Criteria for considering drugs requiring regulations on rates and conditions for health insurance payment in Vietnam from January 1, 2025

Criteria for considering drugs requiring regulations on rates and conditions for health insurance payment in Vietnam from January 1, 2025

The criteria for considering drugs that require the rate and conditions for health insurance payment in Vietnam are stipulated as follows:

(1) Drugs proposed to be included in the list that meet the criteria stipulated in Article 3 of Circular 37/2024/TT-BYT are considered for rate determination, payment conditions, or drugs already on the current list are considered for a reduced rate or stricter payment conditions when at least one of the following criteria is met:

- Drugs with high treatment costs or significant budget impact;

- Drugs with higher treatment costs compared to drugs with the same indications in the current list;

- Drugs requiring strict usage conditions to prevent resistance or drugs requiring technical expertise conditions.

(2) Drugs already in the current list are considered for an increased rate or broader payment conditions when meeting all the following criteria:

- Is the first-choice drug or has superior treatment efficacy, or is included in diagnostic and treatment guidelines by the WHO or Vietnam's Ministry of Health or specialized medical and treatment facilities or competent authorities of other countries, or reputable medical, pharmaceutical, or pathology societies, matching the treatment needs and professional capabilities of medical facilities;

- Has a budget impact assessment report in Vietnam.

(3) Drugs with the same indications and equivalent treatment costs: The payment rate and conditions should be similar. Drugs with the same indications and higher treatment costs are considered for appropriate rate and payment conditions determination.

(4) At the time of consideration of the cases specified in points (1) and (2), if the pharmaceutical business entity has a drug price reduction policy and provides a budget impact assessment report, the rate and payment conditions will be considered accordingly.

More details can be found in Circular 37/2024/TT-BYT effective from January 1, 2025.

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