Conditions for direct payment for patients who buy health insurance drugs themselves

Lawyer Nguyen Thi Thuy, YouMe Law Firm LLC, replied:

Article 59 of Decree 188/2025/ND-CP (effective from August 15) stipulates the conditions for paying costs directly to patients in cases where patients buy medicine and medical equipment themselves as follows:

At the time of prescribing, prescribing drugs, prescribing the use of medical equipment, all conditions must be met according to the following regulations:

1. At the time the patient was prescribed or appointed, the medical examination and treatment facility did not have available medicine or medical equipment as prescribed in Point b, Clause 2, Article 43 of this Decree and was in the following cases:

a) For drugs: there are no commercial drugs containing active ingredients that the patient is prescribed or the same active ingredient but different levels or content or dosage form or sugar used and cannot be replaced for prescription to patients;

b) For medical equipment: there is no medical equipment that the patient is assigned to use and no medical equipment to replace it.

2. Patients cannot be transferred to other medical examination and treatment facilities in one of the following cases:

a) The patient's health and medical condition is determined to be unqualified for transfer;

b) Medical examination and treatment facilities where the patient is being examined and treated are under medical isolation according to the provisions of the law on prevention and control of infectious diseases;

c) The medical examination and treatment facility where the patient is being examined and treated is the specialized medical examination and treatment facility or the highest level of technical expertise in the province or centrally run city.

3. It is not possible to transfer drugs and medical equipment between medical examination and treatment facilities.

4. Drugs and medical equipment prescribed and designated for use must comply with the professional scope of the medical examination and treatment facility.

5. The drugs and medical equipment prescribed for use must be within the rights of health insurance participants and have been paid for medical examination and treatment costs under health insurance at one of the medical examination and treatment facilities nationwide.

6. Medical examination and treatment facilities are responsible for providing certificates of confirmation of shortage of drugs and medical equipment according to Form No. 11 of the Appendix issued with this Decree to patients as a basis for payment.

Thus, from August 15, the conditions for receiving direct payment of expenses when patients buy health insurance drugs themselves are implemented according to the above regulations.