Advanced Search

Circular 40/2014/tt-Byt: Issued And Implementation Guides List Medicine Department In The Scope Of Payment Of Medical Insurance Fund

Original Language Title: Thông tư 40/2014/TT-BYT: Ban hành và hướng dẫn thực hiện Danh mục thuốc tân dược thuộc phạm vi thanh toán của quỹ bảo hiểm y tế

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now for only USD$40 per month.
Number: 40 /2014/TT-BYT
Hanoi, November 17, 2014


Issued and guided by the Catalogue of the Pharmacy

of the payment range of the health insurance fund


The National Health Insurance Act. 25 /2008/QH12 November 14, 2008 and The amended law, which adds some of the provisions of the Digital Health Insurance Act 46 /2014/QH13 June 13, 2014;

Base. Protocol. number 63 /2012/NĐ-CP August 31, 2012 of Government q He is function, mandate, authority and organizational structure of the Ministry of Health. ()

Base of Protocol 105 /2014/ND-CP November 15, 2014 of the Government rules the details and guidelines for the implementation of some of the provisions of the Health Insurance Law;

The Minister of Health issued the Department of Health issued and guided the implementation of the portfolio of pharmaceuticals within the payment range of the health insurance fund.

What? 1. New drug catalog

1. This was issued by the Executive Board of the Health Insurance Fund, 845 active, 1064 prescriptions; 57 radiation and marking compounds.

2. The portfolio of new drug-issued pharmaceuticals is the basis for the health insurance fund to pay the cost of medication used to the person with a health insurance card at the facilities of the disease, healing.

What? 2. Drug catalog structure and usage rank

1. New drug catalog:

a) The drugs or activity are arranged in 27 large groups, according to the ATC code (anatomy, treatment, chemistry). Some drugs or operations have multiple ATC codes, many different designation assigned to a group that are most suitable for limiting the overlap;

b) The name of the drug or activity is inscribed in the same international name and by the regulation of the Vietnamese National Pharmacy, which only records the uses, the form, and does not score.

2. The line of the medication written in the category is united as follows:

a) The drink includes the medicines, aquifers, chewing, under the tongue;

b) The injection line consists of injection of the muscles, injections in the skin, injections in the skin, intravenous injection, intravenous injection, intraocular injection, injection of the eye, injection into the body's chambers;

c) The external external line includes the lubrication, external massage, skin paste, skin spray;

d) The set path includes the vaginal injection, which places the anus, colon-rectal indentation;

) The respiratory line consists of blind spraying, inhalation, powder, spray, gas;

e) The eye line consists of small, eye-eye medications.

3. Medication, which is active in the category of new drug drugs used at the clinics, treating disease according to the hospital classification, namely:

a) Special Class Hospital and Class I use the prescribed drugs at column 5;

b) Class II hospital uses prescribed drugs at column 6;

c) A Class III and IV hospital, including a multi-faculties clinic belonging to a multi-faculties hospital or district health center, district, town, city using prescribed medicines at column 7;

d) The disease examination facility, healing is the township medical station, ward, town and the equivalent of using prescribed medicines at column 8;

For an examination facility, the treatment contracted for medical treatment, medical health insurance, but not a hospital ranking: Professional capacity, medical equipment, and technical services portfolio have been granted approved by the authority, the Department of Health. In coordination with the social insurance organization to unify, decide on the drug use of the disease facility, cure the disease according to the appropriate hospital class on the basis equivalent to the basis of the disease, the treatment of the state.

4. Catalogue of the radiotherapy and marking compound inscribed in the international common name, not according to the hospital classification and is used only at nuclear medicine facilities, oncologist, oncology center, nuclear medicine department, oncologist, or radiotherapy. in other multi-faculties or specialty hospitals.

What? 3. Build a portfolio of drugs within the payment range of the health insurance fund used at the medical examination facility, healing.

1. The drug portfolio and hospital distribution use regulation in this privacy; the hospital class base is approved by the authority; the need for treatment and the ability to pay the health insurance fund, the medical examination facility, the treatment of the medical portfolio. use in the unit for procurement by the rule of law on bidding.

2. The selection of food drugs for procurement, which uses the pathogen in principle: preselection of generic drugs, monoclinic drugs, domestic production drugs.

What? 4. The general principle of payment of drug costs on patients with a health insurance card

1. The health insurance fund payments the drug costs according to the actual number used for the sick person and the purchase price of the medical examination facility, the treatment under the law of the bid to purchase the drug, in accordance with the scope of the rights and the degree of Law. Health Insurance, The Amendment Law, which complements some of the provisions of the Health Insurance Law and the Conducting Instructions.

2. The health insurance fund does not pay for the cases:

a) The cost of the drugs has been incorporated into the price of the technical service, the value of the treatment bed (e.g., the anesthesia, anesthesia, transmission used in surgery, procedure, or phototherapy used in the diagnosis of imaging, disinfides, and murder). Bacteria) or the price to collect the package according to the current procedure;

b) The cost of the medicines in the catalogue has been paid by the state budget;

c) The drug is in the category of use in clinical trials, scientific research;

d) The drugs, the batch of drugs made a decision to suspend the circulation and recall of the competent organ;

The use of the drug is not consistent with the registered designation in the approved drug registry.

What? 5. Payment Regulation for certain medications

1. Other forms of chemical assimilation or other forms of salt in the category of medications are paid by the health insurance fund if they have the same treatment as a chemical or drug name in the category of medications.

2. The drug assigned this group to treat other group condition is paid by the health insurance fund if indicated as registered in the approved drug registry.

3. Some medicines have rules, the payment rate is regulated by the health insurance fund prescribed in column 9 of the drug portfolio and by the general principle stipulated at 1 Article 4 of this.

4. The medication that coordinates many of the activities that this coordination is not yet specified in the category is paid by the health insurance fund if the activities are all in the category as a unit (minus vitamins and minerals) and have the same uses as prescribed. This is two of these two things. The combination drugs are selected to ensure the principle of safe, effective and consistent use of the health insurance fund.

It is the case of a combination of compounds that are used by various hospital-class activities, which are used in the highest hospital class. The case of a combination of compounds with a different payment ratio is proportional to the rate of the activity that has the lowest rate of payment.

5. The case according to the specialized designation, the sick person only uses a portion of the drug in the smallest packaging unit (e.g., the pediatric medication, the oncologist) and the remaining amount of drugs cannot be used (e.g., no patients). With the same designation, the remaining amount of medicine is not enough doable, too late for the maintenance of the drug, and the health insurance fund is at the cost of the smallest packaging unit.

6. The drugs with the sign sign (*) are the medication used only when other medications in the treatment group are not effective and must be given prior to use. The emergency must be the slog on the next day of work.

7. For the drugs in the cancer treatment group:

a) Only the use of cancer treatment at the clinics, healing has cancer treatment functions (including the cancer basis, blood transfusion and nuclear medicine; the department, the oncologist, blood transfusion, and nuclear medicine in the institute, the hospital.) scientific or polyscientific, and is required by a doctor to receive a certificate of practice, a professional activity of cancer or blood transfusion of blood;

b) The case of using treatment for other diseases is not cancer:

The Health Insurance Fund is in accordance with the diagnosis and treatment of the Ministry of Health or of the hospital. In the absence of diagnostic guidance and treatment, we have to consult with the oncologist. There is no diagnostic and treatment manual and no oncologist is required to be investigated under the chairperson of the hospital leadership prior to the designation of use (except for non-consult with the oncologist recorded in column 9).

8. The case of a medical examination, the treatment of the disease that is done by the higher-line technical services according to the technical professional route is used by the prescribed drug-based drugs for the higher line, in accordance with the technical service that has been granted. The authority to approve. The clinic, cure for synthetic disease, sends a portfolio of drugs to the social insurance organization to do a payment basis.

9. The drugs due to the basis of the disease, cure for self-defense according to the prescribed health insurance fund when used at the clinic, cure it. The price of the drug to pay is to be built on a product-valued basis by the director of the hospital after its reunification with the social insurance organization and is accountable to the law.

What? 6. Organization to execute

1. The Ministry of Health is responsible:

a) Command, guide, test, inspector for the construction of the drug portfolio,

bidding for drug purchases, management, use, payment of the drug costs of the medical examination facilities, healing;

b) presided, in coordination with relevant agencies addressing the entanging in the course of execution;

c) Chair, in collaboration with the relevant relevant agency, adjust, modify, add the portfolio of the issued drug attached to this Smart 02 year periodically in response to the treatment needs and in accordance with the payment capacity of the health insurance fund.

2. Vietnam Social Insurance has a responsibility:

a) Do, direct the social insurance of the provinces, the central city, in coordination with the Department of Health and the clinic, cure the disease in the organization of the implementation, payment of the cost of medicines in accordance with the provisions of this and the law of law. The other law is relevant;

b) Coordinate with the associated authorities involved in the organizational process.

3. The Department of Health of the Provinces, the central central city is responsible:

a) Implemencing, directing, instructs, inspectors, examination of the portfolio of drugs, bidding for drug purchases, management, use and payment of the drug costs of the medical examination facilities, healing according to jurisdiction;

b) The construction guide and approval of the catalogue of medications used at the clinic do not have a doctor and Medical Station, ward, town on the prescribed management site.

4. The basis of the disease, healing is responsible:

a) Build a portfolio of medications used in the unit, including those used to carry out higher-line engineering services according to technical specialization, drug-based medicine, self-defense treatment;

b) The full, timely, right Supply, which meets the treatment needs of the medical insurance person according to the name of the drug that has been built, does not allow the sick to buy itself. The basis of the disease, healing of the social insurance organization results in the drug bid results; the portfolio of a specific product medication used at the facility of the disease, healing included: medications are used to carry out, the drug used to carry out the technical services of the line. Higher in terms of technical expertise and medications due to the basis of disease, the treatment of self-defense according to the Appendix 01 issued this message to the basis of payment;

c) Management of prescribation, specifies the use of prescribed medication, assurance of safety, rationalization, savings, and maintenance of the quality of the drug used at the unit; perform the procedure when used for the prescribed (*) signs of a specialized practice; The synthesis of payments in time, the right kind, the right quantity and the right price;

d) Make sure the existing regulations on management, use of drugs and full compliance with the laws of safety and radiation control in management, supply and use and for the radiation and compound drugs, respectively;

The case needs to change or add drugs to the category of medication used in the unit, the medical examination facility, the treatment for the construction of the list of modified drugs, the addition, sending the social insurance organization to the base of the payment;

e) The case needs to propose a revision, remove or add new drug to the prescribed drug portfolio at this Smart, which is suitable for the actual situation, responding to the patient ' s treatment requirements, the medical examination facilities, the treatment that has a sample offer text at Appendix. The number 02 issued by this Privacy, sent to the Ministry of Health (Health Insurance) or the Department of Health of the Provinces, the central city to sum up the Ministry of Health.

What? 7. The transition rule and the reference clause

1. The case of patients with a medical insurance card to the institute before this date is effective but is also being treated at a medical examination facility, treating the disease according to regulation at Digital Notice. 31 /2011/TT-BYT July 11, 2011 and Digital News 10 /2012/TT-BYT June 8, 2012 amendment, adds some of the provisions of the Digital Information 31 /2011/TT-BYT July 11, 2011 until the hospital was released.

2. For the drugs included in the issued category accompanied by Digital Notice 31 /2011/TT-BYT July 11, 2011 and Digital News 10 /2012/TT-BYT June 8, 2012 amendment, adds some of the provisions of the Digital Information 31 /2011/TT-BYT July 11, 2011 without in the category of payment of the medical insurance fund issued under this Notice, the health insurance fund continues to pay until the use of the number of drugs has been contracted according to the result of the supply bid results. medication and has been given the basis of the disease, treating the contracting contract with the contractor prior to this date ' s effective date.

3. For the drugs included in the category issued by Digital Notice 31 /2011/TT-BYT July 11, 2011 but conditional on the condition, the payment rate at this rate, the health insurance fund, according to the condition, the rate of regulation at the same level since 1 January 2015 (except for the specified case at 1 Article).

What? 8. Effect of execution

1. This message has been in effect since 1 January 2015.

2. Digital News 31 /2011/TT-BYT July 11, 2011 issued and guided the category for the cure for the disease primarily used at the clinics, the treatment of the health insurance fund and the Digital Health Insurance Fund. 10 /2012/TT-BYT June 8, 2012 amendment, adds some of the provisions of the Digital Information 31 /2011/TT-BYT July 11, 2011 expires since the date of this date is valid.

In the course of the organization, if there is a difficulty in the request for the Ministry of Health to review the Ministry of Health (Health Insurance) for consideration, the ./.



Nguyen Thi