Health insurance (HI) participants who have to buy medicine themselves because hospitals lack medicine can still be paid directly by the HI fund. However, reimbursement can only be made when all conditions according to the regulations of the Ministry of Health are fully met.
The Ministry of Health has issued Circular 22/2024 stipulating the direct payment of drug and medical equipment costs to people with health insurance cards. Patients are directly reimbursed for drug costs by the health insurance fund in the following cases:
Patients must buy medicine according to the prescription prescribed by the doctor and the purchase of medicine is carried out at the pharmacy of the medical examination and treatment facility, while fully meeting the conditions according to regulations.
The type of drug purchased belongs to the list of rare drugs issued by the Ministry of Health.
Medical facilities lack medicine because the process of selecting suppliers has not been completed, even though bidding and procurement forms have been implemented in accordance with regulations.
There are no other commercial drugs with the same active ingredient or appropriate alternatives for use in patients.
Patients cannot be transferred to other medical examination and treatment facilities due to professional reasons such as health conditions not allowing, being treated at specialized level facilities or being subject to medical isolation.
Drugs cannot be transferred from other medical examination and treatment facilities and the prescription of drug use is appropriate to the scope of professional activities of the treatment facility.
Medications prescribed are on the list that has been paid by the health insurance fund at medical examination and treatment facilities nationwide.
Dossiers, procedures, and direct payment procedures for drug costs between social insurance agencies and health insurance participants have been specifically stipulated in Article 55 and Article 56 of Decree No. 188/2025/ND-CP dated July 1, 2025 of the Government detailing and guiding the implementation of a number of articles of the Law on Health Insurance.
Within 20 days from the date of receipt of dossiers meeting the conditions according to regulations (in case of submitting paper dossiers based on the date recorded on the seal of the official letter or dossier receipt), the social insurance agency must pay expenses to the patient.
The cost is paid directly in cash or by bank transfer according to the patient's account number provided in the written request for direct payment.
