14 pharmaceutical enterprises have pledged to reduce high-cost drug prices
On November 28, the Ministry of Health held a workshop to collect opinions on the circular promulgating the List of pharmaceuticals, biological products, radioactive drugs, markers and regulations on payment for medical gas used in medical examination and treatment under the scope of health insurance (HI) participants. This is the largest adjustment and update of the list of drugs and biological products in the past 8 years.
According to Ms. Tran Thi Trang, Director of the Department of Health Insurance (Ministry of Health), based on the current list, the Ministry has reviewed 1,037 active ingredients specified in Circular 20 on the list of health insurance drugs.
Through initial assessment, the Ministry of Health proposed to add 76 new active ingredients and drugs in 8 groups, mainly cancer - immunotherapy (28 drugs, including 22 target drugs).
Next is the group of parasites - anti-inflammatory (9 drugs), cardiovascular (7 drugs) and some drugs to treat diabetes, high blood pressure, neurology, respiratory, digestion. This addition is expected to increase the health insurance fund's average expenditure by VND 2,449 billion per year.
In the group of cancer drugs, the Ministry representative said that this is the group that is supplemented the most and has high costs. The adjustment is expected to have a big impact on the health insurance fund budget, but the Ministry will mobilize resources from businesses, health insurance and related organizations to ensure the rights of patients.
Ms. Trang said that for expensive drugs, especially new drugs with high costs, the Ministry of Health will carefully consider the payment rate to ensure fund balance. 14 pharmaceutical companies have committed to reducing high-cost drug prices, in order to help include drugs in the health insurance portfolio with a more reasonable payment rate, reducing the burden of co-payment for patients.
"The addition of new drugs is necessary in the context of rapidly changing disease models, the demand for modern and highly effective drugs is increasing," said Ms. Trang.
Along with the addition of new drugs, the Ministry of Health also proposed to adjust the rate and payment conditions for 47 drugs already in the list; at the same time, type 130 drugs belonging to active ingredients with no registration numbers for circulation, not rare drugs or without import licenses.
Expanding the use of hundreds of drugs at commune health stations and primary health facilities
Informing about the draft to adjust the list of health insurance drugs, Ms. Vu Nu Anh - Deputy Director of the Department of Health Insurance (Ministry of Health) - said that a major change is to expand the use of 357 drugs (belonging to 10 groups) at commune health stations and primary health facilities, instead of limiting them to hospital class.
The drug groups include pain relievers - fever reducers, detoxification, parasites - anti-infection, cardiovascular, dermatology, digestion... to help treat non-communicable diseases right from the grassroots level, making it easier for people to access drugs covered by health insurance.
The list of drugs at commune health stations has therefore nearly doubled, to more than 600 drugs covered by health insurance. The use of drugs will depend on disease models and treatment capacity, no longer based on hospital status, thereby reducing the need to be transferred due to drug shortages.
The representative of the Ministry of Health said that regular updating the list will ensure the rights of health insurance participants, help patients access new drugs, effectively and at reasonable costs, and increase the choice of medical examination and treatment facilities near their home.
However, adjusting the list will also affect patients' costs, especially the co-payment or self-payment for drugs with payment rates.
"Self-payment costs are an amount outside the scope of health insurance benefits; co-payment is the part that patients pay with the fund according to the benefit level. For example, drugs have a payment rate of 50%, patients receive 80%, patients pay 50% themselves, co-pay 10%, the remaining 40% is paid by the health insurance fund" - Ms. Nu Anh explained.
Regarding the adjustment of the conditions and payment rate of 47 drugs, the Department of Health Insurance said that it is estimated that in 5 years, the cost of co-payment for patients will increase by 271 billion VND, while the cost of self-payment will decrease by 376 billion VND. Thus, patients will save about 105 billion VND in 5 years, equivalent to 21 billion VND per year.
In 2024, the total cost of health insurance examination and treatment is estimated at about 150 trillion VND, higher than the collection rate; of which the cost of medicine accounts for about 30%. The country has nearly 40 million people who regularly go for health insurance examinations, equivalent to 186 million examinations, an average of 4.5 times/year per person. People still have to pay about 40% of medical expenses themselves.
