The prices of prescription drugs in pharmacies or used in public health institutions are limited by government regulations, but a large number of Montenegrin citizens claim that medications paid out of pocket are much more expensive than in neighboring countries.
The prices of medicines that are prescribed and issued at the expense of the Health Insurance Fund - the so-called positive list, are limited by the Regulation on the establishment of maximum medicine prices. The maximum price of those medicines is formed based on the calculation of average prices of medicines in reference countries determined by the state, currently Serbia, Romania and Croatia, in such a way that it can be a maximum of 95 percent of the average price in those three countries for original medicines. Also, the prices of drugs from the "positive list" are formed in direct negotiations between the manufacturer and the Ministry of Health, and the basic and supplementary list are updated at least twice a year, thus the prices are determined by the state. The state itself chooses reference countries that it considers to be recognized for affordable drug prices, and as an additional, corrective factor, it is taken into account that countries that have an incomparably larger market than Montenegro, therefore have lower prices.
Prescription drugs can be taken in 56 state "Montefarm" pharmacies and about a hundred of the 250 private ones that have signed a contract with the Health Insurance Fund. During the last year, the Fund paid about 70 million euros for those medicines, and about 50 million (71 percent) went to medicines in "Montefarm" pharmacies.
For drugs that the state considers not to be essential for the health of the population (the so-called "negative list"), i.e. drugs that citizens buy out of pocket, the prices are determined by the manufacturer, and the corrective factor can be competition, which most often leads to lower prices.
Citizens often complain that certain drugs that are not on the list are bought in neighboring Serbia at lower prices in pharmacies. "Vijesti" interlocutors say that it is expected that more medicines in Serbia will be cheaper, given that there are drug manufacturers in that country.
"On the other hand, there are often consignment (central) warehouses of large manufacturers in Serbia. It is expected that there will be differences in the price, but they should not be more than 20 percent, because there are costs for customs, file registration, transportation...", one of the interlocutors points out.
Margins prescribed by law are six percent for wholesale and 18 percent for retail in pharmacies.
The Ministry of Health recently assessed that the prices of medicines outside the list are dictated by the size of the market and the interests of large pharmaceutical companies, and that Montenegro is a small market. However, they hinted that in the coming period, through changes to the Medicines Act, they could also limit the prices of those medicines, without specifying in what way.
According to data from state pharmacies, acetylsalicylic acid (aspirin) in Montenegro can be bought at a price of 0,89 to 2,87 euros, paracetamol from 0,90 to 2,12 euros, and ibuprofen costs from 2,18 to 3,24, XNUMX euros, depending on the manufacturer.
Antacids, which reduce stomach acid, depending on the manufacturer, are bought at a price of around 1,70 to 5,84 euros, and proton pump inhibitors, which are also used for the same purposes, citizens pay from 1,66 to 7,43 euros .
Antihistamines, anti-allergy medicines, can be bought for three euros. Nasal decongestants, against stuffy nose, can be bought in the state pharmacy at the lowest price of 2,87, and the prices, depending on the manufacturer, go up to six or 10 euros.
Medicines against coughs and colds cost from 2,75 to 5,74 euros.
Medicines in BiH are getting more expensive, lower earnings in pharmacies in Republika Srpska
Statistical data continue to show that the citizens of Bosnia and Herzegovina (BiH) have been paying the most expensive medicines in the entire region in recent years. The Agency for Medicines and Medical Devices of Bosnia and Herzegovina is the umbrella institution of the state that issues licenses for the sale of medicines in the territory of the country and regulates wholesale, while most of the regulations in the field of pharmacy are adopted by the entity levels.
In addition to the state ones, there are also many private pharmacies, as well as drug wholesalers from year to year. In contrast to the Federation of Bosnia and Herzegovina, state pharmacies in the Republic of Srpska do not have their own wholesalers, but purchase medicines from registered private wholesalers, like all other pharmacies in Bosnia and Herzegovina.
The State Agency maintains the register of wholesalers and it is publicly available. According to the Agency, legal entities that have a license for the sale of drugs in bulk can deal in the sale of drugs in bulk and sell drugs to pharmacies.
"When it comes to prices, the Agency determines the maximum wholesale price of medicines in accordance with the Rulebook on the method of price control, the method of shaping and reporting on the prices of medicines in Bosnia and Herzegovina. In accordance with the by-law, it provides a framework for all medicines that do not have a 'Medicine is dispensed without a prescription' regime and the price of the medicine can be from zero to the maximum wholesale price. Medicine prices are further determined by health insurance funds", he explained to "Oslobođenje" Tijana Spasojević-Došen, head of the drug information department.
Pharmacies are under the jurisdiction of entity ministries responsible for health affairs, as well as the retail margin. For years, we have witnessed how the prices of medicines in pharmacies throughout the Federation of Bosnia and Herzegovina are higher than those in pharmacies in the Republic of Srpska. The difference is sometimes significantly greater, depending on the manufacturer and if it is a question of higher quality drugs or preparations.
Pharmacists explain that the price of the medicine is formed by its import price. When drugstores sell medicine to pharmacies in the RS and FBiH, they sell it at the same price, regardless of whether the drugstore is from the RS or FBiH and to which entity they sell the drug. Citizens are charged wholesale and retail margins on the price of medicine when they buy it at the pharmacy. The price of medicine is inevitably influenced by the VAT in our country, which is 17 percent and is the highest in the neighboring countries, which affects the high prices of medicine paid today by BiH. citizens.
Bosnia and Herzegovina has close to 50 drug wholesalers in the Agency's register. Master of Pharmacy Adisa Džananović, a member of the Management Board of the FBiH Chamber of Masters of Pharmacy, in a statement to "Oslobođenje" emphasizes that Bosnia and Herzegovina does not have a state wholesale, but trade takes place through all registered wholesales, both on the territory of the FBiH and the RS. All pharmacies, public and private, are equal in terms of services and rights. Patients are allowed to choose where to go to get their medicine. Almost all pharmacies have signed contracts with the Health Insurance Institutions and can dispense prescription drugs.
"Margins on medicines are limited and can be a maximum of 25 percent. Considering the patient's free will, where he will go for his therapy and where he will seek service, pharmacies are in a market competition, so that the margins on medicines are significantly lower than the maximum allowed," says M.Sc. Džananović, claiming that there is little difference in drug prices in pharmacies in the entities.
However, the prices can differ, even within the same institution, and considering its location, but these are small amounts, 10-20 pfennig, according to our interlocutor.
We bring the retail prices of medicines from a private pharmacy in the Federation of Bosnia and Herzegovina: acetylsalicylic acid, bospyrin tablet - 4,50 KM (about 2,25 euros), aspirin - 5,15 KM, ibuprofen tablet 400 mg 2,70 KM, brufen 400 mg 6,10 ,10 KM, paracetamol 500x2,15 mg 12 KM, paracetamol tablet 500x2,40 - 8,55 KM. Antacid - gastal table 10,80 KM; rennie board - 10 KM. Antihistamine: lordes tablets 5x3,90 mg - 10 KM, and lostop tablets 10x7,00 mg 1 KM. Decongestants: snup 8,20% 1 KM, rinobact 9,90% 10 KM. Cough syrups: 15-12 KM. Preparation for cold and flu: tylol hot 13,80 - 13,20 KM, theraflu max 20 KM, grippostad caps 11,10 is 7,00 KM, and rhinostop hot XNUMX KM.
When it comes to the prices of medicines in the Republika Srpska in private pharmacies, they are lower, so very often citizens from the Federation of Bosnia and Herzegovina purchase medicines in pharmacies of another entity.
The prices of medicines in Bosnia and Herzegovina are controlled by the Agency for Medicines and Medical Devices of BiH through the maximum approved wholesale prices, while the prices of medicines in the entities, says the president of the Pharmaceutical Chamber of the RS in a statement to "Oslobođenje". Jadranka Bjelaković, are significantly different.
"The wholesale margin in the FBiH is eight percent, while in the RS it is six percent. The retail (pharmacy) margin in FBiH is 25 percent, while in the RS it is a maximum of 18 percent," says Master Bjelaković, stating that it is clearly visible that pharmacies have nine percent (two percent VP and seven percent MP) lower earnings compared to pharmacies in FBiH.
These are the prices of medicines in pharmacies in the RS: Acetic acid: aspirin protect 28X100 mg tbl., 4,15 KM, midol protect 30X100 mg tbl., 4.45 KM. Ibuprofen: ibuprofen 20 X 400 mg tbl., 3.87 KM, brufen 30X400 mg tbl., 5.68 KM. Paracetamol: febricet 12X500 mg. tbl., 2.29 KM, paracetamol 20X500 mg tbl., 4 KM. For excess acid controloc 28X20 tbl., 5.58 KM, pantoprazole 28X20 mg tbl. 5.60 KM. Antihistamines: pressing 10x10 mg tbl., 6.68 KM, flonidan 10x10 mg tbl. 6.86 KM. Nasal decongestants: snup spray for adults 0,1 percent, 7.77 KM, while olynth spray for adults 0,01 percent, 9.15 KM. For expectoration, bosolex 20x8 mg is 8.42 KM, bisolvon 20X8 mg tbl., 9.39 KM.
There is no state pharmacy or wholesale drugstore in Brčko District, they are all private. And all pharmacies, whether private or state, have an equal, legally defined margin on medicines, the Master of Pharmacy told Oslobođenje Emina Hajdarević, from the Public Health Subdivision, Department of Health and Other Services of the Brčko District Government.
We also list the prices of medicines in pharmacies in Brčko District: the price of a 500 mg paracetamol tablet (for adults) costs 2,50 KM, a pack of 12 tablets, and paracetamol tbl. 500 mg Bosnalijek costs 2,10 KM, a pack of 10 tablets. Aspirin tablets 500 mg cost 5,80 KM... The terms antacid and antihistamine are broad, so they could not answer that question. For example, the drug ibuprofen can be in the form of tablets, effervescent tablets, syrup, and the strengths range from 200 mg, 400 mg, 600 mg, 800 mg. The same applies to cough and cold medicines, so they didn't tell us the prices.
Serbia: Trade margins raise prices
Medicines against cough, fever, pain, nose drops and those against allergies can belong to the so-called OTC medicines, that is, some can be obtained without a doctor's prescription. The prices of medicines are formed based on the Regulation on the criteria for forming the prices of medicines for the need in human medicine, which are dispensed by prescription.
As a result, pharmacy margins range from 12 percent on the wholesale price of prescription drugs to 25 percent on OTC drugs.
As a pharmacist from one of the many pharmacies in Serbia explained to "Danas", who wanted to remain anonymous "because he does not have permission to speak to the media", you can buy one and the same OTC drug at a price based on a 12 percent margin, but and 13 percent more expensive if the pharmacy has set a maximum margin of 25 percent.
"It all depends on which city or town you are in, whether there are a lot of pharmacies or a few, and the medicine will be more expensive, of course, if there are fewer pharmacies. But that's rare. Mostly, colleagues calculate a margin of 12 percent on OTC medicines as well. On the other hand, in our country, the situation is such that many state pharmacies are privatized, but they accept prescriptions and in that sense work just like the state ones, while the price of the OTC drug group that is on free sale can differ in relation to the margin", he states. and adds that when it comes to drugs that are issued on a doctor's prescription, their maximum prices are directly determined and controlled by the state.
In order for the complicated story of how, for example, ibuprofen reached the pharmacy shelves and the citizen paid for it, for example, 400 dinars (about 3,3 euros) per box, it is necessary to understand the first step in that system, and it is the Agency for Medicines and Medical Devices (ALIMS)
Pavle Zelic from ALIMS tells "Danas" that before the drug can be found on the Serbian market, the applicant must apply for a license for the drug.
"That can be done by a legal entity registered for this type of activity and with appropriate professional staff who can perform such specialized tasks in the field of healthcare. He submits extensive documentation to the Agency proving, above all, the quality, efficiency and safety of the medicine. This documentation should be adapted to the standards that are valid in the European Union, with which our country is harmonized to the greatest extent in terms of legal provisions, but also procedures and their practical implementation", he explains to "Danas".
He adds that without going into the details of the documentation, it can be pointed out that it includes the complete development path of the drug, from preclinical, clinical trials and data from practical application if the drug was already in circulation on another market, which is the most common case.
"The procedure includes a formal and substantive assessment and is in accordance with the deadlines in the EU, i.e. 30+210 days, not counting the time for supplementing the documentation," says our interlocutor.
Sanda Savić from the Group of Drug Manufacturers tells "Danas" that when the applicant for drug registration in ALIMS receives all the necessary permits for placing the drug on the market in Serbia, that drug has its own wholesale price, which is established in relation to strict rules according to the Regulation on the criteria for establishing the price of medicines for the need in human medicine, whose dispensing regime is by prescription. What is important, the Regulation foresees price comparison in relation to reference countries, in our case Slovenia, Greece and Italy. In this way, the wholesale price is formed. When pharmacies need drugs, they add a margin of 12 percent when forming the retail price of the drug, if it is issued on a doctor's prescription, and it can be up to 25 percent, based on the criteria prescribed by the Regulation", says our interlocutor.
In the Regulation, which "Danas" had access to, it is stated that "the criteria for forming the price of drugs in retail trade are the costs of retail trade, which are charged to the wholesale price of the drug, formed in accordance with the criteria from this Regulation, and that : for medicines whose dispensing regime is by prescription and which are on the List of medicines that are prescribed and dispensed at the expense of compulsory health insurance funds, in the amount of up to 12 percent, while for medicines whose dispensing regime is by prescription and which are not on the List of Medicines , in the amount of up to 25 percent compared to the price of the medicine.
As, among other things, is provided by the Regulation, the holder of the license for the drug is obliged to submit data in written or electronic form at the request of the competent ministries in the procedure for determining the highest prices of drugs, within a maximum of seven days from the date of receipt of the request.
Prof. Radan Stojanovic from the Department of Pharmacology at the Faculty of Medicine in Belgrade adds for "Danas" that it is extremely important for all citizens to understand that the free sale of OTC drugs does not mean their absolute safety for use because many have unwanted effects.
"It is important that citizens consult their doctor or pharmacist before buying ibuprofen, for example, or nasal drops. "Ibuprofen can cause bleeding from the digestive tract, and some of the OTC drugs can interact with other therapy that the patient is taking for a chronic disease or condition," he said.
Prices of medicines in Serbia: acetylsalicylic acid - 200-380 dinars (2,5 to 3,15 euros), ibuprofen - 200 - 570, paracetamol - 200 - 330, antacids - 300 - 500, antihistamines - 200 - 500, nasal decongestants - 200 - 600, cough and cold medicines - 500 - 600.
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