Patients at Hong Kong’s public hospitals and clinics may need to pay more for their prescriptions, with authorities reviewing the current heavily subsidised HK$15 (US$1.92) fee for a 16-week supply of medicine.
Without disclosing details of the fee adjustment review, Dr Simon Tang Yiu-hang, director of cluster services at the Hospital Authority, said the aim was not to cut costs but to boost resources for cancer and rare-disease patients in need of expensive, patented drugs.
“If each patient can fork out a bit more when paying for their drugs, the Hospital Authority’s pie will grow,” Tang said.
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“This will be very beneficial for our operations because we will have more resources to introduce clinically effective but expensive drugs to the drug formulary.
“But how much more are you willing to pay? I’m leaving this for the public to discuss.”
The government currently covers 92 per cent of the authority’s drug costs, with patients only paying HK$15 for a 16-week supply of medication at specialist outpatient clinics.
Those using general outpatient clinics or public hospitals do not need to pay separately for drugs as the charge is included in the attendance fee.
In contrast, the Singaporean government covers 40 to 75 per cent of drug costs, depending on the income level of patients and the type of medicine involved. Mandatory health insurance covers the rest.
In the 2023-24 financial year, the Hospital Authority spent HK$13.1 billion, or 13 per cent of its expenditure, on drugs, a 60 per cent increase from 2019-20. The city’s ageing population and the procurement of new drugs pushed up the figure.
Hospital patients accounted for one-third of the expenses, with the rest spent on those attending clinics. Among these patients, 90 per cent attended specialist clinics.
The standard HK$15 fee only applies to medicines classified as general or special in the drug formulary, which covers 2,700 items.
Tang said some cancer patients, especially middle class ones, would choose not to treat their condition if they did not qualify for the authority’s “safety net” for those facing financial difficulties and had to sell their homes to pay for the expensive drugs they needed.
However, when the authority bargained with drug makers for a more reasonable price and included their medicines in the formulary, allowing the patients to only pay HK$15 rather than tens of thousands of dollars a month, they would be willing to treat their conditions, he said.
Tang said the authority had raised “various options” with the Health Bureau for consideration, adding that it had also talked to patient rights groups regularly about price adjustments. A proposal will be submitted to the bureau after the review.
Tim Pang Hung-cheong, a patients’ rights advocate at the Society for Community Organisation, an NGO, said a survey by the group last year suggested that the fee increase should be capped at 10 per cent.
“It should be acceptable if the new drug fee is still below HK$20 ... the government must ensure chronically ill patients and the underprivileged can continue to afford the drugs they need,” he said.
Pang said the government could not directly compare the subsidy rate with that of Singapore because the financing model was completely different, with Hong Kong residents not required to buy insurance.
“The biggest challenge faced by patients is not the money, but the insufficient resources for drug consultations. They can only see the pharmacists for a short while and have no avenue to ask questions later,” he said.
“We need community pharmacies to better support patients in the long run but the cost of the enhanced services shouldn’t be transferred to patients either.”
In last year’s policy address the government said a community pharmacy programme would be rolled out in the fourth quarter of 2026.
In the meantime, the authority would seek to optimise drug resources by reducing wastage, which was common because patients did not always follow their prescriptions and some medicines only had to be taken “as needed”, chief pharmacist William Chui Chun-ming said.
From March 24, patients will be prescribed a maximum 24-week supply of drugs. Those requiring longer-term supplies, about 9 per cent of patients, must return for refills.
The limit, which mainly applies to chronic disease medications, may be reduced to 16 weeks after a review in three months.
For “as-needed” drugs such as painkillers, eye drops and bruise cream, which patients are unlikely to use every day and often go to waste, only one-quarter of a prescription exceeding 28 days will be dispensed unless a doctor puts down a specific quantity.
For example, for a patient prescribed painkillers for 40 days, only 10 days’ worth will be dispensed by default.
From the fourth quarter, pharmacists will dispense an eight-week supply of those drugs in one go.
The standard HK$15 drug charge will continue to apply.
Discretion may be applied for those who cannot make frequent visits, such as the elderly and disabled.
Chui said an estimated 65 per cent of patients would not return to refill as-needed drugs, saving “tens of millions” of dollars in public funds.
Meanwhile, the authority expected 90 per cent of patients requiring longer prescriptions would return to refill chronic disease drugs, which would inevitably increase the burden on pharmacists. So the new measure will be implemented in phases, depending on manpower.
Healthcare staff will follow up on the remaining 10 per cent.
Tang said the ultimate goal was to shorten the period to a standard of eight weeks with the help of community pharmacies, which would be more convenient for patients.
However, he said the process would take time because the IT systems of hospital pharmacies would need to be connected with their counterparts in the community.
More from South China Morning Post:
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