Ukraine Is Adding 51 Heart and Vascular Medicines to Its Free Drug Programme

Ukraine’s state reimbursement programme is getting its biggest cardiovascular upgrade ever. From July 2026, 51 new medicines — spanning the full range of heart and vascular conditions — are set to join the Dostupni Liky list, meaning millions of patients will be able to pick them up at the pharmacy for free or close to it.

That matters, because cardiovascular disease is responsible for 68% of all deaths in Ukraine — and up to 80% of those deaths are considered preventable with proper treatment. The barrier is rarely ignorance of diagnosis. It is the cost of sustained pharmacotherapy when money runs short, when shelling displaces a family, when a pensioner in a frontline oblast has to choose between tablets and food. This expansion directly addresses that gap.

The new medicines cover every major pillar of cardiovascular care: blood pressure control, heart failure, rhythm disorders, clot prevention, and cholesterol management. Here is what is actually coming.

🫀 Heart Failure & Stable Angina Pectoris

3 INNs added

• Isosorbide mononitrate — long-acting nitrate for chronic stable angina and symptomatic heart failure
• Ivabradine — If-channel inhibitor; heart rate reduction in stable angina and HFrEF where beta-blockers are not tolerated or insufficient
• Eplerenone — selective aldosterone antagonist for post-MI heart failure and HFrEF

🩸 Hypertension — Monotherapies

8 INNs added

• Moxonidine — central imidazoline agonist; second-line option for resistant hypertension
• Doxazosin — alpha-1 blocker; particularly useful in hypertension co-existing with benign prostatic hyperplasia
• Chlorthalidone — long-acting thiazide-like diuretic with among the strongest cardiovascular outcome data of any antihypertensive
• Propranolol — non-selective beta-blocker
• Nebivolol — highly cardioselective beta-1 blocker with nitric oxide-mediated vasodilation
• Nimodipine — calcium channel blocker indicated specifically for cerebrovascular spasm following subarachnoid haemorrhage
• Lercanidipine — third-generation dihydropyridine CCB with high vascular selectivity and good tolerability profile
• Diltiazem — non-dihydropyridine CCB covering both blood pressure reduction and rate control

💊 Hypertension — Fixed-Dose Combinations

A large block of combination INNs is included, pairing ACE inhibitors and ARBs with amlodipine, diuretics, bisoprolol, and sacubitril. Fixed-dose combinations are the most evidence-supported tool for long-term blood pressure adherence — fewer tablets, better persistence.

• ACE inhibitor combinations: captopril, enalapril, lisinopril, perindopril, ramipril — each with amlodipine and/or a diuretic
• ARB combinations: valsartan, losartan, irbesartan, candesartan, telmisartan, olmesartan medoxomil — paired with amlodipine, diuretics, or bisoprolol
• Sacubitril/valsartan — the first ARNI to enter the programme; a landmark addition for HFrEF management that reflects current ESC guidelines

⚡ Arrhythmia

4 INNs added

• Mexiletine — class Ib antiarrhythmic for ventricular arrhythmias
• Propafenone — class Ic; atrial fibrillation and supraventricular tachycardia
• Flecainide — class Ic; paroxysmal AF and SVT, particularly in structurally normal hearts
• Sotalol — class III antiarrhythmic with beta-blocking activity; AF maintenance and ventricular arrhythmia

🩺 Antiplatelet & Anticoagulant Therapy

4 INNs added

• Prasugrel — P2Y12 inhibitor for post-ACS patients treated with PCI
• Ticagrelor — reversible P2Y12 inhibitor for ACS and high-risk secondary prevention
• Cilostazol — PDE3 inhibitor for peripheral arterial disease and intermittent claudication
• Edoxaban — factor Xa inhibitor (NOAC) for AF and VTE treatment and prevention

🧪 Lipid-Lowering Therapy

5 INNs added

• Rosuvastatin — high-potency statin; LDL reduction and primary/secondary cardiovascular prevention
• Ezetimibe — cholesterol absorption inhibitor; used alongside statins when LDL targets are not met on statin alone
• Rosuvastatin + ezetimibe — fixed-dose dual lipid-lowering for high-risk patients
• Rosuvastatin + acetylsalicylic acid — single tablet combining lipid control with antiplatelet protection
• Colchicine — residual inflammatory risk reduction in established atherosclerosis; supported by COLCOT and LoDoCo2 trial data

Author’s Take

This is the most substantive single expansion to the cardiovascular portfolio of Dostupni Liky since the programme launched in 2017. It is a genuine step forward — not a symbolic one.

The antiplatelet upgrade matters most immediately: adding ticagrelor and prasugrel moves post-ACS treatment beyond clopidogrel, which has been on the list for years. Combined with edoxaban completing full NOAC coverage (after apixaban, dabigatran, and rivaroxaban joined in May 2026), the antithrombotic toolkit is now largely in line with ESC guidance. The arrhythmia additions — especially propafenone and flecainide — fill a gap that forced many patients to either pay out of pocket or go undertreated.

The combination antihypertensive block is where population-level impact will be felt most widely, given how many Ukrainians are hypertensive and how many stop treatment. Sacubitril/valsartan entering the programme is a welcome signal that guideline-directed heart failure therapy is being taken seriously. And on lipids, rosuvastatin with ezetimibe directly addresses the reality that statin monotherapy often fails to reach LDL targets in high-risk patients — the combination is now available as a single tablet at no cost.

What this expansion cannot guarantee is immediate availability at the pharmacy counter. The Cabinet resolution authorises NHSU to begin pricing and registration procedures — it does not itself activate prescriptions. The programme’s real-world reach will depend on how quickly those procedures conclude and how many branded products are registered at the reimbursed tariff. That is the part worth watching.