The HIF, through the Positive List and generic competition, ensures lower medicine prices and greater accessibility for patients
The Health Insurance Fund of Macedonia continues with measures to reduce medicine costs and improve insured persons’ access to modern therapy. Through expanding the Positive List and introducing generic competition, the Fund creates conditions for lower prices, greater availability of medicines and more efficient use of public funds.
In certain therapeutic groups, medicine prices in Macedonia are still higher compared with some countries in the region. In addition to the objective constraints arising from the size of the domestic market, there are mechanisms through which medicine prices can be significantly reduced.
The Fund applies the two most important mechanisms:
- introducing new medicines to the Positive List;
- encouraging generic competition, in accordance with the recommendations of the World Health Organization.
During the past month, both measures were implemented. Three anticoagulant medicines were introduced on Positive List A, and generic competition was established in two therapeutic groups.
Rivaroxaban – significantly lower costs for patients
The medicine Rivaroxaban is available through the Positive List for the first time. For therapy costing around 2.200 denars, patients have so far paid around 475 denars in participation and surcharge. From next year, their contribution will be only 160 denars.
At the same time, the price of the medicine has almost halved, which is a concrete example of how competition and the Fund’s policies directly contribute to reducing costs and increasing the availability of therapy.
Beclometasone/formoterol – more choice, without additional cost
In inhalation therapy for asthma and chronic obstructive pulmonary disease (COPD), generic competition is being established through the introduction of a new competing brand with the same composition and the same dosage, produced in a member state of the European Union.
As a result, the reference price per pack is reduced from 2.715 denars to 1.915 denars (including VAT).
For patients, this means that a medicine without surcharge is already available in the same therapeutic group. The reduction in the reference price does not represent an additional financial burden for insured persons.
At the same time, the manufacturer of the medicine “Foster” has officially accepted the new reference price, which will begin to apply after the already delivered quantities have been exhausted. After the price adjustment, “Foster” will also be available without surcharge, with a legally determined participation of 280 denars.
Savings will be invested in new therapies
According to the Fund’s analyses, if the new reference price is applied to the volume of prescriptions issued during 2025 (57.441 prescriptions, with a total value of 166,7 million denars), annual savings of 46 to 49 million denars are expected.
These funds will enable the introduction of a new three-component medicine from the same therapeutic group, giving patients access to even more modern therapy without additional financial burden.
The Health Insurance Fund remains committed to ensuring accessible, high-quality and financially sustainable medicines and health services, through policies that simultaneously protect the interests of insured persons and ensure the rational use of public funds.
Our goal is simple – for patients to pay less, and with the same public funds to provide more and better-quality health services. Every saving we achieve through competition and rational management is returned to the health system, through the introduction of new therapies and better health care for insured persons.– Sasho Klekovski, Director of the Health Insurance Fund of Macedonia
Video explanation: The Director of the HIF answers the most common questions from insured persons, selected doctors and pharmacies
Following the publication of the changes to the Positive List, the Fund registered numerous questions and dilemmas from insured persons, selected doctors and pharmacies, especially regarding the medicine “Foster”, the introduction of generic competition and the way in which these changes will be applied in practice.
In order to inform the public in a timely, transparent and precise manner, the Director of the Health Insurance Fund, Sasho Klekovski, prepared a short video in which he gives clear answers to the most frequently asked questions and explains the key benefits of the new measures.
Video: Frequently asked questions and answers
For those who wish to be informed in more detail, the full press conference of the Fund’s Director is also available below.
