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A new review article explores the Bulgarian legislation on health technology assessment (HTA). It analyses how innovative therapies and orphan drugs in particular would respond to the regulators’ decision-making criteria for reimbursement through hypothetical scenario planning for orphan medicinal products. The paper concludes that the current reimbursement decision-making framework in Bulgaria seems to be generalized, not sufficiently transparent, and unable to precisely assess innovative health technologies. The article is published in the Folia Medica Journal of the Medical University of Plovdiv.