Abstract
Background Essential medicine category E(2) in the National List of Essential Medicine (NLEM) is
high price medicine. Three health insurance schemes have different drug management systems,
pharmaceutical benefits schemes, drug procurement, drug distribution to hospitals, and rational
drug use control that impact drug access and expenditure. Monitoring and evaluation (M&E) are
needed to be developed. This study aims to study the development of M&E for using essential
medicine category E(2) in NLEM at the national level, a case study of Sofosbuvir /Velpatasvir with
extreme amounts and Rituximab with high budget impact.
Methods A mixed methods design was employed in this study. A cross-sectional study gathered
the amount and value of drug utilization at four tertiary care hospitals under the Permanent
Secretary Ministry Office of Public Health and four university hospitals under Ministry of Higher
Education, Science, Research and Innovation in the fiscal year of 2021 (1st October 2020 – 30th
September 2021). In-depth interviews were conducted with related healthcare personnel to study
criteria for prescribing Sofosbuvir /Velpatasvir and Rituximab and patients or caregivers for studying
drug access.
Results The prescribing rate of Sofosbuvir/Velpatasvir, according to the criteria for essential
medicines category E(2) in the NLEM, was 55%. In contrast, Rituximab was prescribed at a higher
rate of 84%. The average values of Sofosbuvir/Velpatasvir per patient were ranged from 593.03
to 819.75 USD, with a per-visit between 265.41 and 378.91 USD. For Rituximab, the average values
per patient were ranged from 1,979.09 to 3,550.82 USD, with a per-visit between 381.77 and
737.91 USD. (34.0908 THB=1 USD on 30th September 2021*)
Conclusion Monitoring and evaluating essential medicines in category E(2) of the NLEM can be
effectively done using hospital databases. This includes assessing prescribing practices, patient
compliance with treatment plans, follow-up on clinical outcomes, and the financial value of drug
use. However, for a more comprehensive analysis of drug access, it is essential to link hospital
databases with healthcare insurance data.
