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Medicines account for a large proportion of HI expenditures on medical examinations and treatment.

Mrs. Tran Thi Trang, Head of the HI Department (Ministry of Health) stated, drugs have consistently been a crucial component, constituting a significant proportion of the total expenditure for HI examination and treatment over the years. While the proportion of drug costs in the total HI fund expenditure has been gradually decreasing, it remains the largest single expense from the fund.

In 2022, the total expenditure from the HI fund for drugs reached 40.01 trillion VND, accounting for 33.41% of the total medical examination and treatment expenditure. This figure increased to 45.841 trillion VND in 2023, accounting for 32.82%. By 2024, drug costs continued to rise to 50.784 trillion VND, although the proportion decreased to 31.22%.

These figures indicate a continuous increase in the demand for drugs in treatment, leading to significant financial pressure on the HI fund. In this context, managing the list of drugs, adjusting payment mechanisms, and updating new drugs in accordance with treatment practices are essential requirements.

Currently, the payment of drug costs for HI participants is implemented according to the list and regulations in Circular No. 20/2022/TT-BYT of the Ministry of Health, issued on December 31, 2022. This list includes 1,037 active ingredients of chemical drugs and biological products, divided into 27 major groups, along with 59 radioactive drugs and tracers for diagnosis and treatment.

However, in reality, most drugs currently covered by HI are still based on the list issued in 2018 according to Circular No. 30/2018/TT-BYT, with only a few additional drugs for Covid-19 treatment. This has caused the HI drug list to not keep up with the development of pharmaceutical science, especially new drugs for treating critical illnesses

This reality requires a more flexible and scientific mechanism for updating the HI  drug list, ensuring that patients can access modern treatment methods while maintaining the sustainability of the HI  fund.

Expanding the list of drugs covered by HI increases access to advanced treatments.

According to health experts, adding new drugs to the HI list not only improves treatment effectiveness but also significantly reduces the financial burden on patients.

Dr. Nguyen Van Truong, from the Oncology Department of Thanh Nhan Hospital, stated that cancer treatment today is multi-modal, combining various methods such as surgery, chemotherapy, radiation therapy, biological therapy, targeted therapy drugs, and stem cell transplantation. These advances help increase the chances of survival for patients but also significantly increase treatment costs

According to Dr. Nguyen Van Truong, many cancer drugs, especially newly invented drugs imported from Europe, are very expensive. Therefore, the Ministry of Health's proposal to add these drugs to the HI list is a practical form of support, helping patients have more opportunities to access advanced treatment regimens.

From the perspective of managing and treating chronic diseases, Dr. Tran Thi Thanh Hoa, former Deputy Director of the National Hospital of Endocrinology, also believes that expanding the HI drug list is essential. According to Dr. Tran Thi Thanh Hoa, many targeted therapy drugs are currently very expensive, with some costing up to approximately 60 million VND per treatment course

"Without HI, many poor or critically ill patients would find it very difficult to access treatment. Including these drugs in the HI list brings great benefits to patients, especially vulnerable groups. The sooner they are added, the greater the treatment opportunities for patients," Dr. Tran Thi Thanh Hoa emphasized.

However, Dr. Tran Thi Thanh Hoa also noted that the expansion of the HI drug list needs to be accompanied by a strict management mechanism to ensure that drugs are used appropriately, rationally, and effectively, avoiding waste of the fund's resources.

84 new drugs are expected to be added to the list of drugs covered by HI.

To meet the practical demands of medical facilities and the desires of the population, the Ministry of Health is finalizing a draft amendment to Circular No. 20/2022/TT-BYT to update the list of HI-covered drugs.

According to the draft, the list of HI-covered drugs is expected to include 84 new chemical drugs and biological products. A notable point is that the draft focuses on high-cost specialty drug groups with outstanding treatment effectiveness.

Among the 84 newly added drugs, 30 are for cancer treatment, accounting for approximately 35.7%. This group includes new innovative drugs, such as targeted therapies, monoclonal antibodies, and immunotherapies. The addition of these drugs is significant because cancer is currently one of the leading causes of death and a disease that puts many families in financial difficulty due to high treatment costs. Patients who are covered by HI fund will have a significant portion of their treatment costs shared, instead of having to pay tens of millions of Vietnamese Dong per treatment cycle as before.

In addition to cancer treatment drugs, the draft also focuses on chronic diseases and rare diseases. Specifically, 24 drugs treat chronic diseases such as cardiovascular diseases, diabetes, respiratory diseases, and mental disorders, accounting for about 29% of the added drugs. Furthermore, 18 drugs for treating rare diseases are also expected to be included in the list, accounting for approximately 21.4%.

This structure shows that policy orientation is gradually shifting from focusing solely on treating acute diseases to strengthening the long-term management of chronic diseases, helping patients maintain stable health and reducing the burden on the healthcare system in the future

In addition to adding new drugs, the draft circular also proposes amending the conditions and payment rates for 52 types of drugs already on the current list. Expanding indications and increasing benefits for some drugs will help patients have more access to treatment while reducing co-payment costs.

Representatives from the Ministry of Health affirm that updating the list will not only reduce out-of-pocket expenses for people but also contribute to more effective use of the HI fund by applying targeted treatment methods and shortening hospital stays. The new Circular is expected to be submitted to the leaders of the Ministry of Health for signing and promulgation, taking effect in 2026.

Healthcare technology assessment: A scientific tool in selecting medications covered by HI.

Introducing a new drug, especially an expensive one, into the HI drug list requires strict regulations to ensure effectiveness and sustainability of the fund.

In Vietnam, Health Technology Assessment (HTA) has become an important scientific tool in the process of developing the drug list and determining payment methods of the HI fund.

According to Ms. Tran Thi Trang, Director of the HI Department (Ministry of Health): HTA helps regulatory agencies determine which drugs should be included in the list, at what stage of treatment, and the scope of coverage to ensure treatment effectiveness while optimizing costs.

This process includes analyzing clinical evidence on the effectiveness and safety of drugs, assessing health economics to compare costs and effectiveness between treatment methods, as well as analyzing the budget impact on the HI fund

In which, Budget Impact Analysis (BIA) helps forecast the amount of money that the HI fund must spend when a drug is included in the list, and at the same time calculate the amount of costs that patients can save when supported by the fund.

Currently, pharmaceuticals are the field in which HTA is applied early and relatively fully in Vietnam. The Ministry of Health has also issued guidance documents on pharmaceutical economic evaluation to standardize the process of proposing and updating the HI drug list.

The use of HTA evidence not only helps ensure fairness and transparency in health policies but also creates a scientific basis for VSS to negotiate drug prices with manufacturers. This is even more important when drug costs currently account for more than 30% of the total expenditure of the HI fund, while the proportion of out-of-pocket spending by people on health care is still at a level that needs to be further reduced in the future.

According to experts, HI policies are not only a financial support but also help patients access timely and effective treatment. Therefore, expanding the HI drug list is a cautious but necessary step, in line with the goal of improving the quality of people's health care.

However, the challenge is not about only adding more medications but, more importantly, about how to utilize the HI fund so that money spent brings practical value to patients.

When policies are built on scientific evidence, strictly managed, and aimed at the benefit of the people, the list of HI-covered medications is a testament to the healthcare system's efforts in ensuring everyone's right to healthcare.

Updating the list of HI-covered medications gradually reduces the financial burden on patients, expands treatment opportunities, and moves towards the goal of sustainable universal healthcare.