Circular 31/2011/tt-Byt: Enacting And Implementing Formulary Guide Is Mainly Used In The Base Doctor, Cure Is A Medical Insurance Fund Payments

Original Language Title: Thông tư 31/2011/TT-BYT: Ban hành và hướng dẫn thực hiện Danh mục thuốc chủ yếu sử dụng tại các cơ sở khám bệnh, chữa bệnh được quỹ bảo hiểm y tế thanh toán

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Pursuant to the law examinations, cure on November 23, 2009;

Pharmaceutical Law base on June 14, 2005; Decree No. 79/2006/ND-CP dated 9 August 2006 from the Government detailing the implementation of a number of articles of the law on Pharmaceuticals;

Pursuant to the law on health insurance, November 14, 2008; Decree No. 62/2009/ND-CP dated July 27, 2009 by the Government detailing and guiding the implementation of some articles of the law on health insurance;

Pursuant to Decree No. 188/2007/ND-CP on December 27, 2007 of the Government functions, tasks, powers and organizational structure of the Ministry of health;

Base circular No. 03/2009/TTLT-BYT-BTC on August 14, 2009 by the Union Health Ministry-the Ministry of Finance shall guide the implementation of health insurance;

The Ministry of Health issued guidelines and formulary is primarily used in the base doctor, healing is the payment of health insurance fund (hereinafter list of medicines) as follows: article 1. Drug indexes issued attached to this circular "formulary is primarily used in the base doctor, cure is a medical insurance fund payments" includes: 1. list of medicine.

2. list of radioactive drugs and compounds.

Article 2. Directory structure 1. Directory of Medicine: a) the formulary includes 900 drugs or active ingredient, sorted by code ATC (anatomical, therapeutic, chemical); recorded under the name international public and in accordance with the Vietnam national mail Pharmacy. For active substances have many ATC code or have many different specified will be sorted into a group match to limit the repetition.

b) formulary has 8 columns are as follows:-column 1 write order number: number the drug name or active ingredient;

-Column 2 record number of smoking, active ingredient list;

-Column 3 write the name of medication, the active ingredient;

-Column 4 write the road user, the form used;

-Column 5 of use for hospitals and special class I;

-Column 6 rules of use for class II hospital;

-Column 7 of use for class III and class IV hospital;

-Column 8 terms of use for clinics and other medical facilities.

2. list of radioactive drugs and the marked compounds including 57 active substances, recorded under the name international, arranged alphabetical order A, B, C, ... and have 5 columns are as follows:-column 1 write the number of the order;

-Column 2 write the name of radioactive drugs and the marked compounds;

-Column 3 write the road;

-Column 4 write formats used;

-Column 5 unit records.

Article 3. Formulary manuals 1. Medicine a) using prescribed class hospitals, specialty drug is used according to the decentralized management and medical engineering practice;

b) the pills with the symbol (*) is possible, limit the use, used only when other medications in the treatment group had no effect and must be consultations (except emergencies);

c) Smoking is rated the group used in treatment of the other group are the health insurance fund payments if indicated as registered in the drug registration documents have been issued;

d) drugs in the treatment of cancer and immune-regulator:-for the only drug indicated for the treatment of cancer, including smoking in addition to the category specified by the Ministry of health: only to be used in the base doctor, cure has the function of cancer treatment and to doctor training , training on specialized cancer specified;

-For the medication indicated for the treatment of diseases other than cancer that is used in hospitals or clinical science other than Oncology under hospital treatment but to have consultations with the cancer specialist to ensure the safe and effective treatment.

DD) specific treatment medications leprosy, epilepsy, mental list of drugs issued herewith but are programs, then use project under the guidance of the program or project.

2. radioactive Drugs and compounds marked list to special control so the supply, use and manage to follow the right rules, regulation of Pharmaceuticals and are in full compliance with the provisions of the law on safety and radiation control.

Article 4. Build the list of drugs used in the base doctor, cure 1. Pursuant to the provisions in article 2, article 3 of this circular; the technical divide, base models of diseases and expense of hospitals, Hospital Director directs the Council and building drug treatment used in unit and organizational plans providing drug treatment needs, according to the provisions of the law on tender procurement of drugs. The Director of the Department of health directed the construction and regulation of drug categories used for communal clinics.

2. The selection of drug products according to the following principles: the priority choice of generic medicine, drug, drug substance manufacturing unit in the country, the drug of the pharmaceutical business of standard drug good manufacturing practices (GMP).

3. The base doctor, cure has the responsibility of ensuring the supply of medicines in full, timely, not to the patient himself buy, including cancer treatment drugs, anti graft waste list but are paying medical insurance fund according to the regulations.

Article 5. The payment of the cost of medication for people with the disease 1. For the category medicine: a drug Name) recorded in the Catalog under a chemical form that are the Foundation of health insurance payments for the chemical form of the drug if the have the same therapeutic effect;

b) is paid if it meets the road user, the form used in the catalog record. These drugs are used as shut up, chewing, placed under the tongue to be the health insurance fund payments as with smoking have used "drink"; These drugs are used as topical, external, massage paste as payment for drugs is "taking apart"; These drugs are used such as intramuscular, subcutaneous injection, injecting in the skin, intravenous injection, intravenous infusion, injection into the joint drive, injected into the cavity of the body as payment for drugs have used "injected".

c) are coordinating much of the active ingredient that this coordination has not been specified in the health insurance fund shall be paid if the active ingredients are in the categories below as appropriate, and on the road, hospital ratings are used (not applicable to the Group of medicines is a mixture of many vitamins);

d) where the hospital perform the technical services of the higher class hospital by online technical expertise by the competent bodies for approval, used the pills prescribed for that class's Hospital.

2. The specialist drugs concocted by the hospital to ensure the prescribed quality. Drug prices are paying medical insurance fund on the basis of product due to the Director of the hospital regulations and responsible before the law.

3. With respect to the base doctor, healing beyond the establishment, pursuant to the technical services are approved by the competent authority, list building and unity with the social insurance agency for payment of the costs of medicines for the sick medical insurance according to regulations.

4. The cost of medicines has been included in the cost of technical services (for example the anesthesia, anesthesia, infusions used in surgery, procedure or medication interfere in optical imaging) are not paid more. The smoking in the Group XV-bleach coincide and be paid in the price and technical services on the bed, not to be split off to a separate payment.

5. where the prescribed professional, the patient only uses a portion of the amount of the drug in the smallest packaging unit (for example the drug for Pediatric specialist, specializing in cancer) and the amount of the remaining medicines can't be used (e.g. no sick people, not enough doses of the drug, the drug's shelf) the health insurance fund, was the full payment by the smallest packaging unit.

6. The Fund for health insurance only pay for some drugs with the following specific treatment: a) Interferon and hepatitis C therapy peginterferon according to Protocol.

b) Rituximab treatment of Hodgkin Lymphoma B cell, CD20-positive there.

c) Has kidney cancer, liver cancer progression;

d) Cerebrolysin, citicolin ear treatment of acute phase cerebral, cranial trauma;

DD) treatment of Nimodipin meningeal hemorrhage caused by aneurysm or brain injury.

Article 6. The sequence, procedure suggest additions, edits, edit the list of drugs 1. Annually, based on the treatment needs, medical facilities, the proposed cure supplement, modify or edit the formulary to suit the actual situation according to the objectives, the following principles: a) target:-ensuring safe medication use, logical, efficient;

-To meet the needs of the treatment for the patient;

-Ensuring the benefits of medicines for sick people join health insurance;

-Fit the economic capabilities of the patient and the affordability of health insurance fund.

b) principles:-recommended Drugs added to the formulary based on the essential drugs list of Vietnam and the World Health Organization;

-Effective in treatment;

-Does the proposal put to the list of drugs is in an advised use of World Health Organization, the Ministry of health or drug and has many side effects;

-Smoking supplement, modify or edit to do drugs and treatment of the hospital proposal.

2. The base doctor, cure has suggested (according to model annex attached to this circular) sent to the Ministry of health (Department of management treatment) or the Health Department of the province, central cities, health sectors to be reviewed or recommended consideration of amendments supplement or correction.

Article 7. Responsibility 1. The list is attached to this circular is the base to the base doctor, cure options, guaranteed payment and treatment needs of medicines for patients.

2. the social insurance agency and patient base, healing is responsible for payment of the drug for the patient have medical insurance card under the provisions of this circular.

Article 8. Enforceable

This circular has effect from the date of 25/8/2011. Abolish the category medicine, drug formulary and radioactive substances marks and manuals listing medicines mainly use in the base doctor, cure attached to decision No. 05/2008/QD-BYT October 2, 2008 by the Minister of health on issuing drug primarily used in medical institutions , healing. Abolish circular No. 03/2009/TT-BYT on 15th January 2010 in the Minister of Health issued the list of additional medication use for children under 6 years of age in the range of payment of the health insurance fund.

In the process of implementation, if there are difficult obstacles suggest that these units reflect on the Health Ministry to consider, resolve./.