“10% of psoriasis sufferers, or 14,000 people, have a severe form of the disease. There are about 140,000 psoriasis patients in our country." This was said by the manager of the National He alth Insurance Fund, Dr. Rumyana Todorova. She attended the presentation of the brochure "Types of Psoriasis Treatment", published by the He alth Insurance Fund together with the Association of People with Psoriasis and Psoriatic Complications, whose vice-president is Iva Dimova.
"BGN 2,300 per month is the average cost of treating psoriasis with biological medications per patient," said Dr. Rumyana Todorova. 50 patients were programmed for the treatment of the disease with biological products, which the NHIF accepts, last year. At the moment, 204 protocols have been submitted to the Cashier for processing, of which 172 have already been approved, 27 have been returned for clarification, and five have been refused.
How do Bulgarian patients deal with the high price of medication for treatment, is there a stigma, are patients with psoriasis treated in our country, we are talking to Iva Dimova, vice-president of the Association of People with Psoriasis and Psoriatic Complications.
Mrs. Dimova, you yourself suffer from psoriasis. How do you feel, what vicissitudes have you gone through?
- I have had psoriasis for 30 years. I used to soak my hands in warm olive oil and I didn't like the smell, and my parents used to smear me with different creams. When my hands were cracking and I couldn't write, my dad would make caps out of band-aids to make it go faster. I am grateful both to them and to my treating dermatologist, Dr. Angelova, for their care during all these years. I have used absolutely everything - from grandmother's ointments to tar. But the most important thing, in my opinion, is that the patient should not be impressed by the psoriasis. I know that in many cases it sounds impossible, but it depends on us. We have to like ourselves - with and without the plaques. I never hid what was falling out of my hair and what my hands or elbows were. Everyone around me knows - family, friends.
Is it with the idea of helping people like you that the Patient Guide "Types of Psoriasis Treatment" appeared?
- Precisely because of this. People should know their disease, know about the types of treatment. Psoriasis is a severe chronic autoimmune disease, which, if the necessary care is not taken - from the most elementary moisturizing of the skin to the therapy prescribed by a dermatologist - progresses quite quickly. We hope that through the media, this booklet will become popular and especially useful for the sick. The Bulgarian patient really does not know what is happening to him in a system with which someone is constantly experimenting. The manual is a step for the patient to know the path of his own treatment, not to get lost in who and how can help him cope with the disease.
The he alth fund pays for biological therapy. Is this good for the sick?
- In truth, it's not quite good. Currently, the He alth Insurance Fund covers only the most expensive - biological treatment,
and when a person is already very bad
But even with this therapy, the criteria are much more restrictive than in Europe. Everything else as treatment is borne by the patient himself. And since not everyone can afford it, therefore very often patients are not treated. People should know that psoriasis is not contagious. This can help many Bulgarians not to be rejected by society. Children can be very cruel to their peers, not out of malice, but because we adults have not taught them tolerance.
From this year, another treatment is covered by the He alth Insurance Fund - immunosuppressants for severe forms of the disease will also be paid for. We run it a bit wrong - from the most expensive to paying for the cheaper medications - but this is a treatment option.
Sufferers are worried about their condition and many of them do not receive treatment. How does your organization help them?
- Lately, since the organization has been around, I have come across some terrifying theories about what psoriasis is. From "God's punishment from which only women suffer" to "this was not there under communism" or "lack of hygiene".
However, people do not know enough about the disease! For many years it was believed that this was a skin defect or a skin disease. Therefore, it is important to know that psoriasis is an autoimmune disease with skin expression. Quality of life depends a lot on where the person is affected, as well as the amount of plaque coverage. If you have spots on your face and it itches, hurts, and sores develop - are you useful to yourself and society?! Can you go to work?
There are requirements regarding new types of medication that are too restrictive - without paying attention to the individual person and their quality of life. And to get better, people with psoriasis have a long way to go. Not every person can afford the treatment prescribed by a dermatologist. And this is the right behavior.
I know of people who
have tried all sorts of ointments,
messed up in someone's garage, or ones imported from overseas. From them, the disease worsens, and when the deterioration is obvious and affects other organs, a specialist dermatologist is sought.
Are the possibilities of climate treatment used in our country?
- Climate treatment is a very basic part in the treatment of psoriasis. It is used to the extent that the patient himself looks for a suitable sanatorium, paying a rather high fee. Years ago, treating doctors necessarily sent patients for climate treatment, the skin clinic had bases on the Black Sea, Plovdiv, Sandanski. Now they don't, NOI provides cards, but only for working people. I will mention that there is a wonderful sanatorium on the Dead Sea, with a wonderful effect on the disease. People don't drink medicine, they just go to the sea, use healing s alts. In our country, no one does anything, we do not use the resources of our own country, but there are patients who are treated in Turkey, with those magical fish that will "eat" the plaques. But that doesn't happen - they just take our money.
Dr. Rumyana Todorova:
We owe it to the patients
Dr. Todorova, the Fund is obliged to pay the most expensive treatment…
- Suddenly he went to treatment which is the most expensive, the latest and the Treasury undertakes to pay for it. Before that, many other possibilities were not used. Especially for the skin form of psoriasis, the classic treatment is local therapy. However, the fund does not pay for any local medication. When the patient is in remission, he needs a very simple oil to lubricate the skin, not to go to heavy therapy.
How much money does therapy cost per month?
- BGN 2,300 per month is the average cost of treating psoriasis with biological medications for one patient. About 140,000 Bulgarians are affected, over 10% have a severe form of psoriasis. That is, they are indicated for biological treatment. That's 14,000 people.
In the Vidin region, phototherapy is not applied in their hospital. How can this change?
- The district hospital there has 51% state participation. To have phototherapy, you need money. The principal, the Ministry of He alth, should be involved in creating conditions for treatment, especially when it is known that there are many patients with psoriasis in this region.
Patients complain that the fees they pay in the sanatoriums for which NOI provides them with cards are high. Can the he alth fund help them with something?
- Unfortunately, no, because we do not have a clinical pathway to provide physiotherapy to these patients. It can be considered a kind of help, but in the coming years. It is a paradox that patients with psoriatic arthritis have a clinical pathway and can use climate treatment for free, but the pure skin form of the disease does not exist as a diagnosis for such treatment. There is much that can be done in the field of rehabilitation and physical medicine, and not just for working people. We owe it to the patients.