Conditions for direct payment of medicines and medical devices to individuals covered by health insurance in Vietnam

Conditions for direct payment of medicines and medical devices to individuals covered by health insurance in Vietnam (Image from the internet)

On October 18, 2024, the Minister of Health issued Circular 22/2024/TT-BYT stipulating the direct payment of medicines and medical devices to individuals covered by health insurance in Vietnam.

Conditions for direct payment of medicines and medical devices to individuals covered by health insurance in Vietnam

At the time of prescribing medicines and medical devices in Vietnam must ensure the following conditions as stipulated:

- The absence of drugs or medical equipment due to ongoing contractor selection according to the approved contractor selection plan in one of the following forms: open bidding, restricted bidding, competitive offer, direct purchase, or contractor selection in special cases. However, the contractor has not yet been chosen, or online pricing or online purchasing has been performed, and a streamlined contractor designation has been implemented as per Point c, Clause 1, Clause 2 of Article 23 Law on Bidding 2023 and Clause 1, Article 94 of Decree 24/2024/ND-CP. Simultaneously, at the medical examination and treatment facility:

+ For drugs: There are no commercial drugs containing the active ingredient prescribed to the patient or with the same active ingredient but of different concentrations, dosages, formulations, or administration routes and cannot be replaced for the patient's prescription;

+ For medical equipment: There is no medical equipment as prescribed for the patient, and there is no replacement medical equipment available.

- Patients are not transferred to another medical facility in the following cases:

+ The patient's health condition and illness have been determined not to meet the criteria for transfer;

+ The medical facility where the patient is being examined and treated is in a period of medical quarantine according to law on infectious disease prevention and control;

+ The medical facility where the patient is being examined and treated is a specialized medical facility.

- Drugs and medical equipment cannot be transferred between medical facilities as per legal regulations.

- Prescribed drugs and medical equipment must match the professional scope of the medical facility and have been covered for medical examination and treatment fees under health insurance at one of the medical facilities nationwide.

- Prescribed drugs and medical equipment must fall within the benefits of health insurance participants.

Direct payment amounts for holders of health insurance cards in Vietnam

- The social insurance agency shall directly reimburse the patient according to these rules:

+ For drugs: The basis for calculating the payment amount is the quantity and unit price recorded on the invoice purchased by the patient at authorized business establishments. If the drug has specific payment rate regulations, follow those rates and conditions;

+ For medical equipment (including reusable medical equipment): The basis for calculating the payment amount is the quantity and unit price recorded on the invoice from the medical equipment sales facility. If the medical equipment has a specified payment limit, it must adhere to the regulations for that equipment.

- The unit price of drugs and medical equipment used as the basis for determining the payment amount must not exceed the payment price at the most recent time for drugs and medical equipment that were successfully bid at the medical facility where the patient was treated.

If the drugs or medical equipment have not yet been successfully bid at the treatment facility, the unit price used to determine the health insurance payment shall follow the effective contractor selection results according to the following priority order:

+ National centralized procurement or pricing negotiation results;

+ Local centralized procurement results within the area;

+ Lowest contractor selection results at the time of payment by public specialized, basic medical facilities, or facilities with the same professional level within the area;

+ Lowest contractor selection results at the time of payment by public specialized, basic medical facilities, or facilities with the same professional level in Hanoi city, Ho Chi Minh city.

- The social insurance agency shall deduct the health insurance payment costs of the treatment facility as follows:

+ If drug and medical equipment costs are included in the medical service price: deductions are made from the health insurance medical service costs at the facility according to above payment rates;

+ If the costs of drugs and medical equipment are not included in the structure of the medical service price: no deductions from the health insurance medical service costs at the facility;

+ The cost of drugs and medical equipment directly reimbursed by the social insurance agency is included in the planned expenses of the medical facility.

More details can be found in Circular 22/2024/TT-BYT which comes into force in Vietnam fromJanuary 1, 2025.

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