Skyrocketing drug prices

At the 2025 Annual Scientific Conference organized by the Vietnam Medical Association, Dr. Due from the Health Strategy and Policy Institute (Ministry of Health) explained that high cancer drug prices stem from prolonged R&D costs, including many failed drugs, and the fact that these medicines often serve small patient populations, especially those with rare diseases.

Over the past two decades, the average annual cost of cancer drugs has surged from $12,000 to over $120,000. Some cutting-edge therapies, such as CAR T-cell treatments, now cost as much as $500,000 per year.

This dramatic price increase is placing immense pressure on Vietnam’s public healthcare budget and limiting patients’ access to advanced treatments.

Dr. Due noted that Vietnam’s total healthcare spending has risen sharply from $17.4 billion in 2019 to $25.6 billion in 2023 and is projected to reach $34.1 billion by 2028.

Drugs alone accounted for 25–28% of this spending in 2023, amounting to $6.6 billion and forecasted to increase to $8.6 billion by 2028.

With health insurance coverage reaching 93.35% of the population in 2023, the national health insurance fund paid out over VND 121 trillion (approximately $4.9 billion) - five times more than in 2009. Of this, drugs accounted for 33.8%, up from VND 11.5 trillion ($465 million) in 2010 to VND 47.23 trillion ($1.9 billion) in 2023.

Yet without effective cost-control mechanisms, the risk of budget overruns remains.

Cancer has the highest treatment costs among non-communicable diseases, with approximately 180,000 new cases diagnosed each year.

Drugs account for 61.1% of total cancer treatment costs. Although original branded medicines make up just 3–4% of total volume, they consume over 30% of the budget.

Cancer drugs and immunomodulators rank second in health insurance expenditure.

Alarmingly, out-of-pocket (OOP) expenses still account for 43–45% of Vietnam’s total healthcare spending, placing a heavy financial strain on families.

Solutions for better access to cancer treatments

To address the challenge, Dr. Due noted that many countries now apply Health Technology Assessment (HTA) in determining reimbursement for cancer treatments, although outcomes vary depending on the national context.

He proposed several measures tailored to Vietnam, including: adopting higher cost-effectiveness thresholds, assigning greater weight to cancer-related quality-adjusted life years (QALY), establishing a dedicated review process, creating special financial mechanisms, implementing risk-sharing agreements, and building patient support programs.

These solutions must be flexibly combined to increase access to innovative therapies while safeguarding the health insurance fund.

Risk-sharing models and cost control

Dr. Due also highlighted the importance of Managed Entry Agreements (MEA), which are increasingly used worldwide to manage access to expensive new drugs under specific conditions.

MEAs link reimbursement to either spending caps or clinical outcomes, helping balance treatment efficacy with financial sustainability and enabling shared risk between payers and pharmaceutical companies.

In Vietnam, MEAs are particularly vital due to the high costs and limited real-world data on newer cancer therapies.

However, implementing MEAs requires several prerequisites: a transparent legal framework, integration with HTA, clear evaluation timelines, electronic health records, patient databases, and real-time data analytics capabilities.

It also demands trained professionals in HTA, pharmacoeconomics, and risk management, as well as open communication among insurers, pharma companies, hospitals, and patients.

Defining clinical indicators, setting refund mechanisms, limiting agreement terms to 2–5 years, and reducing administrative burdens are also critical factors.

Dr. Due cited international examples: South Korea introduced Price-Volume Agreements in 2007 to adjust prices when sales exceeded projections, and from 2013 focused MEAs on cancer, rare diseases, and non-replaceable therapies.

Taiwan (China) began experimenting with Drug Expenditure Caps (DETs) in 2013 and expanded MEAs starting in 2018.

According to Dr. Due, MEAs help control spending, share risks, and expand access to advanced medicines. However, challenges include the need for robust data systems, precise cap calculations, and stronger links between reimbursement and real-world effectiveness.

Phuong Thuy