The Protector of Citizens has requested the National Health Insurance Fund (NHIF) to provide the conditions to include on the List of Reimbursed Medicines the estrogen-boosting medicines which are necessary for safeguarding the health of trans women, as well as the ones who have gone through menopause and those who have had their uterus removed (hysterectomy).
In the Recommendation, the Protector of Citizens has highlighted that the NHIF Central Expert Committee for Medicines should accept the proposal by the National Expert Committee for Transgender States about placing the medicines “estradiol” ampoules and “estradiol valerat” pills on the List and that this amended list, following the Protector of Citizens’ Recommendation, should be subsequently adopted by NHIF Management Board. The NHIF has been given a 60-day deadline to notify the Protector of Citizens about acting upon these Recommendations.
After learning that since 2012 the medicine, produced in Serbia and on A1 Medicine list, for maintaining the hormone status of trans people, as well as women who underwent hysterectomy and postmenopausal women has not been available on the market, the Protector of Citizens launched an own-initiative investigation in July 2019 to control work regularity and legality of the competent authorities.
The Protector of Citizens sought information on the reasons why the medicines were long unavailable from the Medicines and Medical Devices Agency, the National Health Insurance Fund, the Ministry of Health, the National Expert Committee for Transgender States of the Clinical Center of Serbia, which includes the Psychiatry Clinic and the Cabinet of Transgender States.
Based on the submitted responses of the controlled authorities, the Protector of Citizens ascertained that the medicines for boosting estrogen levels are no longer produced in Serbia, that they cannot be found over the counter and that they can occasionally be purchased "in the black market" from pharmacists at much higher prices than the market ones.
During the two-year control investigation, the Protector of Citizens constantly kept communication with the Ministry of Health, representatives of Medicines and Medical Devices Agency and the NHIF, and received the Opinion of the Chairman of the National Expert Committee for Transgender States which emphasized the necessity of urgent provision of a similar medicine.
However, the decision to place a particular medicine on the List is made by the Central Committee for Medicines of the NHIF, which in April 2021 decided to postpone providing their statement on this issue, taking into account, as stated in the response to the Protector of Citizens, "fewer patients who would qualify for the medicines” as well as the fact that in Europe there was no registered ampoule form of the "estradiol" medicine but only "estradiol valerate" pills.
Recalling the fact that state authorities and institutions are bound to take all the necessary measures to create an enabling environment for human rights exercise, including the rights of people of different sexual orientation and gender identity, the Protector of Citizens issued a Recommendation to the NHIF to put the medicines “estradiol” and “estradiol valerte” on the List.