Thông tư 27/2020/TT-BYT sửa đổi Điều 5 Thông tư 05/2015/TT-BYT về Danh mục thuốc đông y, thuốc từ dược liệu và vị thuốc y học cổ truyền thuộc phạm vi thanh toán của quỹ bảo hiểm y tế do Bộ trưởng Bộ Y tế ban hành

CIRCULAR

ON AMENDMENTS TO ARTICLE 5 OF CIRCULAR 05/2015/TT-BYT DATED MARCH 17, 2015 OF THE MINISTER OF HEALTH ON PROMULGATION OF LIST OF ORIENTAL MEDICINES, HERBAL MEDICINES AND TRADITIONAL INGREDIENTS COVERED BY HEALTH INSURANCE

Pursuant to the Law on Health insurance dated November 14, 2008, amending the Law on Health insurance dated June 13, 2014;

Pursuant to the Government’s Decree No. 146/2018/ND-CP dated October 17, 2018 elaborating and providing guidelines for the Law on Health insurance;

Pursuant to the Government’s Decree No. 75/2017/ND-CP dated June 20, 2017 defining the functions, tasks, entitlements and organizational structure of the Ministry of Health;

At the request of Director of Department of Health insurance,

The Minister of Health issues a Circular on amendments to Article 5 of Circular No. 05/2015/TT-BYT dated March 17, 2015 of the Minister of Health on promulgation of List of oriental medicines, herbal medicines and traditional ingredients covered by health insurance.

Article 1. Amendments to Article 5 of Circular 05/2015/TT-BYT dated March 17, 2015 of the Minister of Health on promulgation of List of oriental medicines, herbal medicines, and traditional ingredients covered by health insurance as follows:

“Article 5. Covering costs of medicines, ingredients; herbal remedies used in health facilities and self-prepared medicines of heath facilities

1. General rules: General rules: Health insurance fund shall pay for costs of medicines, ingredients and self-prepared medicines of health facilities according to the use quantity and buying prices of the health facility in accordance with regulations of law on procurement, wastage costs as prescribed by the Minister of Health and other costs (if any), in order to ensure the benefits of patients and level of costs covered by the health insurance prescribed by the Law on Health insurance and its guiding documents.

2. For ingredients:

a) If the health facility buys herbal ingredients to process and prepare ingredients, the health insurance fund shall pay the herbal ingredient costs according to the buying prices of the health facility and the following costs:

- Wastage cost during process of processing, storage, weighing and splitting (if any);

- Cost of medicinal additives;

- Cost of processing and preparation, including power, water, and fuel;

- Packaging cost (if any);

- Labor cost;

- Administration cost and depreciation cost;

b) If the health facility buys ingredients from the providers, the health insurance fund shall pay the buying prices thereof plus wastage cost during the storage and weighing and splitting (if any).

3. For oriental medicines whose ingredients specified in the List of ingredients issued together with this Circular: Health insurance fund shall pay the following costs: 

a) Costs of ingredients as prescribed in Clause 2 of this Article;

b) Decoction cost when the health facility performs decoction at premises for inpatients and outpatients as prescribed in the Circular No. 13/2019/TT-BYT dated July 5, 2019 of the Minister of Health on amendments to Circular No. 39/2018/TT-BYT of November 30, 2018 of the Minister of Health on the unified prices of health insurance-covered medical care services among hospitals of the same rank nationwide and guidelines for the application of prices and payment of health insurance-covered medical costs in certain cases;

c) Packaging cost (if any) if the health facility does not perform the decoction for patients.

4. For self-prepared medicines of health facilities:

a) The health insurance fund covers prime costs of medicines, including:

- Cost of herbal ingredients according to buying prices of the health facility or cost of ingredients as prescribed in clause 2 hereof. Herbal ingredients, ingredients in the medicines must be specified in the List of traditional ingredients issued together with this Circular;

- Wastage cost (if any);

- Cost of excipients, medicinal additives;

- Cost of processing and preparation, including power, water, and fuel;

- Packaging cost;

- Cost of materials, chemicals, ancillary materials for quality control before testing as prescribed in Circular No. 13/2018/TT-BYT dated May 15, 2018 of the Minister of Health on quality of herbal ingredients, traditional medicines (if any);

- Cost of testing as prescribed in Circular No. 13/2018/TT-BYT dated May 15, 2018 of the Minister of Health on quality of herbal ingredients, traditional medicines;

- Labor cost;

- Administration cost and depreciation cost;

b) The head of each heath facility shall approve manufacturing process, quality standards, and prices of their self-prepared medicines, and then concur with the social security authority with which the health facility enters into a health insurance-covered healthcare contract in use of them as the basis for payment.

5. As for administration and depreciation costs as prescribed in point a clause 2 and point b clause 4 hereof, the health insurance fund shall cover them according to predetermined roadmap for adjustments to constituents of prices of insurance-covered healthcare services and to be applied concurrently with prices of insurance-covered healthcare services between the same-rank hospitals nationwide regulated by the Ministry of Health.

6. In case of accrued expenses not mentioned in clauses 2, 3 and 4 hereof, the heath facility shall prepare a detailed presentation to concur with the social insurance authority with which the health facility enters into a health insurance-covered healthcare contract in use of them as the basis for payment. If the health facility fails to concur with the social insurance authority, it shall send a report to the Ministry of Health in case it is affiliated to Ministry or other agency or it shall send a report to Department of Health in case it is affiliated to Service of Health for consideration.

Article 2. Entry in force

This Circular comes into force as of March 1, 2021.

Article 3. Terms of reference

If any document referred to in this Circular is superseded or amended, the new document shall prevail.

Difficulties that arise during the implementation of this Circular should be reported to the Ministry of Health for consideration./.