Herbal Medicines Produced by Medical Examination and Treatment Facilities: How to Settle Payments?

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For traditional medicine, medicines from medicinal materials, and traditional medicinal herbs prepared by medical examination and treatment facilities themselves, these medicinal herbs must first be included in the List of Traditional Medicinal Herbs issued attached to Circular 05/2015/BYT.

The health insurance fund pays based on the product cost, including: costs of materials for making medicine, depreciation costs as regulated by the Ministry of Health, packaging costs, processing costs including electricity, water, fuel, and other costs including excipients, auxiliary materials for making medicine, quality control costs (packaging, raw auxiliary materials, semi-finished products, and finished products);

The head of the medical examination and treatment facility is responsible for approving the production process, quality standards, and the price of medicines prepared by the facility, in agreement with the social insurance organization as a basis for payment.

For medicinal herbs, decoction drugs, and medicines prepared by medical examination and treatment facilities: In cases where there are additional costs beyond the regulations in Clauses 2, 3, and 4 of Article 5, the medical examination and treatment facility will prepare a detailed explanatory report to agree with the social insurance organization as a payment basis. In cases where the medical examination and treatment facility cannot reach an agreement with the social insurance organization, medical examination and treatment facilities under the Ministry or Sector report to the Ministry of Health, medical examination and treatment facilities under the Department of Health report to the Department of Health for consideration and resolution.

Note: The health insurance fund does not pay for cases where medicines and medicinal herbs have already been paid for by the state budget.

Details can be found in Circular 05/2015/BYT effective from May 1, 2015.

Thu Ba

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