Bulgarian authorities have pledged greater transparency in medicines policy after a civic activist unveiled a digital platform that, according to reporting by Euractiv, flagged substantial anomalies in how state hospitals purchase medicines and spend public funds.
Platform flags hundreds of millions in irregularities
The platform, Diagnosis Bulgaria, created by freelance journalist Martin Atanasov, identified what it described as anomalies amounting to more than €300 million in 2025 public‑health spending. The analysis compared procurement prices, expenditure patterns and contracting procedures across state hospitals and found wide variations that the platform characterises as unexplained.
"It is important to me that institutions do not view the platform as an attack, but as an opportunity," Atanasov said, adding that the tool seeks to complement official oversight.
The platform highlighted several concerning trends:
- Large price discrepancies for identical medicines between hospitals, in some cases reaching tenfold differences.
- Substantial variance in spending on categories such as medical supplies, maintenance and outsourced services, with some facilities spending several hundred percent more than comparable hospitals.
- Public procurement procedures that, according to the platform, channel more than €50 million through tenders lacking genuine competition.
Striking examples in oncology medicines
The analysis found the most dramatic deviations in oncology and targeted therapies. One example concerned the chemotherapy drug Armisarte (pemetrexed), where a single state hospital reportedly paid nearly €450 per unit while the median purchase price across hospitals was €35 — a difference of about 12.9 times. For Pemetrexed Sandoz, another intravenous chemotherapy medicine, the gap between median price and some purchases approached a sevenfold difference.
| Medicine | Reported hospital price | Median price | Multiple |
|---|---|---|---|
| Armisarte (pemetrexed) | €450 | €35 | 12.9x |
| Pemetrexed Sandoz | — | — | ~7x (reported) |
The platform also mapped hospitals’ financial positions, liabilities, spending structures and staff remuneration, revealing sharp divergences that may reflect differing contracting practices and market power at facility level.
Government response and implications
According to Euractiv’s reporting, Bulgarian authorities reacted quickly after the platform was presented and the government has committed to greater transparency in medicines policy. Atanasov said Diagnosis Bulgaria is not intended to replace the Ministry of Health, the National Health Insurance Fund or regulatory bodies, but to demonstrate how publicly available data can be combined and analysed to spotlight inefficiencies.
Experts and policymakers will now face several decisions. The findings raise questions about:
- How procurement rules are applied and monitored across hospitals;
- Whether centralised purchasing or stronger price controls are needed for high‑cost medicines, especially oncology drugs;
- The role of data‑driven civic monitoring in complementing formal audits and regulatory inspections.
For patients and clinicians, inconsistent pricing and procurement practices can translate into unpredictable access to medicines, unequal treatment costs across regions, and pressure on hospital budgets that may lead to service cuts.
What this means for other health systems
Digital transparency tools such as Diagnosis Bulgaria are increasingly used worldwide to hold health systems to account. They can strengthen oversight when official data is published in usable formats, but they also depend on the completeness and quality of underlying government records.
Health systems that struggle with fragmented procurement, limited tender competition or weak price benchmarking may be particularly susceptible to the kinds of anomalies the platform uncovered. Rapid government engagement in Bulgaria shows how officials can respond constructively — by using the data to investigate outliers and restore public confidence.
This reporting is based on Euractiv’s coverage of the Diagnosis Bulgaria platform and accompanying government reactions. Readers with concerns about medicines, procurement or access should consult their clinic, treating clinician or the relevant health authority rather than rely solely on public databases.
