Conditions for direct payment of costs of medicines and medical devices for patients covered by health insurance in Vietnam

Conditions for direct payment of costs of medicines and medical devices for patients covered by health insurance in Vietnam

At the time of prescribing medication or indicating the use of medical device, the following conditions must be ensured according to regulations:

- There are no drugs or medical devices available as they are in the process of contractor selection according to the approved contractor selection plan, in one of the following forms: Open tendering, restricted tendering, competitive bidding, direct procurement, selection in special cases where a contractor has not been selected, online bidding, or online procurement, and simplified bidding procedure has been carried out according to the provisions at point c, clause 1, clause 2 Article 23 of the Law on Bidding 2023 and clause 1 Article 94 of Decree 24/2024/ND-CP detailing provisions and measures for implementation of the Law on Bidding 2023 on contractor selection but have not been able to select a contractor.

Simultaneously, at the medical examination and treatment facility in Vietnam:

+ For drugs: There are no commercial drugs containing the active ingredient prescribed to the patient or with the same active ingredient but different concentrations or dosages or forms of preparation or routes of administration and cannot be replaced to prescribe to the patient;

+ For medical devices: There is no medical device that the patient is indicated to use and no medical device available for replacement.

- The patient is not transferred to another medical examination and treatment facility in any of the following cases:

+ The health status and pathology of the patient are determined to be not suitable for transfer;

+ The medical examination and treatment facility where the patient is being treated is under medical quarantine as per legal regulations on infectious disease prevention and control;

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

- Drugs and medical devices cannot be transferred between medical examination and treatment facilities according to legal regulations in Vietnam.

- The drugs and medical devices prescribed, indicated for use must fit the professional scope of the medical examination and treatment facility and the costs have been covered by health insurance at one of the medical examination and treatment facilities nationwide.

- The drugs and medical devices prescribed, indicated for use must be within the benefits scope of the health insurance participant.

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

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