Romania's Health Insurance Chief Proposes Centralized Procurement of Expensive Medications

In a significant move that could reshape how Romanians access vital medications, the President of the National Health Insurance Company (CNAS), Horațiu-Remus Moldovan, has put forth a proposal to centralize the procurement of expensive drugs used in national health programs. This initiative, detailed in an interview with Adevărul, seeks to streamline the acquisition process, moving away from the current system where individual hospitals manage their own purchasing. Moldovan argues that a centralized approach, managed by the National Agency for Health Products (ONAC), would allow hospitals to access these critical medicines much faster, thereby avoiding the administrative bottlenecks that have recently left patients, particularly those undergoing cancer treatment, without their necessary therapies.

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Those expensive and very expensive medications, which are the subject of cost-volume contracts, I think it would be useful to be purchased centrally, through ONAC, and hospitals to be able to access them very quickly; so that 500 hospitals do not conduct 500 procurement procedures.

The current system, as described by Moldovan, often leads to significant delays and stock shortages. He points out that requiring hundreds of hospitals to conduct their own procurement procedures for the same medications creates an inefficient distribution of resources. The CNAS president estimates that national health programs involve an annual expenditure of approximately 10 billion lei. Centralizing this procurement, he believes, would not only prevent hospitals from having to maintain large, costly inventories but also ensure a more consistent supply. This is especially critical for oncological treatments, where a patient's therapy schedule must be strictly adhered to.

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A centralized purchase of all medications in national health programs - which amounts to approximately 10 billion lei - I think is auspicious. In this way, we also avoid the problem of stocks which currently represent a real impediment, because each hospital must maintain its own stock of medicines, especially in the oncological area, so that when the patient comes for therapy, you have the medication in the hospital pharmacy.

Beyond centralizing procurement, Moldovan suggests further reforms, including making certain medications and medical supplies, currently part of national programs, available through the standard health insurance contract. He also envisions a future where some of these expensive drugs could be dispensed through regular pharmacies, increasing patient accessibility. This would represent a departure from the current closed-circuit system where medications are primarily dispensed within hospital pharmacies, often only during hospitalization or upon discharge. The CNAS president deems the current system outdated and believes these changes are essential to improve patient care and ensure that life-saving treatments are readily available when needed, addressing critical issues highlighted by recent events at the Bucharest Oncological Institute.

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Imagine that, if the sum of money you have allocated for these health programs is divided among a very large number of suppliers, then obviously those suppliers must have very large stocks. But this is mathematically impossible: to have a budget that you block in many healthcare units in the form of stocks. And then care must be taken in the future and the way these health programs are carried out must be rethought.