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NEWS 20 Mar 17

Bosnian Cancer Patients 'Waiting Months for Drugs'

Cancer patients in Bosnia are waiting months for medications, according to a professional in the healthcare industry - and the situation could get worse in coming years.

Eleanor Rose
BIRN
Sarajevo
Cancer drug supplies in Bosnia have been hit by delays. Photo: Ekkun/Flickr.

Cancer patients in Bosnia are enduring long waits for essential medications as public procurement stalls and as the worldwide supply of the older drugs used by Bosnian health services begins to drop, according to local experts.

Ana Petrovic, president of the Association of Research-Based Pharmaceuticals in Bosnia, UIPL, told BIRN that the procurement procedure for cancer drugs has been beset by delays again this year and authorities have not addressed inefficiencies in the system.

The problem may be compounded by the fact that Bosnia uses older cancer drugs that are being produced in smaller amounts by global pharmaceutical companies, which could be withdrawn altogether in a few years. 

Bosnia has no special legal framework to purchase medication, so it is done under the wide-reaching, non-specific Law on Public Procurement, Petrovic said. 

Under this system in the Federation entity, for example, dozens of local wholesalers bid to provide the drug to the Health Insurance Fund, becoming the middleman between the global drug producers and the local authorities. 

However, according to Petrovic, because the law is not tailor-made for public health procurement, the cheapest bid often wins regardless of the track record of the wholesaler firm. 

Wholesalers sometimes wait for an order from the government to procure any drugs, since they are expensive, which means delays occur.

Additionally, wholesalers who lose bids for reasons such as not having the appropriate license sometimes appeal against the decision – which can mean the whole process being put on hold.

This happens every year, she said, yet no resolution has been found.

Petrovic said that since cancer patients need the right treatment at the right time, with delays affecting the success of treatment, the result is a waste of state funds. 

“But the most terrible situation is for the patient,” she said. 

“They are waiting, the cancer is progressing, sometimes they have to collect money to buy drugs through another channel and wait to be reimbursed [by the Solidarity Fund, which handles such emergencies as a last resort],” she added. 

Such problems affect patient outcomes and are dangerous, she said. 

Since some patients are buying drugs themselves and then applying for reimbursement, Petrovic said it is hard to know exactly how many people are affected by the delays.

Local media report about 10,000 new cases of cancer per year in Bosnia.

But no new cancer drugs have been incorporated into Bosnia’s public healthcare offering for more than five years, according to experts, while Petrovic said some older drugs still used in the country are being produced in smaller amounts, and could be withdrawn one day.

The Federation entity’s Health Insurance Fund told BIRN in a statement that there are delays in the supply of ifosfamide, used to treat testicular cancer, and of leuprorelin, used to treat prostate and breast cancer. 

These occur when “contractual suppliers order a certain amount of the drug from the manufacturer late [and] at that time, there may be a shortage of the drug,” it said, explaining potential pitfalls in procurement. 

It said that it had funded the purchase of 67 anti-cancer drugs in 157 different forms, but that after signing a contract with a wholesaler, its hands are tied if the deal hits delays since, by law, it is then unable to buy the drug from another supplier even when it is available. 

The Fund blamed market dynamics for supply problems.

“The problem of supply shortage is caused by the fact that nearly all drugs from the group of cytostatics [anti-cancer drugs] are imported from producers in the European Union, the United States, Canada and Japan, for which the Bosnian market is small and does not constitute a priority,” it said.

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