On October 18, 2024, the Ministry of Health issued Circular 22/2024/TT-BYT regulating the direct payment of costs for medicines and medical devices for health insurance cardholders, detailing the conditions, criteria, and payment rates.
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Photo 1: Conditions for payment of medicine and medical device costs directly for health insurance cardholders_Hotline: 097 211 8764
Circular 22/2024/TT-BYT regulates the direct payment of costs for medicines and medical devices for patients with health insurance cards seeking medical examination and treatment, recently issued by the Ministry of Health.
Accordingly, at the time of prescribing medications or indicating the use of medical devices, five conditions must be met as follows:
1. There are no medicines or medical devices because they are in the process of selecting contractors according to the approved contractor selection plan. Simultaneously, there should be no commercial medicines at the healthcare facility containing the active ingredients prescribed for the patient, or the same active ingredient but with different concentrations, dosages, or forms, or routes of administration, which cannot be substituted for the patient. For medical devices, this means that there are no medical devices prescribed for the patient and no alternatives available.
2. Patients should not be transferred to another healthcare facility in the following cases:
- Their health condition or illness does not meet the criteria for transfer.
- The healthcare facility where the patient is being examined and treated is currently under medical quarantine as per infectious disease control laws.
- The healthcare facility where the patient is being examined and treated is a specialized facility.
3. There should be no transfer of medicines or medical devices between healthcare facilities in accordance with legal regulations concerning the rights of health insurance participants.
4. The prescribed medications and medical devices must be appropriate to the professional scope of the healthcare facility and must have had their examination and treatment costs covered by health insurance at any healthcare facility nationwide.
5. The prescribed medications and medical devices must fall within the benefits covered for health insurance participants.
To receive health insurance payment, the Ministry of Health clearly states that the purchaser must present the prescription and medical supplies as prescribed by the doctor to the social insurance agency as the basis for payment. The social insurance agency is responsible for receiving the documents and making direct payments to the patient within 40 days based on the costs incurred.
Regarding the level of direct payment for costs, according to the guidelines of Circular 22, the Social Insurance Agency will directly pay patients as follows:
- For medications, the basis for calculating the payment amount is the quantity and unit price recorded on the invoice from the pharmacy. If there are regulations on ratios or payment conditions, these must be followed.
- For medical devices (including reusable medical devices), the basis for calculating the payment amount is the quantity and unit price recorded on the invoice from the medical device supplier. If there are regulations on payment levels, these must not exceed the stipulated payment levels for those devices.
The unit prices of medications and medical devices used as the basis for determining payment levels must not exceed the unit prices at the most recent time for those that have been contracted at the healthcare facility where the patient was treated.
In cases where the medications or medical devices have not been contracted at the healthcare facility where the patient was treated, the unit price for determining health insurance payments will be based on the effective contractor selection results, prioritized as follows: national centralized procurement results or negotiated prices; local centralized procurement results.
The social insurance agency will deduct the health insurance costs paid by the treating healthcare facility.
Circular 22/2024/TT-BYT will take effect from January 1, 2025.
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