Author: Armela Toska
"I pay for 3 medicines every month, which I have to have. It costs me approximately 75 lek, more than half of my pension. I paid less years ago and now I can't even find them in the same place. Now I'm looking in three or four pharmacies in Tirana", - says Bajame Agalliu, the 87-year-old pensioner, who wanders the streets of Tirana endlessly, to find the right pharmacy, where she can get the medicines with reimbursement. In the stock of medicines he receives in a month, Bajamja says that most of them are non-reimbursable, so more than half of his pension goes to medicines. Most of the pensioners in Albania are in similar conditions. Their very low pensions go almost entirely on medicine. Meanwhile, state institutions have never been committed to building a scheme that can help pensioners.
Albania is a country with great challenges in the field of health and citizens' access to medical Services. One of the main problems is precisely the high cost of medications. High drug prices become a financial burden for people suffering from chronic diseases. According to INSTAT-, Albanian families spend only 5.4% on health, the biggest burden of this cost falls on the most vulnerable layers of society, pensioners and families in need.
"In the families of pensioners, medicine expenses account for almost 30-50% of the budget, because, if a pensioner receives about 16 ALL (which is the average pension in the country), monthly medicines can go up to 8 ALL," he says. economist Pano Soko.
The United Nations in a recent study, which offered for the third age in Albania, evidenced that 60% of the age group over 65 suffer from one or more than one chronic disease. For this reason, they consume about 40% of pharmaceutical products in the country, mainly medications.
The population aged 60 and over accounts for about 60% of visits to primary care institutions. According to the WHO, Albania's health expenditure was only 6.7 percent of GDP in 2016-2017, but 58% of this amount is paid from citizens' pockets, which exceeded the share of public funding.
Studies predict that spending on long-term care for the elderly will increase rapidly in the next 30 years. The UN notes that it is necessary to take a proactive step, to explore all possible options, to create a fiscal space, to finance long-term care.
Demand increases, prices also increase
According to market operators, drug prices have increased by 10-20% since 2020, a gradual increase that has affected society's consumption.
Arnisa Nuna says that in the pharmacy where she works, the demand for drugs has increased significantly, especially for vitamins, supplements and blood thinners, some of which are reimbursed and others not.
"The prices have increased, as the demand for medications has also increased, usually those for the nervous system or blood thinners that pensioners take, as they are diseases left over from the pandemic. The reason for the increase in prices has to do with the lack of some of them in the market, as well as with the wrong policies that are imposed on drug depots", - said Nuna.
According to the data of INSTAT-it, from foreign trade in the first four months of this year, imports of pharmaceutical products reached 2,248 tons, with a 23% increase compared to last year in this period.
The scope for further growth of imports in pharmaceutical articles is high, because Albanians have the weakest per capita consumption of pharmaceutical products in relation to Europe and the countries of the region.
According to the Survey of Income and Standard of Living by INSTAT, poverty is present in 30% of the population and the public budget has limited capacity for health. Albanian patients also suffer from a lack of medication, as consumption is going through a prolonged cycle of crisis due to new circumstances, which were created after the pandemic and the decline of the population.
In the report of Eurostat-it on the health system of the region, it is said that there are several factors that have influenced the increase in the prices of medicines in Albania. A major factor is the lack of effective policies to control drug prices. Often the prices of medicines in Albania are higher compared to other countries in the region. This may be the result of the lack of sufficient competition in the drug market, weak support for local drug production and difficulties in effective drug procurement.
Experts say that in some cases the import of drugs is subject to high customs duties, which increase import costs. This affects the lack of benefits from international competition and the increase in the cost of medicines for patients.
Also, other factors affect the increase in prices, such as the cost of transportation, the costs of marketing and advertising drugs, as well as the profit margins of intermediaries in the market.
Lack of medicines on the market for serious diseases
An observation carried out in the open network of pharmacies in Tirana shows that a significant number of drugs for the treatment of serious diseases have been missing for months, while doctors continue to prescribe them in their prescriptions and patients try to secure them. , where they can.
Medicines that help the most for cancer diseases, such as Neupogen, Letrozole, Methotrexate, Dacarbazine, Bleomycin, as well as many other medicines, essential for their cure.
“In order to get the chemotherapy, I had to buy Bleomycin and Dacarbazine 500 milligrams each time, because there was a shortage in the hospital, the prices ranged from 10-25 thousand ALL per round.
They were expensive and I often had to order them in advance. The prices were set according to the requirements", says Orlanda Toska, patient.
Thousands of people die every year as a result of cancer and rare diseases, due to Albania's lack of access to innovative therapies to treat these diseases.
In the period from 2017 to 2023, Albania has included only 5 new drugs out of 160 that have been used in European countries in the reimbursement list. In this period for the treatment of rare diseases, Albania has not added any new medication to the reimbursement list. Statistics show a rapid spread of cancer, while reimbursement funds remain limited.
Medicines for the nervous system, such as Keppra, the antiepileptic Epixx 500, Amysol (Amitriptyline) etc., are also in marked shortage in the market.
Denada Toska, a pharmacist in Tirana, says that some drugs for the nervous system have been missing for months and are being replaced with other alternatives, even though doctors continue to give them to patients. "The shortage has been felt, as some important warehouses in the country are leaving due to many other problems in the market", she says.
The new drugs, which have a high sales trend in the European and regional markets, have not yet been introduced to the Albanian market. They cost a lot and are not affordable for patients, as the state does not reimburse them. For example, in Albania there are no medications like apixaban, Pembrolizumab, which treat autoimmune diseases.
The Albanian market is under development, where traditional, generic and off-patent drugs represent 76%, while specialized, hospital and innovative therapy treatment, only 24%.
Smuggling is increasing
However, the lack of quality drugs is fueling the demand for smuggled drugs in the country.
In conditions of lack of trust, it happens that some patients take actions to the detriment of their health and postpone their recovery, waiting for medicines that a relative can bring to them from abroad.
G. H is another patient, who is affected by the lack of medication. He says that the medicine prescribed to him is not available in the country, so he has to find it abroad, such as in Italy and Greece.
"Depends on where I can find it first and cheapest. I usually get it in Greece, since Keppra it is a Greek medicine, but it is also found in Italy. It is very necessary for me, because if I don't take it, it can have many consequences on my health. Until now, my doctor has not prescribed me any medication that I can replace," he says.
"During the treatment I had to take Neupogen, which has helped me increase the level of white beads. I found it myself in a pharmacy here in the capital. I knew it was smuggling, but for me it was the only solution", said Orlanda Toska.
"Albanian families, driven by cheap costs, get low-quality products," says Fatos Çoçoli, an economic expert.
"Albanian families with modest incomes are more attracted by the cheap cost of a drug, without having any relevant information about the poor quality; this is also due to the dysfunction of the quality standards of drugs sold in the country. Medicines, which are taken by Albanian families with modest incomes (which are the majority in the country), are of low quality and directly affect the cure of diseases. We hope that the Ministry of Health will take direct measures to solve the problem, but there are other difficulties with medicines in Albanian families", says Çoçoli.
List of reimbursed drugs, limited and unchanged
Another aspect of drug problems is reimbursement. The list of reimbursable drugs in Albania is limited and often does not include the newest, most advanced and most effective treatments. This situation makes it difficult for citizens to access adequate treatment and forces them to pay large sums themselves for the necessary medications.
Experts say that the process of selecting drugs to be reimbursed in Albania is one of the main problems. The established criteria are rigid and often do not match the real needs of patients. This leads to restrictions on citizens' access to necessary treatment and requires them to pay themselves for drugs that are not included in the reimbursement list.
Their lack is another problem encountered in the domestic market. According to pharmacies, some of the reimbursed drugs are the most missing and this forces doctors to prescribe other alternatives.
"The biggest problem with these medications is that often no measures are taken to solve their shortage and there is a lack of important medications for retirees or for serious illnesses," he said to ACQJ Algerta Rakipi, pharmacist.
There are only 373 molecules in the Albanian reimbursement list, while in the Adriatic countries (Serbia, North Macedonia, Croatia, Slovenia) there are 962 molecules, according to the study of Health data.
Free healthcare was one of the most sensational promises of the current government, when it sought the vote of Albanians to govern Albania. The stories narrated in this article show us that after 10 years in power, the socialists are still far from their promises to improve the health system and that the situation with the main health problems in the Albanian population has not changed for the better.
This article is part of the Investigative Journalism Laboratory project, which is financially supported by the Public Relations Office of the US Embassy in Tirana. The opinions, findings, conclusions, and recommendations expressed are those of the author(s) and do not necessarily represent those of the Department of State.
