Proposal to add more cancer drugs to be covered by insurance

Of the 75 drugs proposed by hospitals for inclusion in the new list of health insurance drugs, 28 are cancer treatment drugs. These are targeted therapy drugs that are expected to reduce the burden on cancer patients.

Many hospitals propose health insurance payment for many new cancer treatment drugs - Photo: NAM TRAN

On December 5, the Ministry of Health held a workshop to disseminate Circular 37 and collect opinions on the list of health insurance drugs.

Proposal to add cancer treatment drugs

To develop a new drug list, the Ministry of Health has asked medical facilities to propose drug lists based on actual situations.

Speaking with Tuoi Tre , Mr. Nguyen Quoc Toan - Department of Health Insurance, Ministry of Health - said that he has received proposal documents from hundreds of medical facilities, provincial health departments, pharmaceutical companies, etc.

"According to statistics, most units propose to add drugs to treat cancer, cardiovascular, and endocrine. The most of these are targeted drugs for cancer treatment, including 28 types of drugs.

Next are antibiotics, insulin and hypoglycemic drugs. In addition, many units proposed to change the professional level, conditions and payment rates for 35 drugs and 16 groups of effects," Mr. Toan shared.

According to Mr. Toan, to add new drugs to the list of health insurance drugs, it is necessary to evaluate the impact on the health insurance fund, the effectiveness of the drugs, etc. After synthesizing, these proposals will be evaluated by the expert council for criteria to be included in the new list of drugs.

"New drugs, in addition to ensuring effective treatment and good quality, must also ensure financial balance. In particular, targeted drugs are often expensive, so depending on the actual situation, a part of the co-payment may be required depending on the balance of the health insurance fund. It is expected that a new list of drugs will be issued in the first quarter of 2025," said Mr. Toan.

Will update new drugs, remove drugs that are no longer suitable

According to Ms. Tran Thi Trang, Director of the Health Insurance Department, Ministry of Health, for many years the list of health insurance drugs has not been updated regularly. One of the reasons is that the regulations on criteria and principles for updating the drug list have not been developed in the form of legal documents.

Therefore, every time the drug list needs to be updated, the criteria must be reviewed and rebuilt. This leads to a lack of timeliness and prolongs the process of building and updating the drug list.

"Therefore, the implementation of Circular 37 creates a legal corridor for the drug list to be updated more frequently. Once the legal corridor is in place, the professional councils and agencies of the Ministry of Health and Vietnam Social Security will quickly and proactively build a list of health insurance drugs quickly, updated and ensuring objectivity. This is considered an institutional breakthrough," said Ms. Trang.

According to Ms. Trang, the development of criteria and principles for including new drugs in the list of health insurance drugs will be convenient and transparent.

Based on the regulations, it will be possible to add good drugs with high treatment efficiency and reasonable cost to the list. In addition, it is possible to remove from the list drugs that do not meet the criteria of safety and effectiveness.

This list will be updated regularly and annually to increase access to new and effective drugs, ensuring the rights of health insurance participants.

Eliminate the regulation of dividing drug lists by hospital class

Many medical facilities propose adding cancer treatment drugs to the list of drugs covered by health insurance - Photo: D.LIEU

Speaking with Tuoi Tre, Ms. Trang said that the list of drugs and treatment preparations is being allocated according to hospital class, in accordance with the professional capacity of medical examination and treatment facilities.

"Currently, the current list of drugs covered by health insurance includes 1,037 active ingredients. However, the right to use these active ingredients has clear differences between hospital classes.

While special and first-class hospitals are fully utilized, second-class hospitals are only given 991 active ingredients, while medical stations are limited to 356.

This list of drugs is built in a direction that is suitable for the technical expertise of medical facilities. Among them, some active ingredients and preparations are not used in lower-level hospitals because the units do not meet the requirements of expertise and technical services," said Ms. Trang.

The leader of the Health Insurance Department also said that Circular 37 on the list of health insurance drugs that has just been issued has revised the structure of the drug list.

Specifically, the hospital classification in the list of pharmaceuticals and biological products will be removed. Medical facilities will be able to use the entire list of drugs suitable for their expertise, regardless of hospital classification. This Circular will take effect from January 1, 2025.

Source: https://tuoitre.vn/de-xuat-bo-sung-nhieu-thuoc-tri-ung-thu-duoc-bao-hiem-chi-tra-2024120608253395.htm