The Ministry of Health has issued a new circular supplementing regulations on guidance for drug payment, eliminating the classification of drug lists based on hospital grades to ensure fairness in access to health insurance-covered drugs.
On the morning of November 19, leaders from the Health Insurance Department (Ministry of Health) stated that the drug payment list and regulations for health insurance reimbursement are currently governed by Circular No. 20/2022. According to the Ministry of Health, after nearly two years of implementation, this circular has revealed several issues requiring amendments, supplements, and adjustments to align with practical needs.
To address these challenges, the Ministry of Health issued Circular No. 37/2024, which will take effect in 2025, introducing several new regulations aimed at easing difficulties for hospitals and facilitating convenience for patients.
A notable change in Circular 37 is the restructuring of the drug and biologic lists by removing columns that classify hospital grades for drug usage.
Previously, drugs eligible for use and health insurance payment at medical facilities were categorized based on hospital grades, including Special-grade hospitals (such as Bach Mai, Viet Duc Friendship, Cho Ray, and Hue Central Hospital), Grade I (usually central or provincial hospitals), Grades II, III, and IV, and professional-technical levels including central, provincial, district, and commune levels.
The Health Insurance Department acknowledges that removing the classification of drug lists based on hospital grades offers several advantages. Specifically, medical facilities can utilize the entire list of drugs in line with their scope of professional activities, diagnostic guidelines, and treatment protocols, without being restricted by hospital grade or technical expertise level.
This regulation also helps reduce the tendency of patients to seek treatment at higher-level facilities, thereby alleviating overcrowding at these institutions.
The circular introduces new provisions for drug payment guidance, such as payment regulations for drugs at commune health stations. This aims to enhance drug accessibility for patients with chronic diseases managed and treated at these stations.
Additionally, there are regulations for the payment of chronic disease medications for patients undergoing inpatient treatment for other conditions. These ensure continuous access to medication and protect the health insurance payment rights of participants.
Furthermore, the circular includes payment provisions for drugs under special circumstances, providing flexibility in situations such as natural disasters, wars, or catastrophes.
The Ministry of Health assesses that the new regulations in Circular 37 enhance the scope of cases covered by health insurance funds, improving access to medication, and introducing flexibility in payment guidance for patients. These changes also enable medical facilities to cover drug costs that were previously ineligible for reimbursement due to the lack of specific guidelines.
Related
Source: Vietnam Insider