As of today, 8 July 2025, the National Health Insurance Fund (NHIF) will fully cover one antibiotic in two concentrations for home treatment of children up to the age of 7. This is a historic step towards improving access to healthcare for the youngest patients and their families, and the result of years of efforts by civil society organisations.
The two antibiotics, whose names are not specified, are now included in the Positive Drug List and will be prescribed via e-prescription for the treatment of 26 of the most common infections in children – including sinusitis, pharyngitis, pneumonia, and skin conditions.
The change came into force after, in June 2025, the National Assembly approved the proposal to cover medicines for acute infections for children up to the age of 7 through the NHIF budget. Ten million BGN were allocated until the end of the year. The proposal was based on in-depth analyses and advocacy efforts by the “Colourful Tomorrow for Our Children” initiative, led by the Trust for Social Achievement (TSA) Foundation, with the participation of numerous partner organisations, including the National Network for Children (NNC).
Negotiations are underway with the Marketing Authorisation Holder for the inclusion of a third antibiotic. An application has also been submitted to the National Council on Pricing and Reimbursement of Medicinal Products, as well as to the NHIF, for the inclusion of an antiviral medicine. The application is currently under review. You can read the NHIF’s full statement HERE.
As early as January 2025, over 1,000 parents took part in a national survey on access to medicines, which revealed alarming results:
-
Every second parent struggles to cover the costs of medicines;
-
14.4% are “strongly struggling”;
-
The average annual cost for one child exceeds 560 BGN;
-
In 2024, parents spent over 1 billion BGN on children’s healthcare, including 63 million BGN solely on antibiotics.
The data also shows something else: timely home treatment could reduce the number of hospitalisations, which last year cost the NHIF over 126 million BGN for children – a significant portion of which were repeat and potentially preventable admissions.
Despite this positive change, experts express concern that if initially only two antibiotics are truly accessible, this may lead to:
-
the risk of overuse and misuse due to the lack of other approved free medicines at this stage;
-
pressure from parents for the free medicine to be prescribed even when there is no medical indication;
-
unequal access – some children will receive the antibiotic for free, others will not;
-
a single active substance receiving all public funding.
This is why civil society organisations and supporting stakeholders call for the measure to be upgraded into a broader and more balanced pharmaceutical policy, including:
-
free fever-reducing medicines, cough syrups, vitamins, bronchodilators, etc.;
-
vaccines against influenza and chickenpox;
-
public information campaigns on the rational use of antibiotics;
-
overall prevention through better nutrition, sleep, physical activity, and health education.
Covering the costs of medicines for children from birth to the age of 7 is not just an economic measure – it is a matter of equality, care, and a long-term vision for a healthy generation. Children’s health should not depend on their parents’ income or place of residence. Every child has the right to timely and adequate treatment. We will continue to monitor the implementation of this measure and advocate for its expansion.
