Patient Access to Anticancer Medicines Under Public Health Insurance Schemes in Thailand: A mixed methods study

Abstract

Patient access to anticancer medicines is challenging in Thailand and worldwide. This study aimed to explain and quantify access to anticancer medicines in Thailand using mixed methods of literature review and in-depth interview. Access to anticancer medicines was compared with World Health Organisation-Model List of Essential Medicines (WHO-EML), and recommendations of the National Comprehensive Cancer Network (NCCN). Access to National List of Essential Medicines (NLEM) is indifferent among three Thai schemes. Universal Coverage Scheme (UCS) and Social Security Scheme (SSS) limit access to non-NLEM anticancer medicines by reimbursement caps. Civil Servant Medical Benefit Scheme (CSMBS) provides better access through Oncology Prior Authorisation (OCPA) program. Non-NLEM, non-negative listed medicines are reimbursable if physicians deem necessary. UCS-SSS and CSMBS had 89.7% and 100% of medicines in WHO-EML. However, UCS-SSS had 19.2-100% of NCCN medicines for early-stage and 5.9-52.6% for advanced-stage cancers, while CSMBS had more access (57.7-100% and 41.2-84.2%, respectively). Patient Access Programs were offered by pharmaceutical companies to assist access to non-reimbursable non-NLEM medicines. Access inequity to anticancer medicine was confirmed. However, Thais have adequate access to first- and second-line medicines for both early- and advanced-stage cancers. All stakeholders should consider formulating innovative financial models for high-cost anticancer medicines.