Expanding access to expensive drugs for patients with health insurance

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

Expanding access to expensive drugs for patients with health insurance

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

This circular will take effect from January 1, 2025 and is an important step in reforming the health insurance system, helping patients easily access new drugs, especially expensive drugs at lower-level medical facilities.

Deputy Minister of Health Tran Van Thuan spoke at the workshop.

According to Deputy Minister of Health Tran Van Thuan, drugs are an important part of the cost of medical examination and treatment under health insurance. Currently, the issuance of the list of health insurance drugs is being implemented according to Circular No. 20/2022, but after nearly two years of application, many problems have arisen that need to be adjusted.

Circular 37 stipulates principles and criteria for developing and updating the list of pharmaceutical drugs, biological products, radioactive drugs and markers covered by health insurance.

This circular aims to ensure that the drug list is public, transparent, and effective. At the same time, the structure of the drug list will be revised, removing the hospital classification columns, helping medical facilities to use the entire drug list in accordance with their expertise and treatment requirements, regardless of hospital class or technical expertise level.

The new circular also encourages professional and technical development at lower-level medical facilities, especially health stations, to help reduce the burden on upper-level hospitals.

This will facilitate lower-level doctors to prescribe effective drugs and help patients access necessary drugs, including expensive drugs.

The Ministry of Health has pledged not to discriminate between treatment levels when paying for medicines under health insurance. Lower-level health facilities, including commune health stations and district hospitals, will be covered by health insurance for medicines that were previously only provided to higher-level facilities. New and expensive medicines will no longer be restricted to prescription at lower-level facilities.

Circular 37 also regulates the removal from the list of drugs that do not meet safety and effectiveness criteria, and adds new drugs with clear quality records that have been approved by the Ministry of Health.

According to Mr. Dong Huy Truong, an expert from the Department of Health Insurance, the Ministry of Health currently has 1,037 active ingredients in the list of health insurance drugs, of which special-class and class 1 hospitals are allowed to use the entire list.

However, level 2, level 3 and level 4 hospitals, as well as commune health stations, currently only have access to a small portion of the drug list. The new circular will no longer make such distinctions, helping to equalize benefits for patients at all levels.

Ms. Tran Thi Trang, Director of the Department of Health Insurance, emphasized that Circular 37 will create a clear legal corridor, making the updating of the drug list more transparent and scientific.

Medical facilities will have quick access to updated criteria for new drugs, ensuring patient rights, especially when new, expensive drugs are included in the health insurance list.

The circular will also promote the development of the pharmaceutical industry, encourage research and production of new drugs, and help doctors have more effective means of treating patients.

Ms. Vu Nu Anh, Deputy Director of the Health Insurance Department, added that special cases, such as emergencies, will be covered by health insurance even though the medicine is not on the list, if there is a consultation from doctors at higher levels.

With the new regulations, the circular will not differentiate health insurance drugs by hospital level but will expand access to drugs for patients at all medical facilities, helping to reduce the burden on upper-level hospitals and increase treatment effectiveness at lower-level hospitals.

According to the list of new drugs proposed for addition that hospitals sent their records to the Ministry of Health, there are 75 drugs with 25 groups of effects, including 28 targeted drugs for cancer treatment; the rest are antibiotics, insulin and drugs for treating blood sugar, drugs for treating heart failure, mental disorders, hypertension, angina, contrast agents, Parkinson's, pain relievers, antipyretics, dermatology, endocrine, urinary tract treatment, antithrombotic, antifungal, coagulation treatment, detoxification, antiviral drugs...

Source: https://baodautu.vn/mo-rong-quyen-tiep-can-thuoc-dat-tien-cho-nguoi-benh-huong-bao-hiem-y-te-d231750.html