News

21 May 2025

The Ombudsman Institution approached the Minister of Health Silvi Kirilov, the Governor of the National Health Insurance Fund (NHIF) Petko Stefanovski, the Chair of the NHIF Supervisory Board Yavor Penchev and the Chair of the Bulgarian Medical Association Nikolay Branzalov to notify them about the failure of the NHIF to pay for the biomarker diagnostics which is mandatory for modern medicine in the field of cancer treatment.

The Ombudsman Institution’s move was inspired by a letter from The Life with Cancer Foundation to report violation of rights of cancer patients to access proper diagnostics and thus to deny them modern medical care and the provision of adequate and timely drug medication.

The Foundation draws attention specially to the importance of biomarkers for the diagnosis and the choice of the most appropriate and effective treatment of cancer diseases to the discussions and actions so far regarding the regulation of the payment of biomarker diagnostics by the NHIF.

“As long as a budget is available, the only problem is to clarify the administrative steps for the diagnostics to proceed,” writes Nikolay Dikovski, Chair of The Life with Cancer Foundation, to the Ombudsman Institution.

In his view, the problem is “the completion of the negotiations and the establishment of an administrative procedure for the appointment, performance and payment of biomarker diagnostics.”

He describes in detail the risks facing cancer patients – Bulgarian oncologists have no access to a modern approach to diagnostics and the choice of a therapy approach; there exists absolutely no transparency in public funds spending to pay for medications for which biomarker diagnostics is an imperative requirement to meet the restrictions of the therapeutic indication of the respective product; Bulgarian patients have to bear a huge burden and for some of them modern treatment becomes unaffordable; an unprecedented ethical risk arises for Bulgarian patients who together with their doctors seek how they can receive biomarker diagnostics; the NHIF transfers obligations to ensure the provision of quality, timely and necessary medical service to private-law entities, viz. the pharmaceutical companies.

“Patients have been made hostages to the decision of individual companies to launch campaigns to support affordable biomarker diagnostics through which they may get organizational and financial support, if and as much as the individual pharmaceutical companies can do that,” the Chair of The Life with Cancer Foundation warns further.

“With concern about what is described above, we would like to recall that at the start of this year, the Ombudsman Institution approached the Minister of Health and the Governor of the National Health Insurance Fund to insist that measures be discussed and taken to ensure guaranteed access for patients to biomarker tests and the payment for them with public money. In response, detailed information was received about the steps taken by the Ministry of Health, concluding with the statement that the National Health Insurance Fund is committed to the payment of medications for biomarker diagnosis, in addition to the cost of the outpatient procedure for individuals with certain cancer diseases. At the same time, it is noted that the provision of biomarker diagnostics will ensure individualized treatment, which seeks to ensure better quality and to prolong the life of patients. The NHIF also informed about actions taken and allocations made for medical devices for biomarker diagnostics in cancer diseases,” the Secretary General of the Ombudsman Dr. Aysun Avdjiev writes to the authorities notified.

He emphasizes that he is worried by the information provided not just by the Chair of the Foundation but also by other patients’ organizations about a problem in the regulation of the payment of biomarker diagnostics with public money and the ensuing risk for patients with cancer diseases to be barred from access to the mentioned tests.

“In this regard, with understanding of the need to find a solution that fully guarantees the rights of citizens who are victims of this fatal disease which ranks second among the causes of mortality in EU countries, we ask you to provide an opinion and information on the problem herewith while we would like to point out the need to discuss and take action to guarantee that the commitment made is met and to regulate the payment of biomarker diagnostics with public money,” Dr. Avdjiev writes further.

He insists that understanding be shown to patients with cancer diseases and that their access be not barred to this important tool of diagnostics, which is important for them and which they needed for prescribing the most efficacious and individualized therapy considering the condition of each patient.