Principles for Health Insurance Medication Cost Payment

To be specific, Circular 30 stipulates that when paying for drug costs, the following principles must be adhered to:

The health insurance fund pays for drug costs based on the actual quantity used by patients and the purchase price of the medical examination and treatment facility in accordance with the law on drug procurement bidding, consistent with the scope of benefits and levels of coverage as prescribed by the Health Insurance Law and its guiding documents.

The health insurance fund pays in cases where the prescription of drugs aligns with the indications in the drug usage instructions accompanying the drug registration dossier approved by the Ministry of Health, or with the diagnosis and treatment guidelines of the Ministry of Health. In cases where there are no indications in the drug usage instructions accompanying the drug registration dossier approved by the Ministry of Health, and not included in the diagnosis and treatment guidelines of the Ministry of Health but are necessary for treatment, the Ministry of Health will establish a council to review each specific case.

The health insurance fund pays for drugs, or batches of drugs, that have been decided to be suspended from circulation and recalled as per the guidelines of the Ministry of Health.

Please note, the health insurance fund does not pay in the following cases:

- Costs for drugs that have been included in the pricing of technical services, medical examinations, hospital bed days, or package prices per case according to current regulations;- The portion of drug costs that have been paid by the state budget or other sources;- Drugs used in clinical trials and scientific research.

See details in Circular 30/2018/TT-BYT effective from January 01, 2019.

-Thao Uyen-

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