People with diabetes in Bulgaria are faced with an administrative paradox - if they improve their health indicators, the state deprives them of the free treatment that led to this success. The Association of Patients Active in Healthcare (APAZ) raised the alarm about the problem in an official letter to the Ministry of Health and the National Health Insurance Fund.
The patient organization demands urgent reforms to ensure adequate access to test strips, glucose sensors and insulin pumps.
One of the most serious defects in the system is the mechanism by which successful treatment leads to its termination. When glycated hemoglobin drops, the patient automatically ceases to meet the official criteria for granting the therapy, despite its proven effect. In many cases, this forces patients to pay an additional 50 euros per month out of pocket.
According to APAZ, this approach sanctions good disease control instead of encouraging it. The organization is adamant that decisions should be based on individual medical judgment, not formal administrative thresholds.
The organization's demands are based on a survey among patients and endocrinologists across the country. The data reveals a worrying trend - while the number of patients is growing, the supplies provided by the state are decreasing. The number of adult patients who receive test strips from the National Health Insurance Fund has collapsed by nearly 27 percent - from 45,812 people in 2023 to 33,402 people at the end of 2025.
During the same period, the number of people diagnosed with type 2 diabetes has increased dramatically, reaching nearly 493,000 people. The 150 test strips issued by the health insurance fund per quarter are extremely insufficient for real needs, especially for people on insulin. The lack of self-monitoring sharply increases the risk of serious complications.
Access to modern technologies remains severely limited. Of the approximately 78,000 Bulgarians with type 1 diabetes, sensors for continuous monitoring paid for by the National Health Insurance Fund reach only 1,577 children and 4,492 adults. The situation with insulin pumps is even more critical - only 16 devices have been issued for adults and 13 for minors. Patients with type 2 diabetes are completely excluded from the current criteria for continuous monitoring, although they often have an urgent medical need for it.
The financial burden on patients is enormous. In addition to the costs of therapy, patients pay between 15 and 60 euros for tests, and the specific diet requires an additional between 300 and 400 euros per month. The inability to cover these amounts leads to compromises that put patients in hospital - 35,835 hospitalizations are registered annually for type 2 diabetes alone.
The patient organization also criticizes the heavy administrative burden placed on endocrinologists. Formal procedures eat up the time for a real examination and delay the change of therapy.
„Diabetes requires daily control, not care only when a complication occurs. The system must provide sufficient means for self-control, timely access to specialists and modern technologies. It is unacceptable for patients to be deprived of effective treatment precisely because they have achieved better results“, commented APAZ Chairwoman Aneta Draganova.
The Association calls on the healthcare leadership to immediately begin a dialogue to prepare a specific plan with deadlines for overcoming the crisis.