Thai Govt Won't Pay For Drugs Not On National List

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SPECIAL REPORT

Govt won't pay for drugs not on national list

By Pongphon Sarnsamak

The Nation

The ComptrollerGeneral's Department plans to curb spiralling health costs by not allowing members of the civil servants' medical benefit (CSMB) scheme to be reimbursed for medicine not on national drug lists.

The move will affect drugs used for nine conditions including heart disease, hypertension and cancer.

It comes after the department found that about Bt8 billion or 66 per cent of the cost of hospital drugs was for "unnecessary" and expensive drugs not on the National Essential Drug List.

These include drugs used for ulcers or variceal bleeding, to fight osteoarthritis, angiotensinconverting enzyme inhibitors, angiotensinII receptor blockers, antiplatelets, glucosamine, drugs affecting bone metabolism, and anticancer drugs.

Most of drugs were prescribed to patients at outpatient areas at state hospitals.

Previously, the department announced that it would not allow members of the CSMB scheme to be reimbursed for glucosamine, as the department considered that it gave no benefit as an arthritis treatment. The US Food and Drug Administration says this drug is a supplement.

Health Insurance System Research Office (HISRO) head Dr Samrit Srithamrongsawat said spending on glucosamine was contained last year after the comptrollergeneral's office said it wouldn't help pay for the drug.

"This was the first time in 30 years that we could control spending on an unnecessary and expensive drug," he said.

The ComptrollerGeneral's Department has asked Samrit to study ways to control state spending on healthcare.

Samrit said that in next three months, he would propose that the department issue another announcement to "control" payment for drugs used to counter osteoarthritis and lipidaemia, which lowers blood lipids. He would also ask the department to urge doctors to follow guidelines on medicines strictly. They must prescribe drugs on the national drug list.

If doctors want to prescribe drugs not on the national list, they must give reasons and evidence to explain why the patients need them.

A reference price for drugs on the national list would also be given to control any "irrational reimbursement".

"We just want doctors to prescribe drugs based on rational evidence, not based on what pharmaceutical companies tell them," Samrit said.

Dr Kitima Yuthavong, chief executive of the Pharmaceutical Research and Manufacturers Association (PReMA), said the department's measures to rein in costs for medicine would affect the originaldrug market in Thailand.

She said PReMA's members expected growth in the originaldrug market would drop this year because of the department's measures.

Originaldrug makers based in Thailand who are members of PReMA would have to change their policy and other expenses to cope with a smaller market. Growth in sales of original drugs dropped by about 5 per cent or Bt5 billion over the past year.

The plan to cap drug costs via the civil servants' scheme will cut options for doctors prescribing medicine for patients, especially the elderly.

Medical Service Department chief Dr Rawat Wisarutwet said he would ask health experts to meet at the department today to find a resolution that would help doctors have more choices, to select drugs that were good for patients to use and also help the ComptrollerGeneral's Department control rising costs.

"The Medical Service and ComptrollerGeneral's departments have worked together very well to control costs of the healthcare scheme for civil servants in the past," Dr Rawat said.

Previously his department conducted a study about the benefit of four drugs not allowed for reimbursement by the ComptrollerGeneral's Department - glucosamine, chondroitin sulphate, diacerein, and hyaluronan. The study was given to Public Health Minister Jurin Laksanawisit to help him make decisions and send comments to the comptrollergeneral on what to do.

-- The Nation 2011-02-15

[Ricardo]

Glucosamine is an "expensive drug" ? I pay about GBP 15 (750 Baht) for a one-year supply ! Someone must be taking an awful overdose or, perish the thought, perhaps their purchasing-officers are doing a poor job, for whatever reason ?

[Thai at Heart]

Would like to see this list. A relative of my wife who is a retired civil servant was recently diagnosed with Parkinsons. His monthly bill for drugs is about 15k. I was very surprised when it became apparent that he was completely covered.

If this means that many many sick civil servants are going to have to start paying for drugs, this is going to be a disastrous vote loser for Abhisit.

I hope the issue is that doctors are simply over subscribing expensive drugs when there is a perfectly acceptable alternative on the national list.

[tigermonkey]

It is sad that Thai attitude is such that they insist on a "made in Thailand " list of acceptable drugs for reimbursement. A small amount of foreign consultation would be of great assistance to them.

There are extensive lists of both proprietary and generic drugs which are acceptable to insurance firms and government sponsored drug plans -- these have been accepted, and time proven in many countries. The lists are freely available.

...but I suppose in the finest Thai tradition, they will muddle through and find a " made in Thailand" list after a few years.

Incidentally, none of this will change intentional mis-billing of drugs to make all look legit. I am aware of more than a few senior civil servants who receive their Viagra free this way.

Edited February 15, 2011 by tigermonkey

[Ricardo]

Incidentally, none of this will change intentional mis-billing of drugs to make all look legit. I am aware of more than a few senior civil servants who receive their Viagra free this way.

Poor chaps must now be a bit 'hard-up', eh ?

[jfchandler]

Take your pick from among the dueling govt. docs...

"This was the first time in 30 years that we could control spending on an unnecessary and expensive drug," says Dr. A.

"The Medical Service and Comptroller General's departments have worked together very well to control costs of the health care scheme for civil servants in the past," says Dr. B.

[rubl]

Would like to see this list. A relative of my wife who is a retired civil servant was recently diagnosed with Parkinsons. His monthly bill for drugs is about 15k. I was very surprised when it became apparent that he was completely covered.

If this means that many many sick civil servants are going to have to start paying for drugs, this is going to be a disastrous vote loser for Abhisit.

I hope the issue is that doctors are simply over subscribing expensive drugs when there is a perfectly acceptable alternative on the national list.

As far as I know Parkinson's Decease is not really curable. Some medicines may stop the decease from progressing, but only temporarily.

So I wonder if the diagnosis was correct.

[Bagwan]

It seems that Thailand has run into the problem tha tthe UK NHS faces. Patients want, and doctors prescribe, fancy, expensive new drugs when often a tried and proven old style remedy would work. Ten years ago my GP made a standing prescription that I collected every month for a drug to control the receptors in my stomach that triggered the production of acid. I asked the chemist how much the drug would cost if I had to pay for it and he said 80 GBP. My condition now is controlled by taking an antacid called Belcid, available at most pharmacies for little money and a bottle lasts for 2 or 3 months. If you can get from A to B on a motor bike why use a Rolls Royce?

If the UK doctors needed reining in I am positive that Thai doctors do to. I find it very difficult to get into a Thai doctors thick head that I only want something that will attack the cause of any illness or discomfort. Clear that up and the symptoms and side effects go away on their own.

I think it is dangerous to limit what doctors can prescribe and what they can't, but this is on the understanding that doctors should sensibly put the needs of the patient above all other considerations.

[Bobr]

One can hope that the medical efficacy and appropriate use are the criteria for the list, and not just price. You have to wonder who and how determines that the doctors ordered prescriptions that were not needed.