The audit of the "e-depot" system data and information administered by the Reimbursement Directorate at FSDKSH has identified a problematic practice in the supply chain and reimbursement of medicines, the Albanian Supreme Audit Institution (KSAI) concludes.
According to the findings, some pharmacies under contract with the Fund were supplied by pharmaceutical warehouses with drugs included in the List of Reimbursable Drugs (LBR), which are registered in the system with a value of zero lek per unit. Despite the lack of purchase cost, these drugs were prescribed and dispensed to patients through reimbursable electronic prescriptions, benefiting from full reimbursement by FSDKSH based on the price approved in the LBR.
The reimbursement is calculated on the approved reference price, with the commercial margin for the minority and majority, according to the applicable DCMs.
Under these conditions, it turns out that pharmacies have benefited from reimbursement from the fund for drugs that did not have a real purchase cost, as they were supplied with a zero-value invoice. Meanwhile, the reimbursement scheme has functioned as if the drug had been purchased at the normal market price, generating unjustified financial benefits for the beneficiary entities.
Essentially, the difference between the real cost (zero) and the reimbursed price under the LBR constitutes an unjustified transfer from public funds to private operators, contrary to the basic purpose of the health insurance scheme.
The audit highlights several structural issues such as the lack of an integrated mechanism in the "e-depot" system for automatic verification of the correspondence between the drug's entry price in the pharmacy and the reimbursed value; the lack of control by the Reimbursement Directorate over the real source and effective price of supply; or weaknesses in coordination between the structures responsible for reimbursement, financial control and monitoring of the pharmaceutical supply chain.
These gaps have created significant scope for abuse, turning a social support mechanism into a potential instrument for unfair advantage.
The fundamental objective of the reimbursement scheme is to cover the real cost of supplying medicines to citizens, so that they do not face a financial burden for necessary treatments. When reimbursement is provided for zero-cost products, this objective is distorted and public funds are used to generate profit margins without real expenditure.
In this context, the situation requires immediate intervention in several directions: strengthening electronic control, automatic linking of billing systems with reimbursement, in-depth auditing of identified cases and, if violations are found, administrative and legal prosecution of the responsible entities, the SAI further concludes in the audit.
