Breaking barriers to universal health coverage: Insights from Georgia’s chronic disease medicine program

Despite global progress towards Universal Health Coverage (UHC), achieving financial protection remains a challenge, particularly in low- and middle-income countries (LMICs). Out-of-pocket (OOP) payments for pharmaceuticals drive households into poverty and increase inequalities. In Georgia, pharmaceutical costs cause catastrophic health spending, disproportionately affecting the poorest. This study evaluates Georgia’s Chronic Disease Medicine Program (CDMP), explores its evolution and challenges, and proposes strategies to enhance performance and financial protection. This exploratory qualitative study combined stakeholder interviews with secondary data analysis. Participants were recruited through purposive and snowball sampling, with semi-structured interviews conducted in person and online. Thematic analysis identified key patterns and insights. The CDMP has significantly evolved, expanding benefits, beneficiary groups, and adjusting cost-sharing, leading to broader coverage. Recent measures, like removing reimbursement limits, have boosted participation and uptake. However, challenges persist: inequitable access, poor medicine selection, inadequate patient-centered care, limited public awareness, and insufficient primary healthcare (PHC) provider involvement. While procurement and distribution have improved, capacity constraints and governance issues hinder implementation. The CDMP represents a critical step toward achieving UHC objectives and reducing the burden of OOP payments caused by medicine costs. Enhancing the program effectiveness requires prioritizing vulnerable groups by expanding benefits for them, empowering PHC providers, and implementing targeted awareness campaigns. Strengthened governance and increased system capacity are also critical to overcome remaining barriers and maximize program impact. Findings offer actionable insights for other LMICs seeking to design and implement effective pharmaceutical benefit programs.