Accordingly, this circular stipulates the cases of drugs and medical equipment within the scope of payment, payment conditions, payment levels, and payment records and procedures.
Specifically, regarding payment conditions, 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 we are in the process of selecting contractors according to the approved contractor selection plan.
At the same time, at the medical examination and treatment facility, there is no commercial medicine containing the active ingredient that the patient is prescribed or the same active ingredient but with different concentrations or content or dosage form or route of administration and cannot be substituted for the prescription for the patient.
With medical equipment, when the medical equipment that the patient was prescribed to use is not available and there is no medical equipment to replace it.
In 2025, people with health insurance cards who pay out of pocket for medicine and medical supplies will be paid directly by the Social Insurance agency (Illustration: Hoang Le).
Second, do not transfer patients to other medical examination and treatment facilities in one of the following cases:
- The patient's health condition and illness 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 scope of expertise of the medical examination and treatment facility and the medical examination and treatment costs have been paid for by health insurance 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.
The social insurance agency will pay directly to the patient according to regulations. For example, for drugs, the basis for calculating the payment level is the quantity and unit price stated on the invoice purchased by the patient at the pharmaceutical business establishment. In case the drug has regulations on payment rates and conditions, the payment rates and conditions shall be implemented.
This Circular takes effect from January 1, 2025. In case a patient enters a medical examination and treatment facility for examination and treatment before the effective date of this Circular but finishes treatment after the effective date of this Circular, the provisions of this Circular shall apply.
Source: https://dantri.com.vn/suc-khoe/nam-2025-tu-mua-thuoc-nguoi-benh-duoc-bhxh-thanh-toan-truc-tiep-20241019124618461.htm
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