WHO - World Health Organization Regional Office for Europe

10/10/2024 | Press release | Distributed by Public on 10/10/2024 09:41

North Macedonia updates Positive List of Medicines after 15 years, with WHO support

North Macedonia's revision of the Positive List of Medicines after a 15-year gap was the focus of a high-level policy dialogue held by the Ministry of Health of North Macedonia, with WHO support, to address the country's ongoing challenges in ensuring access to essential medicines. The Positive List has been established as a mechanism to determine which medicines are fully or partially reimbursed by the national health insurance, and its revision promises to alleviate the financial burden on patients who have long faced high out-of-pocket costs for outpatient medicines.

The meeting brought together some of the country's most influential political and health-care figures to address the persistent funding challenges that complicate the consistent addition of innovative medicines to the Positive List. Despite conditional budgets and support from the Health Insurance Fund, the allocation remains insufficient, making it difficult to keep pace with the need for newer, high-cost medicines.

Prime Minister Hristijan Mickoski underlined the significance of the update, calling it a critical achievement in the Government's efforts to ensure health-care equity. "This update demonstrates our dedication to addressing long-standing issues in the health-care system, but we must continue our efforts to ensure that all citizens have access to the medicines they need without facing financial hardship," he stated.

"A public health necessity"

Currently, patients in North Macedonia bear 41.7% of total health-care expenditure, half of which goes towards pharmaceuticals. Much of this financial burden is a result of the limited scope of the Positive List, which excluded many necessary outpatient medicines or offered partial coverage. With the update, more medicines will be included, helping to reduce these out-of-pocket expenses. The Government also announced that from now on, the Positive List will be regularly updated.

Minister of Health Dr Arben Taravari emphasized that the update of the Positive List is not just a technical process but a public health necessity that requires collaboration across various sectors. "This is a significant step, but we need sustained cooperation between the Ministry of Health, the Health Insurance Fund, and other national institutions to ensure ongoing improvements," Dr Taravari said.

WHO representative Dr Natasha Azzopardi Muscat, praised North Macedonia's progress, highlighting the Positive List revision as a crucial step towards achieving universal health coverage. WHO remains committed to supporting the country's efforts to strengthen its health-care system, particularly in the area of pharmaceuticals.

Understanding the obstacles

Key stakeholders included Prime Minister Hristijan Mickoski, Minister of Health Dr Arben Taravari, Minister of Finance Gordana Dimitrieska-Kochoska, WHO Regional Office for Europe Director of the Division of Country Health Policies and Systems Dr Natasha Azzopardi-Muscat, WHO Representative in North Macedonia Dr Akeem Ali, and Head of the WHO Barcelona Office for Health Systems Financing Dr Tamas Evetovits, alongside Health Insurance Fund Directors Sasho Klekovski and Branko Adzhigogov, Director of the Agency for Medicines and Medical Devices Sefedin Jonuzi, and 30 national experts in the field, including heads of relevant national institutions and representatives of the academia.

In his closing remarks, Dr Akeem Ali emphasized the progress made through the high-level policy discussions: "Over the past months, the WHO Country Office, in close collaboration with key national stakeholders, has facilitated discussions to better understand the obstacles to regularly updating the Positive List. Equally critical are the needs for greater clarity in the processes, greater transparency and trust among stakeholders."

As North Macedonia embarks on this new phase of health-care reform, the revised Positive List is expected to significantly improve access to essential medicines, bringing the country closer to its goal of providing equitable health care for all citizens.