Patient rights are guaranteed when buying medicine outside.

When patients buy medicine outside, they will be covered by health insurance when they meet the set criteria. That is the latest content stipulated in Circular No. 22/2024/TT-BYT recently issued by the Ministry of Health.

Patient rights are guaranteed when buying medicine outside.

When patients buy medicine outside, they will be covered by health insurance when they meet the set criteria. That is the latest content stipulated in Circular No. 22/2024/TT-BYT recently issued by the Ministry of Health.

On October 30, the Ministry of Health held a workshop to disseminate Circular No. 22/2024/TT-BYT regulating direct payment of medicine and medical equipment costs for people with health insurance cards going to see a doctor or receive treatment, and to seek opinions on health insurance payment regulations.

Leaders of the Ministry of Health answer questions about medical examination and treatment under health insurance. Photo: Tran Minh

Speaking at the workshop, Deputy Minister of Health Tran Van Thuan said that in recent times, the Ministry of Health has had many solutions to overcome the shortage of drugs and medical supplies, but in some places, medical examination and treatment facilities still do not provide adequate and timely supplies to patients. This leads to the situation where patients have to buy drugs and medical supplies outside the medical examination and treatment facilities.

To ensure the rights of patients, according to Deputy Minister of Health Tran Van Thuan, the Ministry of Health has issued Circular No. 22/2024/TT-BYT (Circular 22) regulating the direct payment of medicine and medical equipment costs for people with health insurance cards when going for medical examination and treatment.

Accordingly, specific regulations are issued for cases where the health insurance fund directly pays for medicine and medical equipment costs for people with health insurance cards who go for medical examination and treatment, including medicines on the list of rare medicines; medical equipment of type C or D, except for in vitro diagnostic medical equipment and personal specific medical equipment.

In addition, Circular 22 also stipulates strict and feasible conditions for direct payment of medicine and medical equipment costs for people with health insurance who go for medical examination and treatment in cases where medicine and medical equipment are not available due to force majeure.

Explaining more clearly about this regulation, according to Ms. Vu Nu Anh, Deputy Director of the Department of Health Insurance, Ministry of Health, the drugs in shortage due to medical facilities not being able to purchase or supply mostly fall into the group of drugs for treating rare diseases, drugs with limited supply on the market.

The list of rare drugs is regulated to have more than 450 active ingredients that are paid for, accounting for nearly half of the list of drugs covered by the health insurance fund. Of which, there are about 214 drugs for treating rare diseases, more than 217 drugs in the list of drugs with limited supply on the market. Therefore, although called rare drugs, the combination of these types that are directly paid for is not small.

At the workshop, representatives of many medical facilities "complained of difficulties" in implementing the regulations in Circular 22, but according to Ms. Tran Thi Trang, Director of the Department of Health Insurance, Ministry of Health, the responsibility for supplying drugs and medical equipment belongs to the medical facilities, so they must do everything possible to purchase and fully and promptly meet the needs of patients. Only when this is no longer possible will Circular 22 be applied.

"This circular only addresses the situation, aiming to partly ensure the rights of health insurance participants, and partially compensate for the costs that patients pay themselves, not all of them," said the leader of the Health Insurance Department.

It is known that according to the provisions of Circular 22, regarding payment conditions, the Circular of the Ministry of Health clearly states that at the time of prescribing drugs and indicating the use of medical equipment, the prescribed conditions must be ensured.

Firstly, due to the lack of drugs and medical equipment due to 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 the contractor has not been selected or online bidding or online procurement and has implemented the shortened bidding as prescribed.

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;

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 condition or illness is determined to not meet the conditions 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 impossible to transfer drugs and medical equipment between medical examination and treatment facilities according to the provisions of law, in violation of the rights of health insurance participants.

Fourth, the prescribed and indicated drugs and medical equipment must be consistent with the professional scope 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.

5. Prescribed and indicated drugs and medical equipment must be within the scope of benefits of health insurance participants.

Regarding direct cost payment, according to the guidance of Circular 22, the social insurance agency pays directly to the patient according to regulations.

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;

For medical equipment (including reusable medical equipment): The basis for calculating the payment level is the quantity and unit price stated on the invoice purchased by the patient at the medical equipment trading facility. In case the medical equipment has a payment level regulation, it must not exceed the payment level prescribed for that medical equipment.

The unit price of drugs and medical equipment used as the basis for determining the payment level must not exceed the unit price paid at the most recent time for cases where drugs and medical equipment have won bids at the medical examination and treatment facility where the patient was examined and treated.

In case the medicine or medical equipment has not won the bid at the medical examination and treatment facility where the patient has been examined and treated, the unit price used as the basis for determining the health insurance payment level is the result of the selection of a valid contractor in the following order of priority: Results of centralized procurement at the national level or price negotiation results; Results of centralized procurement at the local level in the area;

And the lowest contractor selection result at the time of payment of public medical examination and treatment facilities at specialized or basic levels or medical examination and treatment facilities of the same technical expertise level in the area;

The lowest contractor selection result at the time of payment of public medical examination and treatment facilities at specialized or basic levels or medical examination and treatment facilities of the same technical expertise level in Hanoi and Ho Chi Minh City.

The social insurance agency shall deduct the health insurance costs paid by the medical examination and treatment facility where the patient is treated according to regulations.

In case the cost of medicine and medical equipment is included in the price of medical examination and treatment services: Deduction will be made from the cost of medical examination and treatment services covered by health insurance of the medical examination and treatment facility at the payment level according to regulations.

In case the cost of medicine and medical equipment is not included in the price structure of medical examination and treatment services: No deduction will be made from the cost of medical examination and treatment services covered by health insurance of the medical examination and treatment facility;

The cost of medicine and medical equipment paid directly by the social insurance agency to the patient is included in the estimate of the medical examination and treatment facility. Ensure that there is no abuse or profiteering in prescribing and instructing patients to buy medicine and medical equipment themselves.

Source: https://baodautu.vn/quyen-loi-cho-nguoi-benh-duoc-bao-dam-khi-mua-thuoc-ben-ngoai-d228744.html