Regulators in Vietnam are preparing to expand health insurance coverage for high-cost oncology, chronic disease, and rare disease medicines, a change with potential implications for insurers and health systems in Asia.
A draft circular from the Ministry of Health would update the national list of chemical drugs, biological products, radioactive drugs, markers, and medical gases reimbursed under the compulsory health insurance scheme. The regulation, expected to take effect in 2026, is in the final stages of internal review.
According to the Health Insurance Department under the ministry, the proposal adds 84 drugs to the reimbursable list, including 30 products for cancer treatment. Oncology medicines would account for 35.7% of the proposed additions, the largest share among the therapeutic groups under consideration. The oncology group consists mainly of targeted therapies, monoclonal antibodies, and immunotherapies. The draft circular is accompanied by two annexes: one detailing chemical and biological drugs and another listing radioactive drugs and markers. A representative from the Health Insurance Department said high oncology drug prices, driven by research and clinical development costs, have not prevented policymakers from examining broader coverage. The official said the proposed inclusions would increase available treatment options and bring domestic treatment protocols closer to those used in developed markets.
Cancer drugs already account for one of the largest groups in Vietnam’s existing health insurance drug list. Under Circular No. 20/2022/TT-BYT, effective March 1, 2023, the list covers 1,037 active pharmaceutical ingredients and biological products in 27 major categories, together with 59 radioactive drugs and tracers. Within that framework, 81 cancer and immunomodulation drugs are reimbursed by the Health Insurance Fund. These sit alongside 182 antiparasitic and anti-infective products, 110 cardiovascular medicines, and 75 gastrointestinal agents, placing oncology among the therapeutic areas with the highest number of active ingredients covered under the scheme.
The pipeline of oncology therapies has expanded in recent years. Vietnam has seen a relatively high number of new cancer drugs registered for circulation compared with other therapeutic classes, according to the Health Insurance Department. This has led to a larger volume of oncology products being put forward in the latest update cycle. “However, in recent years, the number of cancer drugs invented worldwide and registered for circulation in Vietnam has been quite large compared to other drug groups. Therefore, the number of cancer drugs considered for updating in this revision of the list is also greater than that of other drug groups,” a representative from the Health Insurance Department said. The national list is structured by active ingredient rather than by brand. As a result, the number of commercially available products actually reimbursed is higher than the number of listed ingredients, depending on how many brands and presentations receive marketing authorisation.
Beyond oncology, the draft circular seeks to broaden coverage for long-term conditions. It proposes 24 additional medicines for chronic diseases, including cardiovascular, diabetes, respiratory, mental health, and urinary tract conditions. These chronic disease treatments make up about 29% of the new drugs proposed. The draft also introduces 18 medicines for rare diseases, accounting for 21.4% of the new adjunct drugs. Fourteen of these 18 are cancer treatments, reflecting overlap between rare conditions and oncology in the Vietnamese market.
Health Insurance Department representatives state that rare diseases, cancer, and chronic conditions are associated with prolonged treatment and high cumulative costs. Officials say that adding more of these medicines to the reimbursed list is expected to reduce direct payments by patients and families and may affect workforce participation and health system capacity. In parallel, the draft circular would revise usage conditions and reimbursement rates for 52 medicines already on the list. Many of these products would have expanded indications or adjusted reimbursement levels, with the stated aim of improving access and moderating patient cost-sharing.
Medicines remain a major driver of health insurance expenditure in Vietnam. Drug spending reached VND 40.01 trillion in 2022, equivalent to 33.41% of total health insurance outlays. In 2023, this rose to VND 45.841 trillion (32.82%), and in 2024 to VND 50.784 trillion (31.22%). Although the share of medicines in total spending has declined gradually, pharmaceuticals continue to represent the largest single spending category for the Health Insurance Fund. Against this backdrop, policymakers are assessing the budget impact of each high-cost product and modelling reimbursement scenarios to preserve fund sustainability. Regulators say the “rational selection, use and payment” of medicines is one of the tools being used to control treatment costs, manage the fund, and limit out-of-pocket spending.
The current revision also emphasises expanding the set of reimbursable medicines available at commune health stations. The move is in line with national policies to strengthen primary care and increase access to services at the initial point of contact, consistent with Resolution 72-NQ/TW and Directive 52-CT/TW. The Ministry of Health plans to maintain expert councils for each therapeutic group to advise on product inclusion and reimbursement parameters. The circular is scheduled to be finalized, submitted to ministry leadership for signature and implemented in 2026.
The proposed benefit expansion is occurring as Vietnam’s social health insurance scheme approaches near-universal coverage. According to Vietnam News, Vietnam Social Security reported that by the end of 2025, 95.2% of the population was enrolled in health insurance, surpassing by 0.16 percentage points the target set in the Resolution of the 13th National Party Congress for the 2021-2025 period. The coverage rate also meets, five years early, the objective under Resolution No. 42-NQ/TW to achieve more than 95% coverage by 2030. In 2025, the national health system handled an estimated 195.5 million insurance-covered medical visits, with proposed claims of approximately VND 161.628 trillion. The Health Insurance Fund has been used to pay for a range of high-cost interventions, including cases involving hereditary bleeding disorders and advanced paediatric treatments such as organ transplantation and cardiovascular surgery. These cases show how the scheme has been applied to high-cost, low-frequency events.
Administrative changes and digitalisation have accompanied Vietnam’s coverage expansion. By 2025, the social security and health insurance systems had deployed 70 online public services that operate end to end and had integrated them into the National Public Service Portal. Authorities report that the roll-out of digital health insurance cards through the VssID and VNeID applications has increased use of electronic processing, with more than 91% of dossiers – about 113.5 million files – handled online. According to Vietnam Social Security, user satisfaction with social and health insurance administrative services reached 89.5% in 2025, exceeding the 2025 target set in Resolution No. 28-NQ/TW by 4.5 percentage points. Looking ahead, Vietnam Social Security has indicated that health insurance policy will shift from an emphasis on broad coverage to a focus on quality, sustainability, and effective development.
