

Pavel Kolev: Bulgaria has long been late with strategic reforms in healthcare, and this fact became very clear during the COVID-19 pandemic and thereafter. If we continue to postpone decisions and underestimate the importance of sustainable financing, the consequences will not be temporary. They will manifest in three directions – health, social, and economic – and they will be negative and long-term.

Above all, our lag in access to innovation and modern therapies will deepen. In the worst-case scenario, Bulgaria risks becoming less attractive to international pharmaceutical companies, which means fewer clinical trials, less innovation, and more limited choices for patients and their treating physicians.

Unfortunately, patients will bear the heaviest part of the consequences. Timely access to diagnostics and modern treatment will become increasingly difficult, and this directly reduces the chances of full recovery or good disease control. With limited public resources, more people will be forced to pay more out-of-pocket for their treatment, and this will inevitably increase social inequality.

Health becomes a function of income, which is the most alarming signal for any system.

The third effect is economic. When patients do not receive timely treatment, hospitalizations increase, hospital stays are prolonged, workforce productivity decreases, and quality of life deteriorates. This creates a vicious cycle: more sick people → more expenses → less economic growth → even fewer opportunities for health investment.

That is why I often say that the question is not whether we need reforms, but whether we can afford to postpone them any longer. Underfunding is not just an accounting problem; it is a risk to the country’s future. If we want sustainability and European quality of healthcare, we need a realistic and long-term financing model that meets people’s needs. It requires consistency, political will, and open dialogue between institutions, the medical community, and the industry. Only then will Bulgarian patients receive healthcare that does not just treat, but provides perspective.

What conditions are needed for Bulgaria to remain an attractive destination for investment in healthcare and science?

Pavel Kolev: If we want Bulgaria to remain attractive for investment in healthcare and science, we must say things directly: industry invests where there is predictability, sustainable financing, reasonable rules, and respect for the value of innovation. Everything else is a risk that international companies simply cannot afford.

A predictable regulatory environment is a key condition. Companies make decisions with a long-term horizon. When processes are slow, inconsistent, or change suddenly, trust is undermined. And without trust, there can be no investment.

A sustainable financing model is needed that actually covers health needs. When budgets lag and risk is transferred unilaterally to the industry, investors pull back.

Bulgaria must show a clear vision for the role of innovation. Countries that clearly state that innovative therapy, digitalization, and scientific progress are priorities automatically become preferred partners. And we in Bulgaria are at a crossroads. Either we create an environment where rules are stable, decisions are predictable, and access to therapy is guaranteed, or we must accept the risk of seeing a withdrawal of investment, a slowdown in innovation, and worsened prospects for patients.

SECTION 3. INNOVATIONS AND THERAPEUTIC PRIORITIES

Which scientific fields and therapies will define AbbVie’s strategic focus in the coming years? Where is the great potential for transformation?

Pavel Kolev: AbbVie’s strategic focus in the coming years will be defined by those scientific fields where innovation has the potential to fundamentally change the way we treat and increasingly prevent serious diseases. Over the past few years, AbbVie has significantly accelerated its investment in research and development, focusing on developing new therapies specifically in the fields of autoimmune diseases, neurology, aesthetic medicine, and oncology. In parallel, the company has entered into strategic partnerships with leading biopharmaceutical companies and research institutions. This is not just about expanding the portfolio; it is a long-term strategy that will allow us to build on the potential of existing therapies and introduce completely new solutions for patients.

The main key pillar of the company is immunology. Here the transformation is most palpable – from broad-spectrum therapies to precise, targeted solutions that address specific disease mechanisms. Crohn’s disease, ulcerative colitis, rheumatological, and dermatological immune-mediated diseases are areas where there is still huge untapped potential. New generations of biological and modulator therapies will be decisive over the next decade.

The second strategic focus is oncology. This is one of the fields where science is advancing most rapidly. AbbVie invests in therapies targeting specific molecular mechanisms of tumor growth to new immuno-oncology platforms and personalized combination approaches. The goal is to turn some of the most severe oncological diagnoses into chronically manageable diseases.

A key priority for the company is also neurology – an area where social and demographic pressure is growing exponentially. Diseases such as Parkinson’s, Alzheimer’s, migraine, or rare neurological conditions require a new type of innovation. AbbVie is already working on therapies that target specific brain pathways and cellular mechanisms, and this is one of the areas where I expect the greatest acceleration in the coming years. In short, the great potential for transformation lies precisely in this – the intersection of biology, data, and technology. In this sense, AbbVie’s focus in the coming years is clear – to be in those areas of science where innovation can change the course of serious diseases – on a large scale, long-term, and in reality.

Where do you see the strongest potential for partnership between industry, the medical community, and institutions – so that collaboration is not formal but brings measurable value?

Pavel Kolev: Partnership between industry, the medical community, and institutions makes the most sense where we can together change the trajectory of diseases and ensure a better quality of life for people. I believe that it is precisely in prevention, early diagnosis, and adequate access to modern therapies that the greatest untapped potential lies. These are areas where no single party can achieve a sustainable result independently.

When industry provides data, scientific evidence, and real solutions, the medical community brings clinical experience and expert assessment, and institutions create a predictable framework and policies, then the system begins to work in sync. This is exactly the moment when partnership ceases to be formal and becomes a driver of real change.

Another important direction where we can achieve much more together is the use of data and digital tools. Bulgaria needs an integrated health information system that does not just collect data but turns it into insights for earlier disease detection, more accurate prognosis, and more informed decisions.

And something very important: partnership is not a process of coordination. It is a process of building trust. It works only when it is transparent, based on facts, and when our focus is the same – the patient.

SECTION 4: LEADERSHIP AND PERSONAL PERSPECTIVE

What motivates you personally to take on the leadership of the Board of Directors of ARPharM at this exact moment, when the sector is under a strong public spotlight?

Pavel Kolev: This is an exceptional honor for me, as this position is elective, and precisely because of the trust placed in me, I perceive it as a huge responsibility. I am motivated by the fact that the sector is at a critical stage and needs strong, consistent leadership. Today, healthcare and the pharmaceutical sector face three key challenges:

• Chronic underfunding and hidden deficits, which threaten access to innovative therapies.

• Strong geopolitical and economic instability, which increases uncertainty and puts European competitiveness in innovation at risk.

• Political unpredictability and lack of long-term vision, which hinder reforms and sustainable development of the system.

Under these conditions, it is important for the industry’s voice to be clear and consistent. My motivation comes from the conviction that we can achieve real results – to protect access to modern therapies, to work for a predictable environment, and to place healthcare among national priorities.

Looking at your role as General Manager of the Bulgarian affiliate of AbbVie – how do you build a corporate culture where ego has no place, and personal responsibility is maximized?

Pavel Kolev: Ego having no place… that is what I dream of and work for daily. Cliches are cliches because they are true – “culture eats strategy for breakfast.” At AbbVie Bulgaria, we develop a team that is engaged, responsible, and adaptable, because in a dynamic environment, the ability to change is more valuable even than experience and knowledge. I am proud to work with professionals who put their hearts in daily and seek the best in everything they do. My role is to encourage the team to look forward, because what has brought us success so far will not always guarantee it tomorrow.

Regarding personal responsibility, there is one rule – trust. I strive to be a leader who supports, listens, and stimulates open dialogue. I maintain an “open door” policy, and everyone on the team knows they can turn to me at any time.

Do you have a personal formula for balance between ambition, responsibility, and personal life, or is balance simply a form of discipline?

Pavel Kolev: I don’t have a universal formula! I don’t believe in formulas in real life, although I consider myself good at mathematics and logical thinking.

Ambition is valuable when supported by ability, effort, and a clear goal.

I value responsibility most – it builds trust and shows true leadership, especially in difficult moments. I strive for my ambition to always go with vision and taking responsibility for my decisions.

I am fortunate to receive strong support from my family, which helps me find balance – or step out of it when necessary. My wife and children support me fully and understand me in most cases.

I believe that boundaries and balance are a personal and difficult choice… I know one thing – without sacrifice there is no success, and without risk there is no victory. I am against complaining and shifting responsibility onto others for our own work-life balance. This is a matter of individual choice, a matter of priorities and conscious decisions. And as for whether there is an ideal scenario – probably not!