Circular 05/2015/tt-Byt: Issued Directory Of Oriental Medicine, Medicinal Herbs And Drugs From Traditional Medicine In The Scope Of Payment Of Medical Insurance Fund

Original Language Title: Thông tư 05/2015/TT-BYT: Ban hành Danh mục thuốc đông y, thuốc từ dược liệu và vị thuốc y học cổ truyền thuộc phạm vi thanh toán của quỹ bảo hiểm y tế

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The CIRCULAR issued directory of Oriental medicine, medicinal herbs and drugs from traditional medicine in the scope of payment of health insurance fund _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ pursuant to the law of health insurance;
Pursuant to the law of Pharmacy;
Pursuant to Decree No. 105/2014/ND-CP on November 15, 2014 the Government detailing and guiding the implementation of some articles of the law on health insurance;
Pursuant to Decree No. 63/2012/ND-CP on August 31, 2012 of the Government functions, tasks, powers and organizational structure of the Ministry of health;
The Minister of Health issued a circular issued directory of Oriental medicine, medicinal herbs and drugs from traditional medicine in the scope of payment of the health insurance fund.
Article 1. Directory of Oriental medicine, medicinal herbs and drugs from traditional medicine 1. Issued directory of Oriental medicine, medicinal herbs and drugs from traditional medicine in the scope of payment of medical insurance fund, include: a) directory of Oriental medicine, the drug from medicinal herbs;
b) directory of the traditional medicine.
2. list of Oriental medicine, drugs from pharmaceutical chemicals (hereinafter collectively referred to as drug) and the list of traditional medicine (hereinafter referred to as the category) attached to this circular is the basis of the health insurance fund to pay the cost of the drug, the drug used for patients having medical insurance card at the medical facility , healing has made examinations, cure health insurance.
Article 2. Formulary structure, the 1. The formulary is organized into 11 groups according to physical medicine traditional medicine and have 5 columns are as follows: a) column 1 write the number order of the drug in the category;
b) column 2 record numbers of drugs in each group;
c) column 3 complete component name of the drug under the name of medicinal herbs; the component has slash "/" part can replace each other; components placed in parentheses "()" is part might join, rising;
d) Column 4, line record was as follows: sugar drink including drinking, shut up, chewing, placed under the tongue; roads also include topical, external, massage the Paste on the skin, spray, skin spray, dipping, stormed.
Column 5) notes some information to keep in mind the limits specified and limited patient base, healing is the use of drugs.
2. list of herbs including 349 herbs from plants, minerals, as drugs are arranged into 30 groups according to physical medicine traditional medicine and has 6 columns are as follows: a) column 1 write the number in the category;
b) column 2 record numbers of drugs in each group;
c) column 3 write the name;
d) Column 4 write the origin of drugs: the symbol "B" just the herbs are cultivated from foreign exploitation; the symbol "N" denotes the fed, cultivated or mined in the country;
DD) Column 5 write the scientific name of the drug;
e) Column 6 write the scientific name of the plant, or mineral as drugs.
Article 3. Instructions for use the formulary, the list 1. For the list of drugs: a) The drug has been used in the category in the base doctor, healing must comply with regulations on prescribed medication and match skills of medical establishments;
b) The health insurance fund is paid when the components, used in the category, including the drugs have the ingredients can replace each other and smoking have components can join, rising;
For example: (1) Smoking numbers 3 in column 1 the formulary component include: Sai HO, HO, cross frame, only Money, Qiang, active, Independent spirit, the white ghost, ginseng, ginseng, Party, licorice. The health insurance fund paid for the pharmacy component are as follows: + Sai HO, HO, cross frame, only Money, Qiang, Poison, Easter, Ling, ginseng, licorice;
Sai HO, HO, Money + Regular frames, Just, Independent, active, active Qiang ling, Party, ginseng, licorice;
Sai HO, HO, Money + Regular frames, Just, Independent, Transparent, Jiang ling,, ginseng, licorice;
Sai HO, HO, Money + Regular frames, Just, Independent, Transparent, Jiang ling, Party, ginseng, licorice.
(2) Smoking numbers 45 in column 1 the formulary component include: human ceiling, alisma, rhubarb, B., Equivalent Circuits, Long đởm, qui, Prince, Queen, (licorice), (Moc). The health insurance fund will pay with the pills are composed as follows: + Human ceiling, alisma, rhubarb, B., Equivalent Circuits, Long đởm, qui, Prince, Prince;
+ Personnel ceilings, alisma, rhubarb, B., Equivalent Circuits, Long đởm, qui, Prince, Queen, liquorice;
+ Personnel ceilings, alisma, rhubarb, B., Equivalent Circuits, Long đởm, qui, Prince, Queen, Carpentry;
+ Personnel ceilings, alisma, rhubarb, B., Equivalent Circuits, Long đởm, qui, Prince, Queen, licorice, Myrrh.
(3) Smoking numbers 108 in column 1 the formulary component include: ginseng, ginseng, Party/Equivalent rules, Bach Wuzhu, Promoted ma, Sai HO, Tran, licorice, (Born Qiang), (Apple). The health insurance fund will pay the pills are composed as follows: + ginseng, Equivalent, attributed to Bach, Wuzhu, promoted to ma, Sai HO, Tran, liquorice;
+ Ginseng, Equivalent, attributed to Bach, Wuzhu, promoted to ma, Sai HO, Tran, licorice, Qiang;
+ Ginseng, Equivalent, attributed to Bach, Wuzhu, promoted to ma, Sai HO, Tran, licorice, Apple;
+ Ginseng, Equivalent, attributed to Bach, Wuzhu, promoted to ma, Sai HO, Tran, licorice, B. Jiang, apples;
+ Party, Equivalent, attributed to Bach, Wuzhu, Promoted ma, Sai HO, Tran, liquorice;
+ Party, Equivalent, attributed to Bach, Wuzhu, Promoted ma, Sai HO, Tran, licorice, Qiang;
+ Party, Equivalent, attributed to Bach, Wuzhu, Promoted ma, Sai HO, Tran, licorice, Apple;
+ Party, Equivalent, attributed to Bach, Wuzhu, Promoted ma, Sai HO, Tran, licorice, B. Lee, the great Apple.
c) Drugs are specific records under the name components. These drugs are medical insurance fund payments when medicinal ingredients are included in the list of medications, including dosage, extract form of medicinal herbs;
This user groups Drug) treatment in the other group are the health insurance fund payments if the drug indicated as registered in the registration records of medication has been approved by the Ministry of health.
2. for the category: a) the herbs contained in the list is used in the base doctor, healing must comply with the rules on prescription drugs, in line with professional ability and authority to prescribe drugs of doctors of traditional medicine, traditional medicine doctors or medical salary working at the base hospital , healing;
b) the drugs labeled "B" in column 4 of the list are the health insurance fund to pay for the originating feed, grown, mined from abroad or within the country;
c) The herbs Ganoderma is derived from the foreign, Interior and ginseng when poison or the drug ladder stats only coordination of your medication or three drugs have to be consultations before the specified use. Form of consultations under the regulations by the Ministry of health consultations issued.
Article 4. Build the list of drugs, the drugs used in the treatment facility, treatment and medications by medical establishments, self healing manufactures in the scope of payment of health insurance fund 1. Basis of examination and treatment base on the formulary and the list attached to this circular and disease models, the range of professional activity to build location smoking, drug use at the base hospital, treatment and medications by medical establishments, self healing manufactured (if any) to stores under the provisions of the law of tenders treatment demand, and as a base for payment with the health insurance fund.
2. The selection of medication formulary and the attached to this circular is made according to the principle: favor the drug production in the country; smoking of the drug business standard of good manufacturing practices (GMP); the drugs came from the source feed, grown or mined in the country; the drugs, herbs can effectively cure, reasonable cost.
3. the base of the drug, the specific drug stores, medical facility, synthetic drug cure, herbs used at the base hospital, treatment and medications by medical establishments, self healing manufactures send social insurance organizations to do the payment base.
Article 5. The payment of the cost of smoking, smoking, smoking ladder use at the base hospital, treatment and medications by medical establishments, self healing manufactured 1. General guidelines: the health insurance fund to pay the cost of drugs, herbs, smoking due to the base doctor, healing self manufactured based on the actual number used for sick people and purchase price on the basis of the provisions of the law on procurement, in line with the scope and the level of benefits enjoyed under the provisions of the law on health insurance and the writing guide does.
2. With regard to the health insurance fund paid the price, taste medicinal drugs which the patient base, healing purchased in accordance with the law on public tenders with costs of frivolous decimated under the provisions of the Ministry of health (if available).
3. for clear component from the drugs in the list attached to this circular: the health insurance fund to pay the costs including the costs according to the principle specified in paragraph 2 of this article, the cost of packaging, the cost of the medicine colors included , water, fuel. The base doctor, healing are paying the cost of packaging and cost medicines identity when identity organization smoking establishments.
4. With regard to smoking due to patient base, self healing manufactures the medication): a part of the medication must be in the traditional medicine attached herewith;
b) billing Health Insurance Fund on the basis of the product, including: the cost of raw materials, cost of frivolous decimated under the provisions of the Ministry of health, the cost of packaging, the cost of manufacture including electricity, water, fuel and other costs including excipients, drug-making material , testing costs (packaging, raw materials, semi-finished and finished products);
c) who heads the base doctor, healing is responsible for approval of production processes, quality standards and the price of medicines by automatic dosage basis, consistent with the social insurance organization to do the payment base.

5. For smoking, smoking and smoking by the base doctor, cure yourself manufactures: the case of the expenses incurred in addition to the provisions in paragraph 2, paragraph 3 and paragraph 4 of this article, the base doctor, cure created a detailed presentation to United with the social insurance organization as a basis for payment. The base case consultations, healing is not consistent with social insurance institutions, medical facility, the healing Ministry of Industry, Ministry of health reports, medical facility and treatment Department of Health Department of health reports to consider, resolve.
6. The Fund for health insurance of non-payment in the case of smoking, smoking has been the State budget.
Article 6. Implementation 1. The Ministry of health is responsible for: a) the direction, instruction, inspection, inspection of the construction of the category and the category of drug unit, bidding to buy drugs, management, use, paying the cost of the medical facility;
b) presiding, in cooperation with the relevant authorities to solve the problems arising in the process of implementation;
c) presiding, in cooperation with relevant agencies up-to-date, adjust, modify, supplement the formulary, the attached to this circular in response to treatment needs and in accordance with the solvency of the health insurance fund.
2. social insurance is responsible for Vietnam: a) to make, the direction of social insurance in the province, central cities, in cooperation with the Department of health and medical establishments, healing in the Organization made, the payment of the cost of medicines in accordance with the provisions of this circular and the other legal texts concerned;
b) coordinate with relevant agencies to resolve problems arising in the process of implementation.
3. the Department of health, the central cities are responsible for: a) directing, instructing the patient base, built on healing drug formulary, medication, smoking by the base doctor, cure itself; bidding to buy drugs and pay the cost of drug use to the base doctor, healing in the management authority;
b) testing, inspection, timely handling of violations and problems in a tender, supply, prescription and use of drugs for the treatment of human disease.
4. patient base, responsible for healing: a) list building smoking, smoking, smoking units in use by the base doctor, cure yourself prepared, send social insurance organizations as the basis for payment according to the model in annex 1 attached to this circular. Case of need changes or additions to the category, the base doctor, cure has additional responsibilities as stipulated in paragraph 3 article 4;
b) management, supply and use of drugs under the current rules, ensure adequate drug supply, timely, properly regulated, to meet the needs of the treatment of sick people have medical insurance card under the category have built, not to sick people to buy drugs. The tender to buy drugs made under the provisions of the law of tenders;
c) comply with the rules on prescription drug, specified using the medication as prescribed, of secure, affordable, efficient, economical and quality assurance of drugs, the drugs used in the unit; make judgments when used for smoking regulations in point c Paragraph 2 of article 3;
d) case should propose to modify, remove or supplement pills, the new drug on the formulary in the scope of payment of the health insurance fund, the base doctor, cure has suggested text according to the model in Appendix 2 and Appendix 3 attached to this circular posted on the Ministry of health or the Department of health of the province of the central cities, to General sent the Ministry of health.
5. social insurance in the province, central cities are responsible for: a) in collaboration with the medical facility and treatment in the construction of the formulary, medication, smoking by the base doctor, cure yourself manufactures are paying medical insurance funds;
b) coordinate and unify with the base doctor, cure made payments to the contents specified in article 5 of this circular.
Article 7. Transitional provisions and terms of reference 1. Cases of sick people have medical insurance card to the front of this circular effect but is still being treated at the base hospital, healing from May 1, 2015 shall follow the provisions of circular No. 12/2009/TT-BYT on April 29, 2010 Ministry of health until the patient discharge.
2. for smoking, the smoking in the scope of payment of medical insurance fund in accordance with circular No. 12/2009/TT-BYT on April 29, 2010, the health insurance fund to continue payments until the use of the drug has hit the bid under bidding results of drug supply and has been the basis of consultation , healing supply contract with the contractor before the date this circular effect.
3. for smoking in the scope of payment of medical insurance fund in accordance with circular No. 12/2009/TT-BYT on 29th April 2010 but the specified limits specified in this circular, the health insurance fund to the payment according to the conditions specified in this circular since May 1, 2015 except where the provisions of Paragraph 1 of this article.
4. With regard to the drug use scale, at the base hospital, treatment and medications by medical establishments, healing itself, the health insurance fund payments as defined in article 5 of this circular since the day this circular effect.
Article 8. Effect 1. This circular is effective from October 1, 2015.
2. Circular No. 12/2009/TT-BYT on April 29, 2010 by the Minister of Health issued traditional medicine formulary is primarily used in the clinical facility expired from the date of this circular effect.
In the process of implementation, if there are difficult obstacles suggest that these units reflect on the Department of health (health insurance) to consider and resolve.