Nearly 56 million prescriptions were sent by doctors via SMS in 2024. It cost the SIDC over CZK 33 million – one fifth of its operating expenses
PRESS RELEASE ON AUDIT NO 24/25 – 3 November 2025
The State Institute for Drug Control (SIDC) spends a significant portion of its operating budget on electronic prescriptions that doctors send to patients via SMS messages. In 2024, the SIDC paid more than CZK 33 million for SMS prescriptions – almost one fifth of its total operating expenses. And the number of SMS prescriptions keeps increasing: while in 2020, 28.5 million prescriptions were sent by SMS, in 2024 the number had risen to nearly 56 million. That represents almost 65% of all e-prescriptions issued. With the introduction of mandatory eVouchers for medical devices in 2026, further substantial growth in SMS-related costs is expected. Yet there are other ways to deliver prescriptions to patients or to collect medications at the pharmacy – though the public is largely unaware of them. This was revealed by the Supreme Audit Office (SAO) during its audit of the SIDC’s finances for the years 2020 to 2023 and the following period.
All prescriptions issued in the Czech Republic go through the ePrescription (eRecept) system. This system represents a key element in the digitalisation of Czech healthcare and forms part of the state’s critical infrastructure. It is managed and operated by the SIDC. Electronic prescribing of medications has been mandatory for all doctors since 1 January 2018. Patients can choose how to receive their prescription – either through the ePrescription application (where the prescription is always visible), via SMS, by e-mail, or in printed form. Since June 2020, patients have also been able to collect their medication in pharmacies simply by presenting a valid identity card, as the pharmacist can locate the prescription directly in the ePrescription system.
“Compared to some other state digital systems, we are successfully using the ePrescription. However, SMS-based ePrescription already generates annual operating costs of around CZK thirty million for the SIDC, which will continue to rise in the future. We consider this to be a non-systemic solution that the state should reconsider and find another way to cover the costs of such successful communication between the state and its citizens. For example, could the SMS messages sent by the state be provided free of charge by mobile operators?” asks SAO Member Jan Stárek, who led the audit.
Costs could be reduced through wider use of the application
Since 2020, patients have had access to the ePrescription application (available as a mobile application or web version). Users can log in using their citizen identity, bank identity, or the eGovernment mobile key. In 2024, just over 290,000 prescriptions were issued to patients through the ePrescription application – less than half a per cent (0.34%) of all prescriptions.
The application offers citizens a range of additional useful features: after logging in, users have access to an overview of all prescribed and dispensed medications, information about the prescribing doctor, pharmacy, and package leaflets. In November 2023, a Registry of Mandates function was added to the application, allowing patients to grant power of attorney for representation. This simplifies matters for those who cannot or do not wish to manage their health data themselves, such as elderly people or those with limited mobility. From 2024, the application also enables users to check which of the 20 nearest pharmacies have a limited-availability medication currently in stock. Since this year, the application also includes a record of co-payment limits, which was previously maintained by health insurance companies.
The SAO found that wider use of the ePrescription application could reduce the SIDC’s operating costs. Nevertheless, the information and media campaign promoting the application was not launched until 2025 – nearly five years after the application became available. The campaign aimed to reduce the number of SMS prescriptions, increase the number of active users of the application, and encourage healthcare professionals to make greater use of the medications record. At the time of the audit, however, the SAO was unable to assess its impact, as contractual obligations had not yet been fulfilled.
Errors in public procurement
The SAO audit also found that the SIDC had made errors in its public procurement processes. In eight out of fifteen reviewed contracts, the SAO identified violations of legal regulations. In public procurements related to the purchase of information and communication technologies worth CZK 37.6 million (excluding VAT), auditors found violations of the principle of transparency. The SIDC failed to retain documentation concerning the determination of the estimated value of the contract, which is a key element of the so-called audit trail. This omission made it impossible to retrospectively verify whether the chosen procurement procedure was correct and appropriate.
In the case of a public procurement for catering services, the SIDC awarded the contract directly to a provider on the basis of an exemption, even though the conditions for applying this exemption were not met. The SIDC therefore did not act transparently and violated the principle of equal treatment by concluding a contract with a specific supplier without a tender process. This gave the chosen supplier an unfair advantage over others. During the audited period from 2020 to 2023, the SIDC carried out 100 public contracts worth CZK 397.5 million and acquired assets worth CZK 178.7 million.
Communication Department
Supreme Audit Office