Balancing Innovation and Affordability: Health System Trade-offs in Thailand’s Reimbursement Restriction Policies for High-Cost Medicines
Author(s)
Chanthawat Patikorn, PharmD, PhD, Thanapol Khuharatanachai, PharmD, Sutinee Soopairin, PharmD, MSc, Parnnaphat Luksameesate, PhD, Suthira Taychakhoonavudh, BSc, MS, PhD.
Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
OBJECTIVES: To manage rising pharmaceutical expenditures, Thailand’s Civil Servant Medical Benefit Scheme (CSMBS) introduced reimbursement restriction policies under Comptroller General’s Department (CGD) correspondences No.34 in 2018 and No.21 in 2023 (w34/21). These policies established a negative list for newly approved drugs and required conditional reimbursement mechanisms to ensure budget control. However, the comprehensive impact of these policies had not been systematically assessed. Thus, we aim to evaluate the impact of CGD’s reimbursement restriction policy on access to innovative drugs in Thailand.
METHODS: A mixed-methods study was conducted, comprising (1) policy document review, (2) systematic analysis of drugs with conditional reimbursement, and (3) in-depth interviews with 19 stakeholders. Drug coverage was compared against the National List of Essential Medicines (NLEM) and National Comprehensive Cancer Network (NCCN) guidelines between 2019 and 2025.
RESULTS: As of December 2024, 602 drug data entries with reimbursement conditions were identified, encompassing 187 distinct drug products. Of these, 51% were non-reimbursable. Most affected were oncology drugs (ATC code L). Despite initial access limitations, reimbursement coverage of NCCN-recommended cancer drugs improved from 67% in 2019 to 90% in 2025. Patient Access Programs (PAPs) were available for only nine drug items. While policies enhanced budget control and reduced the financial burden for patients, they introduced substantial administrative challenges for hospitals and delayed access to some drugs due to limited committee capacity.
CONCLUSIONS: The w34/21 policies have been instrumental in budget containment and have progressively improved access to high-impact therapies under the CSMBS. However, their implementation has created administrative burdens and delayed access to certain drugs. Policy refinements, such as prioritization criteria for unmet needs and enhanced review capacity, are essential to achieve equitable and sustainable drug access in Thailand.
METHODS: A mixed-methods study was conducted, comprising (1) policy document review, (2) systematic analysis of drugs with conditional reimbursement, and (3) in-depth interviews with 19 stakeholders. Drug coverage was compared against the National List of Essential Medicines (NLEM) and National Comprehensive Cancer Network (NCCN) guidelines between 2019 and 2025.
RESULTS: As of December 2024, 602 drug data entries with reimbursement conditions were identified, encompassing 187 distinct drug products. Of these, 51% were non-reimbursable. Most affected were oncology drugs (ATC code L). Despite initial access limitations, reimbursement coverage of NCCN-recommended cancer drugs improved from 67% in 2019 to 90% in 2025. Patient Access Programs (PAPs) were available for only nine drug items. While policies enhanced budget control and reduced the financial burden for patients, they introduced substantial administrative challenges for hospitals and delayed access to some drugs due to limited committee capacity.
CONCLUSIONS: The w34/21 policies have been instrumental in budget containment and have progressively improved access to high-impact therapies under the CSMBS. However, their implementation has created administrative burdens and delayed access to certain drugs. Policy refinements, such as prioritization criteria for unmet needs and enhanced review capacity, are essential to achieve equitable and sustainable drug access in Thailand.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD65
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Oncology