Abstract
Thailand has “the National List of Essential Medicines (NLEM)” as an important tool of the drug
system. It is a referenced pharmaceutical benefit package of the public health insurance systems of
accessing to essential medicines. This retrospective review aimed to review access to high-cost essential
medicines through a drug selection process of subcategory E (2) during 2007-2019, to analyze the developments
of drug selection process including stakeholders, and to provide suggestions to stakeholders
further developments of the NLEM process. The results found that the subcategory E (2) process enhanced
access to high-cost essential medicines through the drug selection process developed and designed
specifically for subcategory E (2). The guideline for regulating drug use and the process of determining
the affordability and the budget capacity were included to subcategory E (2) selection process. Despite
stricter control in drug use and reimbursement of subcategory E (2) compared to other subcategories,
many challenges were found. Drug items and indications listed under the subcategory E (2) have been
increased with an annual increase of budget. However, the monitoring and evaluation (M&E) of drug use
in subcategory E (2) were lacking. Therefore, it is important to suggest development of the national M&E
system to be beneficial for policy decision making of access to high-cost essential medicines through the
drug selection process of the NLEM.
