The Medication Gap

The Treatment Is There. The Medication Often Is Not.

For most leukemia patients in Europe, the chemotherapy itself is covered by the state. But treatment is never just one drug. It is a combination of medications that work alongside chemotherapy to keep a patient's body functioning through one of the most aggressive medical interventions it will ever face.

These supporting medications prevent infections when the immune system has been wiped out. They stop the nausea that would otherwise make eating impossible. They manage the mouth sores that make swallowing painful. They keep the body stable enough to tolerate the next round of treatment.

And in most European countries, they are either partially covered, covered only with a co-payment, or not covered at all.

The Reimbursement Gap Across Europe

A 2024 study examining 15 European countries found that the average time between a leukemia drug being approved and a patient being able to access it through state reimbursement was nearly 30 months. In countries like Latvia and Lithuania, that wait approaches 900 days. In Romania, Slovakia, and Estonia, fewer than one in five newly approved cancer medicines are reimbursed at all.

Bulgaria, where the Francesco Salerno Foundation is based, has no structured access program for innovative therapies. Patients must apply case by case, with no guarantee and no timeline.

What this means in practice is that a patient whose life depends on a specific oral targeted therapy may wait two years for the state to fund it, or pay for it themselves, or go without.

What the Gap Actually Costs a Patient

The out-of-pocket medication burden for a leukemia patient in active treatment across Europe typically includes:

1. Generic anti-nausea medication (ondansetron) for each chemotherapy cycle: the drug is off-patent and inexpensive, but not always fully reimbursed. A monthly course runs approximately €20 out of pocket after insurance
2. Antifungal and antibiotic prophylaxis to prevent life-threatening infections during immunosuppression: roughly €20 per month for generic versions
3. Oral care products to manage mucositis, the mouth sores caused by chemotherapy that can make eating and speaking painful: approximately €10 per month
4. Co-payments or partial coverage gaps on oral targeted therapies, particularly in lower-reimbursement EU countries: approximately €15 per month on average

That is roughly €65 per month in uncovered medication costs, for drugs that are not optional. For a patient who has lost income because treatment makes working impossible, €65 a month is a genuine crisis on top of an already impossible situation.

Why This Cause Needs Funding

The Francesco Salerno Foundation does not pretend to solve pharmaceutical pricing or government reimbursement policy. What we can do is cover the gap for a specific patient, for a specific treatment period, so they do not have to choose between buying medication and paying rent.

Our goal of €9,000 is based on supporting 30 patients through five months of active treatment. We calculate approximately €300 per patient, covering the monthly out-of-pocket medication costs described above. We focus only on what insurance does not cover. We do not duplicate what the state already funds.

Your donation covers:

1. Generic anti-nausea medication for each chemotherapy cycle, so treatment-induced vomiting does not become malnutrition
2. Antifungal and antibiotic prophylaxis, so a suppressed immune system does not become a fatal infection
3. Oral care for mucositis, so a patient can eat and take their other medications
4. Co-payment contributions for oral targeted therapies in countries where state reimbursement is partial or pending

The foundation does not take an administrative fee. Every euro raised for this cause goes directly to medication costs for identified patients.

What Your Donation Actually Does

Somewhere in Europe right now, a leukemia patient has been told their treatment plan includes a drug their insurance will not cover. The drug exists. Their doctor has prescribed it. The pharmacy has it in stock. They simply cannot afford it.

That is the gap your donation closes.

A specific person, a specific prescription, filled.