Research Paper

Transparency and Professionalism of Drug Reimbursement Policy

Chapter: Slovakia | Year: 2019

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About the chapter:

Transparency Slovakia works to reduce corruption and increase the transparency of institutions. It follows the powerful, pushes for solutions and engages people in public scrutiny. It’s vision is for Slovakia and the world with responsible people and open institutions without corruption.

CPI Score: 50

CPI Rank: 57

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Theory of Change

Policy & Insititutional Change
Better Institutional Processes


Slovakia spent a total of €1.1 billion of public money in 2015 on medicines (reimbursed to health insurance companies). This is more than the annual budgets for the Ministries of Defence and Culture combined.

The categorisation of medicines is a key part of the decision-making process on drug expenditure. The health care system decides whether medicines are subject to full or partial public health compensation.

Given the high level of spending, TI Slovakia has been working to increase the transparency of the categorisation process. It believes that the process should be subject to transparency standards that allow for the widest possible public scrutiny. In particular, scrutiny around the entry of innovative, uncategorised medicines, medical device and dietetic foods.

Annually, the Ministry of Health receives near one hundred requests from pharmaceutical companies and other manufacturers to categorise a new drug, with decisions made by expert working groups on pharmacoeconomics.

TI Slovakia has studied this process with a view to making recommendations designed to improve transparency and accountability.


The research analysed a total of 265 categorisation proceedings (January 2013 and December 2015).


  1. Declarations of conflicts of interest of advisory group members is missing.
  2. The decisions are insufficiently justified and do not allow for control or public debate.
  3. Advisory group membership is free, although they decide millions of euros per year, which increases the risk of bad or corrupt decisions.
  4. Data on estimates from pharmaceutical companies and other manufacturers are not very reliable, which may undermine the quality of decision-making on funding priorities,


  1. Introduce professionalisation of the categorisation process, including paid experts and selection proceedings.
  2. Introduce mandatory public declarations of conflicts of interest for the evaluators of drug applications.
  3. To publish more detailed minutes on the discussions for/against the inclusion of medicines.
  4. Control the consumption of newly categorised medicines and the financial impact on the public health insurance as opposed to categorisation assumptions.
  5. Publish categorization procedures in a more user-friendly form - open data.