How medicine prices are set in Bulgaria

Healthcare · Last reviewed: 2026-08-23

Who takes the decision

The body responsible for prices and reimbursement is the National Council on Prices and Reimbursement of Medicinal Products. It has the status of a STATE COMMISSION regulating the pricing and reimbursement of medicinal products authorised for use in the Republic of Bulgaria, and it is also the national health technology assessment body (Ministry of Health institutional page, checked 23 August 2026 — confirm current details on the official page).

The Council's functions cover almost every question people have about medicine prices: it approves and registers prices of medicinal products; includes, changes or excludes products from the Positive Medicines List; maintains the reimbursement status of products on that list; performs health technology assessment; monitors the effect of therapy for innovative products; adopts regulations on pharmacotherapeutic guidelines for treatment; and EXERCISES CONTROL over compliance with approved prices, ceiling prices and registered prices.

What the price is based on

The framework of price regulation is set out in a regulation establishing the conditions and rules for regulating the prices of medicinal products included in the Positive Medicines List and paid with public funds. In other words, a manufacturer who wants a medicine paid for from public funds cannot set the price freely: it applies through the prescribed procedure, the price is reviewed, and on approval the product enters the list. Health technology assessment is part of the same process: whether a product deserves public money is judged not by price alone but together with the therapeutic benefit it delivers.

Where the co-payment comes from

For a medicine on the positive list, the part paid from public funds is the reimbursement and the rest is your co-payment. The ratio between the two differs by product and cannot be expressed as a single percentage. That is why this article contains NO sentence of the form such-and-such per cent is covered: such a sentence could only be true for a specific product on a specific date.

In practice the strongest tool for reducing your co-payment is the GENERIC EQUIVALENT. Products from different manufacturers containing the same active ingredient differ in price, and because reimbursement is calculated against a reference within the group, choosing a product near the reference means less out of your pocket. There is one sentence to say to the pharmacist: which product with this active ingredient has the lowest co-payment? Almost nobody asks it, and it is the question that saves the most money over a year.

Expensive medicines requiring a protocol

Expensive medicinal products for home treatment of certain chronic and severe diseases, paid fully or partly from public funds, are prescribed by electronic protocol and released after an expert opinion from a specialised commission at a healthcare facility. The logic here is not price but INDICATION control: so that an expensive medicine reaches the patient who genuinely needs it. The practical consequence: for such a medicine, asking how much it costs at the pharmacy is meaningless; the real question is whether your diagnosis falls within the protocol and how long the procedure takes.

How to check your own medicine

1. 1

   Write down the active ingredient

   Not the brand name but the international non-proprietary name and the dose. Every official list works on that name; searching by brand leads to the wrong answer.
2. 2

   Ask whether it is on the positive list

   Ask your GP or pharmacist. If the answer is no, the whole price is yours and looking for an equivalent matters even more.
3. 3

   Ask how many products share that ingredient

   There is usually more than one manufacturer. Ask for the co-payment difference in writing; a verbal comparison is forgotten by the time you get home.
4. 4

   Account for pack size

   The price per box misleads. The correct comparison is per unit, that is, by daily treatment cost. A pack of thirty tablets and a pack of sixty cannot be compared box against box.
5. 5

   Check whether a protocol is required

   If it is, the process starts at the doctor and takes time. Ask weeks before your medicine runs out.
6. 6

   Review once a year

   Lists and reimbursement statuses change. On chronic treatment, ask your doctor once a year whether your medicine's status has changed.

The problem with saying medicines are cheap in Bulgaria

You will hear this often and it is almost always half a sentence. It conflates three different things: the LIST price of a medicine, the amount out of the PATIENT'S pocket, and the WEIGHT of that amount in a household budget. For prescription medicines the list price is regulated, hence more predictable than a free market; but the out-of-pocket share depends on reimbursement status and on your own insurance status. For an uninsured person there is no such thing as a cheap country: the whole bill lands on them.

If you are comparing countries, watch three traps. First, packaging: the same active ingredient is sold in different pack sizes in different countries, so box prices are not comparable. Second, authorisation: a product sold in one country may not be authorised in another, in which case you are comparing two different things. Third, reimbursement: a low out-of-pocket amount may reflect not a low price but a high reimbursement. The correct unit of comparison is not the box but the DAILY COST OF TREATMENT.

Tax, importing and buying online

The rate of value added tax applied to medicines is NOT written here, because tax rates belong to tax legislation and must be verified from a current official publication of the tax administration. Ask the price question and the tax question separately; online commentary that merges them usually gets both wrong.

On buying online, one rule suffices: do not buy prescription medicine from an unfamiliar website. The European Union has a common logo scheme for recognising pharmacies that sell online, and the logo links from the seller's site to the national authority's list. Nobody can guarantee what a medicine bought from a site with no logo, no address and no authorisation details actually contains — and the cheapest-looking medicine becomes the most expensive one when it delays your treatment.

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