After nearly 8 years, the list of health insurance drugs has been updated and adjusted. The Ministry of Health proposed to adjust and add 76 active ingredients and new drugs, including many oncology, immunology, and targeted drugs.
The above information was given by the Ministry of Health at the Workshop to solicit opinions on the draft Circular promulgating the List of pharmaceutical drugs, biological products, radioactive drugs, markers and payment in medical examination and treatment within the scope of benefits of health insurance participants held on November 28.
Medicines account for about 30% of expenditure.
According to statistics from the Department of Health Insurance, in recent years, drugs have always been an important component and always accounted for a large proportion of total health insurance medical examination and treatment costs. Although the proportion of drugs in total health insurance medical examination and treatment costs has gradually decreased in recent years, it still accounts for the largest proportion of expenditure from the health insurance fund. In 2022, it will be 40 trillion VND, accounting for 33%; in 2024, it will be 50 trillion VND, accounting for 31.22%.
Therefore, ensuring drug benefits for health insurance participants always plays an important role in effectively implementing health insurance policies and policies to protect, care for and improve people's health.
Deputy Minister of Health Vu Manh Ha emphasized that in order to effectively implement Resolution No. 72 of the Politburo on a number of breakthrough solutions, strengthen the protection, care and improvement of people's health and Directive No. 52 on implementing universal health insurance in the new period, ensuring financial sustainability is a key factor; in which the state budget is the main source of finance, the Health Insurance Fund is an important financial resource for health insurance participants and combined with mobilizing social resources.
In recent years, the proportion of drugs in total health insurance medical examination and treatment expenses has been continuously decreasing, but still accounts for the largest proportion of expenditure from the health insurance fund. Therefore, choosing to use and pay for health insurance for drugs appropriately is very important, thereby contributing to reducing treatment costs, effectively using the health insurance fund and reducing people's out-of-pocket expenses.
Permanent Deputy Minister Vu Manh Ha said that currently, payment of drug costs for health insurance participants is implemented according to the list and regulations of Circular No. 20 dated December 31, 2022 of the Ministry of Health, effective from March 1, 2023.
The list of drugs issued with Circular No. 20 is mainly based on the list of drugs issued in 2018 according to Circular No. 30 of the Ministry of Health, only adding a few drugs to treat COVID-19 according to the direction of the Government to meet treatment requirements during the COVID-19 epidemic and expanding some drugs for commune health stations.
In order to meet the treatment needs of people and medical facilities, recently the Ministry of Health has presided over and coordinated with relevant agencies and units to review, update, amend and supplement Circular No. 20. Based on the proposals of agencies and units, the Ministry of Health has compiled and organized many meetings to review and seek opinions from clinical experts, health economic experts, and leading medical facilities in each field and each group of pharmacological effects.
Expanding the drug list at the health station
Ms. Tran Thi Trang - Director of the Department of Health Insurance (Ministry of Health) said that in 2024, the total cost of health insurance examination and treatment is estimated at about 150 trillion VND, higher than the revenue; of which medicine costs account for about 30%. The whole country has nearly 40 million people regularly going for health insurance examinations, equivalent to 186 million visits, an average of 4.5 times per person per year. It is noteworthy that people still have to pay about 40% of medical expenses themselves.
The Director of the Health Insurance Department emphasized that the review, update, amendment and supplementation of the list were carried out in accordance with regulations, ensuring scientific, public and transparent nature. After the review, the new drugs proposed for inclusion in the list included 81 drugs. Of the 81 newly proposed drugs, 76 drugs met the criteria for inclusion in the health insurance list, ensuring that the proposed drugs have good treatment effectiveness and safety, while some remaining drugs are being reviewed and considered.
Among them, the main ones are cancer/immune treatment drugs (28 drugs, of which 22 are targeted drugs); Next are the parasitic/anti-infective groups (9 drugs), cardiovascular (7 drugs) and some drugs for treating diabetes, high blood pressure, nervous system, respiratory, digestive...
Regarding the group of cancer drugs, the Ministry of Health informed that this is the group with the most additions and high costs. The adjustment is assessed to have a major impact on the health insurance fund budget, but the Ministry of Health will mobilize resources from businesses, health insurance and related organizations to ensure the rights of patients.
In addition, the Ministry of Health has 14 proposals to reduce prices for 14 drugs with a commitment to reduce drug prices from 6.5% to 60.77% to have a better payment rate for patients, reduce costs for patients and contribute to the balanced and effective use of the health insurance fund...
Ms. Vu Nu Anh - Deputy Director of the Department of Health Insurance, 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 by hospital class. The groups of drugs include pain relievers-antipyretics, detoxifiers, antiparasitics-antiinfectives, cardiovascular, dermatological, digestive... to help treat non-communicable diseases right at the grassroots level, making it easier for people to access drugs covered by health insurance.
The list of drugs at the commune health station has therefore nearly doubled, to more than 600 drugs covered by health insurance. The use of drugs will depend on disease patterns and treatment capacity, no longer based on hospital class, thereby reducing the need to transfer due to drug shortages.
According to statistics from the Health Insurance Department, the addition of 76 new drugs to the list, including many drugs for cancer and cardiovascular disease treatment, will have an impact on the Health Insurance Fund. It is estimated that in 5 years, the additional expenditure will be about 12,245 billion VND. Thus, on average, the Health Insurance Fund will increase its expenditure by about 2,449 billion VND per year.
Thus, if including the proposed new drugs, drugs with proposed changes in conditions and payment rates and drugs proposed to be removed from the list, it is estimated that the health insurance fund will increase spending by about VND 13,776 billion in 5 years, on average each year the health insurance fund is estimated to increase spending by about VND 2,753 billion.
The Director of the Health Insurance Department said that the Ministry of Health is continuing to listen to opinions and absorb appropriate proposals to complete the draft to be submitted to the Ministry's leaders for promulgation in early 2026 and it is expected that this new Circular will take effect at the end of the first quarter of 2026./.
Source: https://www.vietnamplus.vn/se-bo-sung-them-76-thuoc-moi-thuoc-dich-vao-danh-muc-bao-hiem-y-te-chi-tra-post1079860.vnp
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