Shocked by the cost of self-financed medicines? Learn about the public hospital drug formulary in one article.

In Hong Kong, public hospitals are subsidised by the Government, and their medical fees are far lower than those of private hospitals, leading some people to develop a mindset of “relying on the Government when they fall ill”. However, the medical expenses at public hospitals can still be substantial, especially when medications not subsidised by the Government are required. Therefore, it is crucial for patients and their families to understand how the “Drug Formulary” system operates, as well as the subsidy safety net behind it.

When receiving treatment at a public hospital, why are some medicines almost free while others have to be paid for out of pocket? This is all due to the Hospital Authority’s (HA’s) “Drug Formulary” system.

The HA introduced the “Drug Formulary” in 2005 to standardise the medication policies and use of medicines across all public hospitals and clinics, ensuring that patients can be prescribed medicines that are cost-effective, safety-validated and effective. Some medicines listed in the “Drug Formulary” are subsidised by the Government, making them inexpensive. However, if patients need to use medicines that are not subsidised by the Government, they must bear the cost themselves.

The HA regularly evaluates new medicines and updates the formulary every quarter (that is, in January, April, July and October each year).
 

The “Drug Formulary” currently contains more than 1,500 medicines, mainly divided into three categories: General Drugs, Special Drugs and self-financed drugs subsidised through the safety net.

General Drugs

General Drugs are the medicines most commonly used in the public hospitals’ drug inventory, including antihypertensive drugs, blood glucose-lowering drugs, antibiotics and painkillers. Medicines in this category have been proven to be suitable and effective for patients’ clinical conditions and can be widely used. They account for approximately 80% of the medicines in the formulary. Patients can obtain prescriptions by paying the standard drug fee, currently HK$15 per medicine for a maximum of 16 weeks.

Special Drugs 

Special Drugs are prescribed for patients under specific clinical conditions following clinical assessment by a specialist, such as certain targeted cancer drugs and drugs for rare diseases. When prescribed for specific clinical applications, public hospitals and clinics charge the standard fee of HK$15 per medicine. However, if individual patients choose to use Special Drugs outside the specific clinical applications, they must pay for the medicines themselves.

Self-financed Drugs 

These medicines have been proven to have significant therapeutic effects but, following assessment, have not been included in the General Drugs or Special Drugs lists due to cost-effectiveness considerations. They are generally very expensive and patients must purchase them at their own expense. Examples include drugs for rare diseases and new drugs. However, the Hospital Authority continues to provide drug subsidies through safety-net schemes, such as the Samaritan Fund and the Medical Assistance Programme under the Community Care Fund, for patients who require these medicines but face financial difficulties.

If you would like to learn more about the medicines in the “Drug Formulary”, you can click here to view the full list of the “Drug Formulary”.
 

To help patients facing financial hardship cope with expensive medication costs, the Hospital Authority has two major assistance programmes——the “Samaritan Fund” and the “Community Care Fund Medical Assistance Programme”. Together, they form Hong Kong’s medication safety net.

Samaritan Fund 

The Samaritan Fund covers self-financed drugs for different specialties, including haematology, rheumatology, neurology, oncology, endocrinology and dermatology, as well as a small number of drugs for treating rare diseases. Patients in need who wish to apply for assistance must be assessed and referred by their attending doctor, undergo a financial assessment by a medical social worker, and obtain approval from the Fund’s office before receiving full or partial medical assistance. Patients receiving Comprehensive Social Security Assistance are not required to undergo a financial assessment.

Community Care Fund Medical Assistance Programme 

The Community Care Fund Medical Assistance Programme covers certain self-financed cancer drugs that have not yet been included in the Samaritan Fund, but for which medical evidence is rapidly accumulating and the relative benefits are slightly higher, such as drugs for treating specific types of cancer. Applicants are likewise required to undergo a financial assessment.

According to Legislative Council papers, in 2023–24, the Samaritan Fund and the Community Care Fund Medical Assistance Programme provided approximately HK$1.05 billion and HK$860 million respectively in drug subsidies for patients.
 

Patients wishing to apply for the Samaritan Fund or the Community Care Fund Medical Assistance Programme must undergo a means test. The assessment is conducted on a family basis, taking into account the income, expenditure and assets of the patient and their co-residing core family members to calculate the “Annual Disposable Financial Resources” (ADFR). The Hospital Authority will then determine the patient’s maximum contribution based on a contribution ratio table. Generally speaking, the stronger a family’s financial position, the higher the proportion of medical expenses it must contribute. The maximum contribution rate is 20% of the patient’s ADFR, and the patient’s contribution remains unchanged regardless of the cost of the medication.

To make this easier to understand, we have set out the following example and used the Hospital Authority’s means test calculator to work out the figures.

For example, consider a four-person family that has to bear annual targeted drug costs of HK$700,000. Suppose their monthly household incomes are HK$80,000 and HK$160,000 respectively, and their household assets are HK$700,000 and HK$1.5 million respectively. Roughly speaking, their monthly recognised deductible expenses are both HK$40,000. If their applications for assistance are successful, how much of the drug costs would they have to pay themselves?

According to the table above, Patient A and Patient B are estimated to incur maximum annual out-of-pocket costs of HK$106,000 and HK$378,000 respectively. Spread over each month, the costs would be approximately HK$8,833 and HK$31,533 respectively, accounting for approximately 11% and 19.7% of their monthly household income. Even for middle-class families, meeting these costs is likely to be considerably burdensome. Of course, the actual approval and subsidy amounts will need to be handled by a medical social worker.

Although the Drug Formulary and related subsidy safety nets provide the public with basic healthcare protection and embody the principle that everyone should have access to medical treatment, these safety nets are not all-encompassing. When treatment requires drugs beyond General Drugs and Special Drugs, particularly some innovative and expensive self-financed drugs, not every family can meet the financial eligibility thresholds for subsidies. For those who fail to pass the assessment or belong to the “sandwich class”, the heavy cost of medication may become an overwhelming burden on their families at any time. Therefore, it is particularly important to plan ahead and take out suitable medical insurance, so that patients have more treatment options when needed, without having to worry about the cost of medication.

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Sources: Hospital Authority, Legislative Council documents

Further reading:
Is your old medical insurance no longer sufficient? Three ways to cope with rising healthcare costs in Hong Kong
【The secret weapon against claim rejection】Does “full reimbursement” under medical insurance cover everything? What you need to know about the “medically necessary” clause
What is targeted therapy? Can it treat cancer? Learn about its principles, types and effects
 

Last updated: 16 June 2025

This English version of this article has been generated by machine translation powered by AI. It is provided solely for reference purposes. In the event of any discrepancy or inconsistency between this translation and the original Chinese version, the Chinese version shall prevail.