Are patients who buy medicine outside the hospital covered by health insurance?

On the sidelines of the Ministry of Health's press conference on the afternoon of December 15, discussing the content when patients are paid for the cost of self-purchased medicine that they should have received when participating in health insurance, Ms. Tran Thi Trang, Director of the Health Insurance Department, said that the ministry has developed a draft circular regulating the direct payment of medicine and medical supplies costs for patients participating in health insurance. The circular is being consulted by the whole society before being issued.

3 conditions for direct cost payment

According to this draft circular, the Health Insurance Fund will pay for medicine and medical supplies directly to patients with Health Insurance cards or pay for medicine and medical supplies to medical examination and treatment facilities if all three conditions are met:

Firstly, the drugs and medical supplies prescribed to patients are within the scope of benefits of health insurance participants.

Second, the patient is diagnosed, prescribed and assigned medicine and medical supplies, but at the time of use, the active ingredients of the medicine and medical supplies are not available at the medical examination and treatment facility: There is no finished medicine containing the active ingredients that the patient is prescribed; There is no suitable medical supplies that the patient is prescribed to use.

Third, the drugs and medical supplies prescribed to patients are within the scope of benefits of health insurance participants.

Patients are diagnosed, prescribed and assigned drugs and medical supplies, but at the time of use, the active ingredients of the drug and medical supplies are not available at the medical examination and treatment facility.

It is necessary to ensure the rights of patients who have participated in health insurance.

How are payments made?

The draft circular of the Ministry of Health clearly states that direct payment of medicine and medical supplies costs for health insurance participants is carried out as follows:

The patient or the patient's relative or legal representative as prescribed by law must present to the Social Insurance agency the prescription and medical supplies prescribed by the medical staff at the medical examination and treatment facility and the legal and valid invoice for the purchase of drugs and medical supplies as the basis for payment.

Hospital pharmacy of the medical examination and treatment facility where the patient is treated; The unit supplying drugs and medical supplies that meet the conditions has won the bid with any medical examination and treatment facility that has signed a contract for medical examination and treatment covered by health insurance; Drugs and medical supplies that have been used and paid for patients with health insurance cards at the medical examination and treatment facility where the supplier won the bid; The contract for the supply of drugs and medical supplies is still in effect.

The patient or the patient's relative or legal representative as prescribed by law must present to the Social Insurance agency the prescription and medical supplies prescribed by the medical staff at the medical examination and treatment facility and the legal and valid invoice for the purchase of drugs and medical supplies as the basis for payment.

The Social Insurance Agency that receives the application for direct payment is responsible for directly paying the cost of medicine and medical supplies for the patient according to the prescribed cases.

The cost paid directly by the health insurance agency to the patient is equal to the cost recorded on the patient's legal invoice provided by the hospital pharmacy or supplier and according to the benefit level within the scope of benefits of the health insurance participant.

Source: https://www.baogiaothong.vn/benh-nhan-mua-thuoc-ngoai-vien-co-duoc-bhyt-thanh-toan-192231215173709896.htm