Bulgaria’s cancer biomarker testing gets funding boost

Critical diagnostic tests for cancer patients will finally be funded by the Bulgarian government after a long campaign by health rights organisations.

Biomarker testing isn’t covered by public funds in Bulgaria, tests are mostly funded by programmes developed by private pharmaceutical companies, which are starting to withdraw their support. Patients deciding to pay out-of-pocket for their tests have to spend several thousand euros, depending on the number and type of biomarkers.

Biomarker tests in Bulgaria cost around €5 million a year, the state is now expected to increase funding later in the year. The National Health Insurance Fund (NHIF) is limited to a €2.5 million budget for biomarker tests which are used to determine the most appropriate treatment for each patient based on the tumour’s genomic profile.

A long-standing request

In August 2024, the Association for the Development of Bulgarian Healthcare addressed a letter to the Supervisory Board of the National Health Insurance Fund, demanding that biomarker tests be paid for.

“Between 40-50% of all newly diagnosed cancer patients receive support through temporary donation programs funded by pharmaceutical companies. These programs provide only a fraction of the biomarker testing. The remaining patients have to pay for the biomarker tests themselves or do not get the opportunity to be treated with the most appropriate drug treatment at all,” the NGO stated in a position paper.

The association argues that the way the state treats patients is “unacceptable at a time when medicine is advancing, and treatment can be provided for a very large number of cancers.”

Partly funded

The Bulgarian state pays for 40 cancer-targeted therapies and immunotherapies to treat 56 types of oncological diseases. These therapies are significantly more effective in treating tumours with specific genetic mutations, but they cannot be prescribed and administered to patients without first conducting biomarker diagnostics.

This results in the therapies being restricted to patients who can afford the tests in Bulgaria, one of the less affluent EU countries.

The National Health Insurance Fund announced at the end of December that it would provide at least part of the necessary funding.

The Bulgarian Medical Association, which is the representative organisation of the medical guild in the country, immediately opposed the way the state promised to pay for these tests.

Doctors’ objections

The Association claims that the state is allowing the payment to be used for unnecessary full genome sequencing, which involves expensive tests. The doctors’ union questions whether this could enrich the only hospital in the country with the necessary equipment.

“The aim is more efficiency in the treatment of insured persons with malignant diseases, objectivity and accessibility of diagnostics, which are currently sponsored by the pharmaceutical industry or paid for by the patient, including more transparency and cost-effectiveness related to limiting the costs of more expensive medicines,” the National Health Insurance Fund noted.

Former health minister Stoycho Katsarov also discussed possible corruption in biomarker diagnostics. “The way the state finances these tests could delay their introduction by at least a year and create conditions for corruption,” he told Euractiv.

[Edited by Vasiliki Angouridi, Brian Maguire]