Changing the drug list to expand benefits for health insurance participants

The Ministry of Health is drafting a list of drugs covered by health insurance.

Permanent Deputy Minister of Health Vu Manh Ha said that in order to successfully implement the goals of expanding people's health care benefits based on the pillar of health insurance policy, ensuring the supply and regular updating of new, modern, quality and effective medical services, medicines and medical equipment within the scope of payment of the Health Insurance Fund is a key task that needs to be prioritized.

Over the years, medicine has always been an important component and accounted for a large proportion of the total cost of medical examination and treatment under health insurance. Ensuring medicine benefits for health insurance participants has always played an important role in effectively implementing health insurance policies and policies to protect, care for and improve people's health.

According to the leaders of the Ministry of Health, although the proportion of drugs in the total health insurance medical examination and treatment expenditure has gradually decreased in recent years, it still accounts for the largest proportion of expenditure from the health insurance fund, always at more than 30%. Therefore, choosing to use and pay for health insurance for drugs in a reasonable way needs attention to contribute to reducing treatment costs, effectively using the health insurance fund and reducing people's out-of-pocket expenses.

Currently, the payment of drug costs for health insurance participants is implemented according to the list and regulations of Circular No. 20/2022/TT-BYT dated December 31, 2022 of the Ministry of Health, including: 1,037 active ingredients/pharmaceuticals and biological products divided into 27 large groups and 59 radioactive drugs and markers. Over the years, the drug list has not been updated in a timely manner.

In order to meet the treatment needs of people and medical facilities, from 2023 to present, the Ministry of Health has presided over and coordinated with relevant agencies and units to review, update, and develop a draft list of pharmaceutical drugs to replace the list of drugs in Circular No. 20/2022/TT-BYT.

Based on the proposals of agencies and units, the Ministry of Health has compiled and coordinated with specialized associations to organize many scientific seminars and technical meetings to review and seek opinions from clinical experts, health economic experts, and leading medical examination and treatment facilities in each field and each group of pharmacological effects.

Notably, this update, revision and supplement also focuses on expanding the drug list for commune health stations to properly implement the policies of Resolution No. 72-NQ/TW and Directive No. 52-CT/TW on developing the health system, improving the quality and efficiency of grassroots health care, and increasing full and convenient access to health care for people right at the initial level.

This policy is also particularly suitable for the policy on two-level local government when commune health stations are invested in, have their facilities developed, have their functions supplemented and their capacity enhanced to become an important nucleus in performing the task of taking care of people's health at the gateway of the health system.

The group of drugs for treating dermatological diseases is also adjusted and updated in the new list.

The draft Circular has been developed based on the Party and State's orientation and policies on strengthening the protection, care and improvement of people's health in the coming period to ensure meeting treatment needs, contributing to reducing people's out-of-pocket spending on health care, and ensuring fairness in access to medicine for patients at all levels of technical expertise.

The review, update, amendment and supplementation of the list have been carried out in accordance with regulations, ensuring scientific, public and transparent nature, and have been carefully reviewed and assessed for impact.

Director of the Department of Health Insurance (Ministry of Health) Tran Thi Trang said that after review, the newly proposed drugs to be included in the list include 81 drugs, of which 76 drugs meet the criteria to be included in the health insurance list, ensuring that the proposed drugs have good treatment effectiveness and are safe.

Notably, the largest number of drugs proposed for addition this time is the group of drugs for treating cancer diseases, with 28 active ingredients, including chemicals, targeted drugs, immunomodulators and antidotes for patients after radiotherapy. The second group with the most additions is antifungal, anti-bacterial and anti-parasitic drugs. Currently, the rate of people suffering from these diseases is also increasing and causing great and long-term impacts on the lives of patients.

Particularly for the group of psychotropic drugs, over the past years, the number of drugs invented in this group has been very small, the cost of drugs is high, patients' access to drugs is also difficult, businesses have little investment, while this group of patients is a group of people who are greatly affected and have very low ability to pay, so in this update, the drafting agency also paid attention to including some drugs in this group.

In addition, the drafting agency also proposed other groups of drugs to be updated this time including: dermatological group, musculoskeletal group. Some other groups of drugs are also of great interest to be included in this list such as cardiovascular drugs, endocrine drugs, diabetes.

Thanh Mai

Source: https://nhandan.vn/thay-doi-danh-muc-thuoc-de-mo-rong-quyen-loi-cho-nguoi-tham-gia-bao-hiem-y-te-post926808.html