The biggest obstacles inhibiting the growth of the Macedonian pharma market were limited competition due to its small size and intricate procedures to register new medicines. The external manifestation of these circumstances was the relatively high cost of some pharmaceuticals and medical devices in comparison to the neighbouring countries. In addition, the supply of the reimbursed drugs included in the list provided by Health Insurance Fund was frequently insufficient. Since the availability of the medicines which could be bought by the patients privately was adequate, the expenditures of the customers on the health care were significantly elevated.
To overcome these problems, the reference price system was implemented. The reference price is the maximum amount, which can be reimbursed by Health Insurance Fund. In case of higher expense of a medicinal product, the consumer has to cover the difference between its actual and reference price or to choose a therapeutically comparable product. The second aspect of the new strategy was to simplify the procedure of drugs registration to foster the big producers from EU and the USA to enter the market more willingly. Moreover, the prices of drugs were set at the same level in every pharmacy in the country.
In the aftermath of these changes, it turned out that the reference prices were lower than the export ones. Going further, the new pricing system has become unfavourable for drugs producers to sell their products in Macedonia. Pharmaceutical companies did not want to supply medicines for the referent prices proposed by the government and the supply of these products became insufficient again. Therefore, the only possibility was to buy an analogous drug of another producer, but with usually higher co-payment.
In October 2012 the Macedonian government lowered the price of some medicines once more. The drugs for cardiovascular diseases, for example, were cut by 70% and antibiotics by 18 to 40%. Another consequence of the slashes is the phenomenon of so-called pharmaceutical tourism. People from neighbouring countries, such as Serbia, Bulgaria, Greece and Albania, buy medicines in Macedonian pharmacies since they are significantly cheaper there than in their domestic drugstores. In one of the Macedonian pharmacies, a customer from Bulgaria said for the Southeastern European portal SETimes.com, "We come here almost every weekend from Blagoevgrad to buy medications from your pharmacies, but also to buy other products. It is true that here the prices are lower than in Bulgaria, and I also know a lot of friends who often come in Macedonia to buy the needed products."
The example of the Macedonian healthcare strategy shows that every regulation has to be introduced with caution and all possible effects have to be taken into consideration during such changes. Nevertheless, it is a good sign that the pharmaceutical market in Macedonia is being reformed and it is very interesting to observe what will happen in the future.
by Jakub Chrustowicz
Lazarevik, Vladimir. "Policy Interventions to Tackle Health Inequities in Macedonia: Patient Rights and Reference Pricing of Pharmaceuticals." Macedonian Journal of Medical Sciences 3.1 (2010): 57-60. Web.
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