The National Hospital of Dermatology and Venereology (NHDV) in Hanoi has formally proposed an increase in health insurance coverage for biologic medications used to treat psoriasis, advocating for a shift from the current 50% reimbursement rate to 70%. This initiative, championed by hospital leadership, aims to alleviate the mounting financial burden on thousands of patients suffering from chronic, debilitating skin conditions that require lifelong management. The proposal also includes an urgent request to expand the list of covered medications to include modern, highly effective therapies currently excluded from the national health insurance formulary.
This announcement was made by Associate Professor Dr. Le Huu Doanh, Director of the National Hospital of Dermatology and Venereology, during the "Understanding and Living Well with Psoriasis" symposium held in Hanoi on October 25. The discussion highlighted the stark reality for patients who depend on advanced biologic treatments—drugs that target specific immune pathways to halt inflammation—only to face exorbitant annual costs that often exceed 200 million VND (approximately $8,000 USD).
The Burden of Chronic Psoriasis Management
Psoriasis is a chronic, autoimmune condition that affects roughly 2% of the Vietnamese population. Unlike transient skin issues, it is a lifelong diagnosis characterized by persistent skin lesions, intense discomfort, and, in severe cases, psoriatic arthritis, which can lead to permanent joint damage and disability.
For many patients, conventional topical treatments or phototherapy are insufficient. Biologic agents—a class of drugs derived from living organisms—have revolutionized care by providing long-term remission for severe cases. However, their accessibility is severely restricted by their high cost. At the NHDV alone, approximately 6,700 patients are registered for psoriasis treatment, with 560 individuals currently relying on ongoing biologic therapy.
The financial strain is palpable. During the symposium, 35-year-old patient Quang Huy shared his struggle. Diagnosed at 21, he has been on biologic therapy for five years. His regimen requires two injections every month, costing roughly 18 million VND. Even with the existing 50% health insurance subsidy, he must personally cover 9 million VND monthly, totaling over 100 million VND annually. For many, this cost is prohibitive, leading to the dangerous practice of skipping doses or discontinuing treatment entirely, which invariably results in the rapid recurrence of painful lesions and systemic complications.
Chronology of Treatment Advancements and Policy Gaps
The evolution of psoriasis treatment has moved from basic ointments to targeted biological therapies. Over the last decade, the introduction of monoclonal antibodies and TNF-alpha inhibitors has drastically improved quality of life. However, the regulatory framework governing health insurance reimbursement has struggled to keep pace with the high costs of these innovative pharmaceuticals.
- Pre-2015: Psoriasis treatment in Vietnam was largely limited to topical corticosteroids, methotrexate, and phototherapy. Patients with severe disease often faced limited options for disease clearance.
- 2015–2020: The introduction of biologic agents provided a breakthrough. As these drugs entered the Vietnamese market, hospitals began integrating them into treatment protocols, though initial access was restricted to affluent patients or those with specialized insurance.
- 2021–2024: The National Hospital of Dermatology and Venereology expanded its network to 36 specialized dermatology departments nationwide, aiming to decentralize care. Despite this, the cost of drugs like Adalimumab—priced between 6 to 9 million VND per injection—remains a barrier.
- Current Status: Newer, highly efficacious drugs such as Guselkumab, which can cost up to 37 million VND per dose, are currently undergoing price negotiations with the Ministry of Health to determine their inclusion in the insurance-covered formulary.
Data and Clinical Implications
The clinical necessity of consistent biologic therapy is supported by robust data. Dr. Hoang Thuy Phuong, Head of the Planning and General Affairs Department at NHDV, emphasized that adherence is the single most critical factor in achieving "skin clearance" and preventing the progression to psoriatic arthritis.
When a patient reduces their dosage due to financial constraints, they do not merely return to their baseline state; they often experience a "rebound effect," where inflammation flares with increased intensity. This leads to emergency visits, prolonged hospitalizations, and a greater overall cost to the healthcare system than if the initial treatment had been consistently funded.
From a public health perspective, the economic argument for increasing coverage is strong. By stabilizing patients with biologics, the healthcare system reduces the frequency of acute flare-ups that require intensive, in-patient care. Furthermore, it restores the productivity of patients who would otherwise be unable to work due to the physical pain and psychological stigma associated with severe psoriasis.
The Path Toward Policy Reform
The proposal submitted by the NHDV is currently being reviewed by relevant health authorities. The request focuses on two pillars:
- Increased Reimbursement: Raising the BHYT (Health Insurance) coverage from 50% to 70% for existing biologic therapies to bring them within reach of the middle class and low-income families.
- Expansion of the Formulary: Fast-tracking the inclusion of next-generation biologics into the list of medications eligible for health insurance reimbursement.
The Ministry of Health has acknowledged the severity of the issue. Negotiations regarding price capping and volume-based procurement are underway. These measures are expected to reduce the per-unit cost of these medications, potentially allowing the insurance fund to cover more patients without jeopardizing the long-term sustainability of the health insurance pool.
Broader Impact and Social Responsibility
Beyond the hospital’s proposal, there is a growing consensus among dermatologists that the "standard of care" for psoriasis must evolve. The establishment of the "Fund for Leprosy and Dermatology Patients," which provides financial support for expenses not covered by insurance, serves as a stopgap measure for the most vulnerable. However, hospital administrators agree that institutionalized insurance reform is the only sustainable solution.
The impact of this policy change would extend beyond the 560 current patients at the NHDV. By setting a precedent for chronic autoimmune condition coverage, the government could improve the standard of care for thousands of other patients suffering from conditions like rheumatoid arthritis or Crohn’s disease, which often utilize similar biologic platforms.
As the government evaluates this request, the medical community remains hopeful. The integration of advanced medicine into the national insurance framework is not merely a budgetary decision; it is a commitment to the fundamental right to health for those suffering from chronic, life-altering conditions. For patients like Quang Huy, the decision could mean the difference between a life of constant physical pain and the ability to lead a healthy, productive, and dignified life. The final decision, expected in the coming months, will serve as a critical indicator of Vietnam’s commitment to modernizing its healthcare landscape and prioritizing the long-term well-being of its citizens.
