Access and Use of Medicines in Ukraine

Ukraine is a lower middle-income country in the east of Europe. Until 2017, the healthcare system was based on integrated Semashko model and the universal health coverage was guaranteed by the Constitution with free access to healthcare services for all citizens. Due to the range of reasons, access to healthcare services and to medicines was highly restricted in the country. During the past decade the public health spending was consistently low in Ukraine. Over 99% of all spending on medicines was made by patients in 2015. The recent WHO review suggests that majority of Ukrainian citizens experienced the financial hardship by the use of the health services, including medicines. To improve healthcare outcomes and ensure the financial protection of the population, starting from 2017, the Government of Ukraine implemented a range of healthcare reforms. The new legislation in 2017 defined the extent of healthcare services and medicines that will be completely covered by the state. The state budget assigned to health is around 5% of gross domestic product. The National Health Service of Ukraine was established as a single national health-care purchaser. A new essential medicines list defined the restricted list of medicines for the public procurement and reimbursement. To improve access to medicines, Affordable Medicines Programme was introduced in 2017. The Ukrainian patients may receive 23 INN medicines free-of-charge for the treatment of cardiovascular diseases, diabetes type 2 (except insulin) and bronchial asthma. Despite its implementation recently, the programme proves to have a significant impact on access to medicines. In 2017 more than 8 million Ukrainians benefited from the programme, of whom 7.2 million suffered from cardiovascular diseases, 700, 000 from type 2 diabetes and about 160, 000 from bronchial asthma. It was shown that the prices remained stable or either decreased for the medicines reimbursed. For the patients with insulin-treated diabetes, a special programme of the insulin reimbursement was introduced in 2016. The new National Registry of patients with diabetes allows the precise planning and allocation of budget. The reimbursement procedures enable the access to insulin for patients free-of-charge or with copayment in all regions of Ukraine. In 2019 the government is planning to reimburse 100% costs for insulin from the state budget.