The BMA Assembly granted a mandate for signing the 2026-2028 NFA under specific parameters

With 152 votes in favor, 45 against, and 19 abstentions, the 79th Extraordinary Assembly of the Bulgarian Medical Association granted a mandate to the BMA Management Board to sign the upcoming 2026-2028 NFA according to specific parameters approved by the delegates. This was reported by the professional organization.

The Chairman of the BMA thanked the highest forum of physicians for the decision to assign and delegate the Management Board to conduct negotiations for signing the NFA once again under extreme conditions, without an adopted budget. Dr. Branzalov added that the 2026-2028 National Framework Agreement will enter into force after the adoption of the national budget, as the prices and volumes of medical activities are an integral part of it; however, given the political situation, there is no clarity on the timeframe for this.

The BMA will advocate for at least a 10% increase in clinical pathway prices if the budget increase remains as it is currently. In primary outpatient care, the increase is 5.5%, and in specialized care, nearly 5%, with a slight increase for all major examinations in specialized outpatient medical care.

Regarding the new points in the text, which were discussed with the specialty boards, consensually adopted during negotiations between the NHIF and the BMA, and coordinated with the Ministry of Health, amendments to Ordinance 9 are forthcoming. Two new outpatient procedures are being established: “Radionuclide therapy with theranostic radiopharmaceuticals for neuroendocrine tumors” and “Radionuclide therapy with theranostic radiopharmaceuticals for prostate carcinoma.”

At the request of pediatric intensive care specialists, two clinical procedures are included for Intensive treatment, monitoring, and intensive care with mechanical ventilation and/or parenteral nutrition in children, and Intensive treatment, monitoring, and intensive care without mechanical ventilation and/or parenteral nutrition in children.

Two new clinical pathways have also been agreed upon: Transient Ischemic Attack and Treatment of Urogenital System Infections.

The policy of dividing certain clinical pathways by severity levels continues. It was also agreed that medical referrals for PET scans will be valid for 60 days, instead of the current one-month period.

At the request of the BMA, referrals for specialist examinations required for the continuation of home treatment with medicinal products prescribed by protocol, as well as Form No. 3 referrals for preventive check-ups for children up to 1 year of age—consultations with an ophthalmologist, orthopedist, and ultrasound of the urinary system—will be outside the regulatory standard.

GPs will be able to issue prescriptions without an examination for individuals with a temporary factual inability to visit the doctor for medical reasons, as well as for health-insured persons with permanent mobility impairments. Prescriptions can be issued for a period of up to 6 months from the last documented examination. Another new feature is the simplified procedure for changing a GP. Patients will continue to choose a new one twice a year, but the procedure will be completed within one working day.

The 79th Extraordinary Assembly of the Bulgarian Medical Association also welcomed the creation of an electronic health card and adopted the financial execution report of the budget as of November 30, 2025, as well as the draft budget of the professional organization for 2026.

Delegates voted using electronic devices, which has occurred repeatedly at BMA Assemblies.