Bulgarian pharmacists oppose state-funded medicine vending machines, threaten protests

Bulgarian pharmacists say they are ready to start protests if parliament passes a bill for state-funded vending machines selling medicines in towns without pharmacies.

The bill was introduced by the radical pro-Russian Revival party, the third force in the Bulgarian parliament. It received initial support before the start of the election campaign for the early general election, scheduled for 27 October.

The bill states: "The state finances the opening of pharmacies, including 24-hour pharmacies, or the sale of medicinal products through vending machines in municipalities for which there is a shortage of pharmacies." The bill also provides for a reduction in the corporate tax on medicine suppliers in small towns with no pharmacy, from 10% to 8%.

The proposed legislation was never finally adopted as parliament was dismissed at the start of the election campaign - but the political debate is likely to resume in November.

Pharmacies over vending machines

Pharmacy associations say they suspect underhand lobbying interests behind the bill and are demanding that the government pay for the opening of pharmacies in small towns rather than vending machines.

Revival justifies the proposal by citing the lack of interest from pharmacies in opening branches in towns with a small population, pointing out that there are no 24-hour pharmacies in six large regional centres. Some MPs from Revival suggested that even the sale of prescription drugs from vending machines could be allowed, which caused an additional sharp reaction from the pharmacy sector.

"There is no problem with prescription drugs, which are prescribed by a doctor, to be purchased from pharmacies, and not only from the vending machines for medicines," Revival MP Margarita Gencheva said.

According to Gencheva, the goal is to do "everything possible to ensure access to medicinal products in small settlements".

Uneven distribution

An analysis by the influential Bulgarian think tank Institute for Market Economy found that in 2023, nearly 10% of Bulgarian municipalities did not have a pharmacy. Another 15% had only one. The total number of pharmacies in 2023 continued to decrease.

Additionally, their location continued to be concentrated in the big cities.

Nearly 25% of all pharmacies in the country are in the capital, Sofia, while access to medicines in the smallest municipalities remains very limited.

The population of some tourist municipalities is best provided with pharmacies - the Black Sea municipalities of Nessebar, Primorsko and Tsarevo, as well as the municipality of Bansko, where one pharmacy serves less than 1,000 people. At the other end are the agricultural municipalities, where one pharmacy serves more than 10,000 people.

Revolt of the pharmacy sector

Bulgarian pharmacists immediately announced they were ready to protest the bill proposed by Revival.

"Deputies openly talked about providing prescription drugs through vending machines outside the pharmacy! This would set a precedent with irreparable and irreversible consequences for patient safety and health, thus worsening patient access to medicines and pharmaceutical care," said a statement signed by all national pharmacy associations.

They added that "The bill as it stands will not solve any of the problems in the pharmacy supply; on the contrary, it will deepen the current ones and has the potential to open new ones."

The pharmacy industry claimed that the vending machines would stimulate lobbying interests because the merchants could load medicines into the machines after tacit agreements with certain pharmaceutical companies or distributors.

Bulgarian law currently allows vending machines for the sale of medicines without a prescription, but only inside pharmacies.

In the last two years, there has been a fruitless debate in the country about expanding access to medicines with vending machines, but the initiative has been stopped by the pharmacists' resistance.

The pro-European coalition We Continue the Change - Democratic Bulgaria, however, spoke out against the introduction of vending machines for medicinal products because the law allows the sale of medicines with a doctor's prescription.

According to the Chairman of the Parliamentary Committee on Health, Alexander Simidchiev, the pharmacists' concerns are reasonable.

"Vending machines cannot solve the problems because the sale of prescription drugs can only be done with a secured video link with a pharmacist," Simidchiev said. He added that vending machines cost a lot of money and, if put in small settlements, they will not pay for themselves.

[Edited by Vasiliki Angouridi, Brian Maguire]