Uzbekistan has approved landmark legislation to improve both affordability and access to medicines at primary health-care level through the integration of community pharmacies. Through the reimbursement system, community pharmacies are reimbursed by the State Health Insurance Fund (SHIF), reducing the financial burden on patients, which ensures that outpatient medicines are available in communities without delays.
The new system marks a milestone in the country’s efforts to make life-saving treatments available to everyone without resulting in financial hardship. Initially piloted in Syrdarya oblast in 2022 with a selected group of medicines for 5 priority noncommunicable diseases, the new system will extend countrywide and aim to cover the entire population of 36 million by 2027, as part of a comprehensive health system reform.
“The new legislation is a major achievement for the Government and for the people of Uzbekistan. It paves the way for greater affordability and equitable access to essential medicines,” explained Dr Asheena Khalakdina, WHO Representative to Uzbekistan. “Most importantly, the process has become simpler and more convenient for patients, ensuring that they can obtain the medicines they need more easily. This contributes to better treatment outcomes and improved health for everyone.”
Improving access, affordability and equity
WHO has supported the Government of Uzbekistan throughout this process, helping to shape the country’s national reimbursement system into a patient-centred partnership involving the Ministry of Health, SHIF, prescribers, and the private pharmaceutical sector – in particular, manufacturers, distributors, and community pharmacies.
Dr Asiyo Isayeva is a family doctor at the Central Multidisciplinary Polyclinic in Gulistan. She emphasizes that the new reimbursement system has led to a positive change in the way patients take ownership of their care.
“With the new system, medicines are more affordable, and patients are more attentive to their health. They come regularly for their prescriptions, understanding the importance of ongoing treatment,” she says. “Family circumstances and financial constraints are no longer a barrier.”
The system is designed to operate seamlessly using digital infrastructure. Doctors issue e-prescriptions via an online portal, and key information – prescription codes – is sent to the patients’ mobile phones via text messages. With this, the patients can go directly to a community pharmacy and pick up their medicines free of charge. Pharmacies will then send an invoice to SHIF to receive reimbursement.
“Seeing people satisfied when they receive their medications really makes my day,” says Anna Zinina, a pharmacist working in Gulistan district. “It’s especially meaningful in the case of retirees, who often mention how much it helps them. Recently, an elderly lady came with her son to pick up her diabetes medicines, and I heard him say how relieved he was that she now stays on track with her treatment”.
A major achievement
This new milestone is the result of long-standing collaboration among key stakeholders and ongoing support from the WHO Country Office in Uzbekistan and the WHO Regional Office for Europe in Copenhagen, to strengthen equity and access to health care across the country.
“WHO’s comprehensive support has been instrumental in shaping our national reimbursement system into a patient-centred partnership. This initiative is expanding its reach, benefiting more people across Uzbekistan,” says Dr Farrukh Sharipov, Deputy Minister of Health and former SHIF Executive Director.
Legal foundation
The new reimbursement system aligns with Uzbekistan’s goal to establish a sustainable, people-centred health system that leaves no one behind. It forms part of a broader health sector reform framework outlined in the Resolution of the Cabinet of Ministers (No 619), signed in October 2024. The resolution establishes key legal and regulatory mechanisms to accelerate the implementation of the medicine reimbursement system, ensuring nationwide rollout by the end of 2026.
Key provisions of the resolution include:
- a phased launch of the reimbursement system in regions where state health insurance mechanisms are already in place;
- community pharmacies that have signed a contract with SHIF will participate in the reimbursement system;
- medications prescribed by doctors using electronic prescriptions will be dispensed to patients free of charge by community pharmacies through the reimbursement system;
- the cost of medications dispensed by community pharmacies through the reimbursement system will be covered from public funds by SHIF;
- the Ministry of Health determines the list of reimbursable medicines based on the state-guaranteed benefit package, and SHIF will have the mandate to determine the reimbursement amount; and
- SHIF is given the mandate to negotiate prices, leveraging its role as a strategic purchaser to ensure lower costs and better value for money.