Standardizing Drug List for Insurance Policyholders

Always placing the rights and interests of health insurance policyholders on top, Vietnam Social Security (VSS) recently made a proposal to facilitate health insurance policyholders to easily access medicines and technical services for their disease treatment, a move to help it successfully achieve health insurance targets and tasks. This is one of the notable discussions at the recent thematic conference on health insurance information.

Drugs covered by health insurance have basically met patients’ treatment needs

According to the VSS, the current list of drugs and technical services covered by the health insurance fund includes 1,030 drugs and biological products and 59 radioactive drugs and markers specified in Circular 30/2018/TT-BYT dated October 30, 2018 of the Ministry of Health on the drug list, payment rates and conditions for pharmaceuticals, biological products, radioactive drugs and markers benefited by health insurance policyholders. In the list, 136 active ingredients/drugs are conditioned for priority indication in some cases; 25 active ingredients are subject to payment rates (30%, 50%, 60% and 70%) and 31 active ingredients are assigned both indications and payment rates. These active ingredients are mainly expensive or newly created.

At the same time, the list is also comprised of 349 traditional medicinal ingredients and 229 traditional medicines with over 1,200 preparations stated in Circular 05/2015/TT-BYT dated March 17, 2015 of the Ministry of Health on the list of traditional medicines and medicinal ingredients covered by the health insurance fund.

According to a WHO report, in countries with similar conditions such as Thailand and Indonesia, the list of insurance-covered drugs has about 600 drugs (Thailand: 660 and Indonesia: 601). In Vietnam, the list of drugs covered by the health insurance fund basically meets treatment requirements and facilitates the insured to have access to new drugs as guided by the Ministry of Health.

The VSS said, over 19,000 technical services are licensed by the Ministry of Health in Vietnam. However, at present, 9,190 services are eligible for insurance coverage (with just 124 services/service groups are specified with payment conditions and rates) because many of the 19,000 services are similar in nature regardless of having the same names or different names. The list also includes many services uncovered by insurance like cosmetic or denture services. Some service payment rates are not regulated.

According to the VSS, the list of technical services covered by the health insurance fund includes a full range of technical services in 28 specialties, including modern and traditional medical techniques from the grassroots level to the central level.

Promoting drug procurement to address medical shortages

At its recent press conference, the VSS admitted shortages of medicines and medical supplies at many health facilities in Bac Giang, Binh Duong, Ha Nam, Can Tho, Dak Lak, Bac Lieu, Quang Ngai and Quang Nam.

Mr. Le Van Phuc, Director of Health Insurance Policy Department, VSS, attributed this reality to delayed tenders for drugs, equipment and supplies. In fact, bidding packages from last year to now have not been completed or implemented. In particular, the most obvious reason is the complicated development of the COVID-19 pandemic in the past.

The VSS sent documents to localities to direct biddings to speed up drug procurement to address medical shortages for insured patients. The perspective of the insurance agency is to assess as quickly as possible the proposal so that hospitals can quickly procure drugs.

Regarding the procurement of medical equipment and supplies, the relevant regulatory process is more difficult than drug procurement because not many provinces and cities conduct centralized bidding for this content while the demand mainly comes from hospitals. Regulations on bidding for medical supplies are obscure and the Ministry of Finance is dissecting them to find the optimal solutions. The VSS will coordinate with the Ministry of Health and the Ministry of Finance to ensure superiority, inclusiveness and accessibility of disease treatment services for health insurance policyholders, especially during the COVID-19 pandemic period.

The VSS has coordinated and joined with the Ministry of Health to develop a circular on economic and technical norms of medical treatment services to build the framework for service prices. Besides, the agency will develop principles and criteria for amending and adding drugs to the list; principles and criteria for revising and supplementing pharmaco-chemical drugs, biological products for COVID-19 treatment for health insurance policyholders; and amend and supplement the list of drugs covered by the health insurance fund.

By Huong Thom, Vietnam Business Forum