Pay for medicine and medical equipment costs directly to people with health insurance cards
This Circular regulates the direct payment of costs of medicines and medical equipment within the scope of benefits of health insurance participants when going for medical examination and treatment as prescribed in Point c, Clause 2 and Clause 3, Article 31 of the Law on Health Insurance at medical examination and treatment facilities that have signed contracts for health insurance examination and treatment from the health insurance fund, including:
In case of drugs and medical equipment within the scope of payment; Payment conditions; Payment level; Payment records and procedures.
In case of drugs and medical equipment covered by payment, including: Drugs on the List of rare drugs issued with Circular No. 26/2019/TT-BYT dated August 30, 2019 of the Minister of Health regulating the List of rare drugs.
Type C or D medical devices, except for in vitro diagnostic medical devices, personal specific medical devices, medical devices on the list of medical devices issued by the Minister of Health, are purchased and sold as ordinary goods according to the provisions of Decree No. 98/2021/ND-CP dated November 8, 2021 of the Government on the management of medical equipment.
Payment terms
The Circular of the Ministry of Health clearly states that at the time of prescribing drugs and indicating the use of medical equipment, the following conditions must be ensured:
Firstly, there are no medicines or medical equipment because they are in the process of selecting contractors according to the approved contractor selection plan in one of the following forms: Open bidding or restricted bidding or competitive bidding or direct procurement or contractor selection in special cases but have not yet selected a contractor or online bidding or online procurement and have implemented a shortened bidding appointment according to the provisions of Point c, Clause 1, Clause 2, Article 23 of the Law on Bidding and Clause 1, Article 94 of Decree No. 24/2024/ND-CP dated February 27, 2024 of the Government detailing a number of articles and measures to implement the Law on Bidding on contractor selection but have not selected a contractor. At the same time, at medical examination and treatment facilities:
For drugs: No commercial drug contains the active ingredient that the patient is prescribed or the same active ingredient but in a different concentration or content or dosage form or route of administration and cannot be substituted for the prescription for the patient.
For medical equipment: There is no medical equipment that the patient is prescribed to use and there is no medical equipment to replace it.
Second, do not transfer patients to other medical examination and treatment facilities in one of the following cases:
The patient's health and medical condition are determined to be ineligible for transfer.
The medical examination and treatment facility where the patient is being examined and treated is under medical isolation according to the provisions of the law on prevention and control of infectious diseases.
The medical examination and treatment facility where the patient is being examined and treated is a specialized medical examination and treatment facility.
Third, it is not possible to transfer drugs and medical equipment between medical examination and treatment facilities according to the provisions of law.
Fourth, the prescribed and indicated drugs and medical equipment must be consistent with the professional scope of the medical examination and treatment facility and have been covered by health insurance for medical examination and treatment costs at one of the medical examination and treatment facilities nationwide.
Fifth, prescribed and indicated drugs and medical equipment must be within the scope of benefits of health insurance participants.
