Hundreds of new drugs will be covered by health insurance

Doctor visits patient being treated at Ho Chi Minh City Dermatology Hospital – Photo: THUY DUONG

This is a “burden” in the treatment process of patients. Many patients said that if they were not supported and paid by health insurance, they might have to stop treatment.

How will hundreds of new drugs be covered by health insurance in the near future?

Every month have to pay tens of millions for medicine

Ms. LTMT, 49 years old, living in Long An province, was diagnosed with lung cancer by doctors at the Ho Chi Minh City Oncology Hospital 5 years ago. Since then, the doctor has prescribed her to take three Spexib pills every day.

Thus, each month Ms. T. has to pay more than 23 million VND for this medicine.

“Since I started treating lung cancer, I have been staying at home and not doing anything to earn money. My husband works as a bus boy and only earns a few million VND per month. When he found out I was sick, my father gave my husband and I a piece of land. I sold it for 310 million VND to have money to buy medicine for the first few years,” Ms. T. said.

For the past two years, the doctor has reduced the medication from three pills to two pills a day. Although the monthly cost of medication has decreased, with Ms. T's family's income, spending more than 15 million VND a month on medication is still high.

For the past two years, Ms. T. has had to borrow a total of more than 200 million VND from her mother-in-law to buy medicine to treat her illness. Recently, she and her husband told the treating doctor: "We have run out of money to buy medicine, we may have to stop treatment."

Hearing that, the treating doctor encouraged Ms. T. to continue treatment and not to stop. The Oncology Hospital has proposed that this medicine be covered by health insurance.

Ms. T. was so happy that she cried. She and her husband discussed trying to borrow money to continue treatment for a while longer, waiting until the medicine was covered by health insurance.

Mr. HTL, 45 years old, also living in Long An, said that his 72-year-old father has two cancers: stomach cancer and lung cancer that have metastasized. In 2021, his father had his stomach removed by doctors at the Oncology Hospital and since April 2024, his father has been treated for lung cancer here.

Since being diagnosed with lung cancer, the doctor prescribed intravenous medication. Every three weeks, his family had to pay 43 million VND. Treatment time is from 8-12 months depending on the condition.

Mr. L. hopes that patients who are treated with new drugs like his father will have health insurance to share part of the burden of drug costs. If health insurance does not support payment, Mr. L. does not know if he will be able to pay in the near future.

A doctor treating patients at the Ho Chi Minh City Oncology Hospital said that the Oncology Hospital currently uses many new and expensive drugs to treat patients, but these drugs are not yet covered by health insurance. The drugs covered by health insurance are drugs that have been available for more than 10 years. According to this doctor, "this is very unreasonable and unfair to patients."

This doctor believes that health insurance must approve drugs based on the effectiveness of each drug. Drugs that are highly effective in treatment should be approved by health insurance early for patients.

There are targeted drugs (new drugs), after 5 years of use, up to 60% of patients have not developed drug resistance. This is a very large number that speaks to the treatment effectiveness of this new drug.

Because, a patient with stage 4 lung cancer must be treated with chemotherapy as before, on average after 8 months of treatment only 50% of patients are still alive and the remaining 50% of patients die. Very few patients live up to 4 years.

New drugs with high prices, not covered by health insurance, have caused many patients to not receive treatment or have to stop treatment halfway, causing great disadvantages for patients.

When the doctor knew that the patient was losing the ability to pay for the medicine, he tried to "save" the patient by reducing the dose of the medicine, for example from three pills to two pills/day. However, there were patients who developed brain metastases when the dose was reduced.

At this point, the doctor convinced the patient to buy enough medicine to take again because “this is an emergency.” When the patient took all three pills again, the patient’s brain metastasis was gone.

This doctor said that these targeted drugs are very effective, even bringing unimaginable treatment results. In the past, patients with similar diseases had to undergo chemotherapy very hard.

When chemotherapy is given to patients with hair loss, it takes a long time for the tumor to shrink, but now, after taking these new pills for 1-2 days, the tumor has shrunk.

The results of this treatment surprised the doctors because even when these particles were removed and soaked in concentrated acid, they could not shrink so quickly. However, not all patients taking the drug were so lucky because many patients developed drug resistance from the beginning.

Patients complete health insurance medical examination and treatment procedures at a hospital – Photo: HA QUAN

Ho Chi Minh City proposes about 80 types of drugs supported and paid for by health insurance.

Similarly, many patients with Pemphigus who are being treated at the Dermatology Hospital in Ho Chi Minh City have been given a specific immunosuppressant drug for this disease, the biological drug Rituximab.

Dr. Nguyen Thi Thanh Huyen, Ho Chi Minh City Dermatology Hospital, said that patients with Pemphigus will be treated for a year and a half with five doses, including dose 1 and dose 2 as two attack doses, treated two weeks apart. This drug has two main types. One type is produced in Switzerland and costs 20 million VND/bottle, while the other type is produced in India and costs 10 million VND/bottle.

Each treatment requires two bottles of medicine. Most patients treated at the Dermatology Hospital in Ho Chi Minh City often choose Indian medicine because it is cheaper. So the entire treatment process will cost 100 million VND, not including other expenses. However, this medicine is not yet covered by health insurance.

“Recently, Ho Chi Minh City Dermatology Hospital also sent a document to the Department of Health proposing that this drug be covered by health insurance,” said Ms. Pham Thi Uyen Nhi, deputy head of the general planning department of Ho Chi Minh City Dermatology Hospital.

In 2024, the Ho Chi Minh City Department of Health sent a document to the Health Insurance Department of the Ministry of Health proposing to add about 80 types of drugs to be paid for by health insurance for patients. These drugs include cancer treatment drugs, drugs to treat poisoning, antipsychotic drugs and drugs affecting the nervous system, drugs affecting the respiratory tract, etc.

Many proposals to make cancer treatment drugs covered by insurance

To develop a new drug list, the Ministry of Health has asked medical facilities to propose a drug list based on the actual situation. Speaking with Tuoi Tre, Mr. Nguyen Quoc Toan - Department of Health Insurance, Ministry of Health - said that he has received proposals from hundreds of medical facilities, provincial health departments, pharmaceutical companies, etc.

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

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, the expert council will evaluate the criteria for inclusion in the new list of drugs.

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

According to Ms. Vu Nu Anh, Deputy Director of the Department of Health Insurance, Ministry of Health, the criteria for considering adding drugs to the list have been specifically stipulated in the circular. Based on these criteria, the expert council will consider adding drugs to the list.

For example, drugs included in the list must be drugs included in the diagnosis and treatment guidelines of WHO or the Ministry of Health, competent authorities; drugs must have a budget impact assessment report; have scientific evidence on cost-effectiveness...

In addition, drugs and active ingredients that are not recommended for use; drugs and active ingredients that have safety warnings or benefits that do not outweigh the risks... will be considered for removal from the list.

“With specific regulations and criteria, it will create a corridor for hospitals, pharmaceutical companies, etc. to build records to consider adding drugs to or out of the health insurance list, meeting the treatment needs of the people,” said Ms. Nu Anh.

Source: https://tuoitre.vn/hang-tram-loai-thuoc-moi-se-duoc-bao-hiem-y-te-chi-tra-20241210230022183.htm