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Accordingly, Circular No 22/2024/TT-BYT stipulates direct payment for drug and medical device costs within the scope of benefits for health insurance participants when seeking medical examination and treatment as prescribed in point c, clause 2 and clause 3, Article 31 of the Health Insurance Law at medical facilities that have signed health insurance contracts with the Health Insurance Fund, including: drugs and medical devices within the scope of payment; Payment conditions; Payment levels; Payment documents and procedures.

Cases in which drugs and medical devices are within the scope of payment:

Drugs included in the List of Rare Drugs issued together with the Ministry of Health’s Circular No 26/2019/TT-BYT dated August 30, 2019 regarding the List of Rare Drugs.

Medical devices of type C or D, excluding in vitro diagnostic medical devices, personalized special medical devices, and medical devices included in the list of medical devices issued by the Minister of Health that are traded as ordinary goods according to Government’s Decree No 98/2021/NĐ-CP dated November 8, 2021 on the management of medical equipment and the Government’s Decree No 07/2023/NĐ-CP dated March 3, 2023 amending and supplementing a number of articles of the Government’s Decree No 98/2021/NĐ-CP dated November 8, 2021 on the management of medical equipment.

Payment conditions
At the time of prescription or indication for use of medical devices, the following conditions must be met:

- There are no drugs or medical devices because they are currently in the process of selecting a supplier according to a pre-approved procurement plan through one of the following methods: Open tender, restricted tender, competitive bidding, direct purchase, or supplier selection in exceptional circumstances but a supplier has not yet been selected, or online bidding or online procurement, and a simplified bidding has been conducted as prescribed in point c, clause 1, clause 2, Article 23 of the Law on Bidding and clause 1, Article 94 of the Government’s Decree No 24/2024/NĐ-CP dated February 27, 2024 detailing a number of provisions and measures to implement the Law on Bidding regarding supplier selection but a supplier has not been selected. At the same time, at the medical facilities:

+ For drugs: There is no commercially available drug containing the active ingredient prescribed for the patient, or a drug with the same active ingredient but a different concentration or dosage form or route of administration, and cannot be substituted to prescribe for the patient;

+ For medical devices: There is no medical device that the patient has been indicated to use, and there is no available substitute medical device.

- The patient cannot be transferred to another medical facility in one of the following cases:

The patient's health condition or medical condition is determined to be ineligible for transfer; The medical facility where the patient is being examined and treated is currently under medical quarantine as prescribed by law on the prevention and control of infectious diseases; The medical facility where the patient is being examined and treated is a specialized medical examination and treatment facility.

- Drugs and medical devices cannot be transferred between medical facilities as prescribed by law.

- The drugs and medical devices prescribed or indicated for use must be within the scope of expertise of the medical facility and have been covered by health insurance costs at one of the medical facilities nationwide.

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

Direct payment methods
- The Social Security offices will directly pay the patient according to the following regulations:

+ For drugs: The basis for calculating the payment level is the quantity and unit price recorded on the invoice issued by the patient's purchase at the business establishment. In case there are regulations on the ratio and payment conditions for the drug, the payment will be made according to the ratio and payment conditions;

+ For medical devices (including reusable medical devices): The basis for calculating the payment level is the quantity and unit price recorded on the invoice issued by the patient's purchase at the medical equipment trading establishment. In case there is a regulation on the payment level that does not exceed the prescribed payment level for that medical device.

- The unit price of drugs and medical devices used to determine the payment level must not exceed the unit price paid at the latest time for drugs and medical devices that have been awarded a tender at the medical facility where the patient has received medical examination and treatment services.

In case drugs and medical devices have not been awarded a tender at the medical facility where the patient has received medical examination and treatment, the unit price used to determine the health insurance payment level is the effective tender result in the following order of priority:

+ Results of centralized national procurement or price negotiation results;

+ Results of centralized local procurement in the area;

+ The lowest tender result at the time of payment of specialized public medical facilities, basic-level public facilities, or medical facilities with the same technical expertise in the area;

+ The lowest tender result at the time of payment of specialized public medical facilities, basic-level public medical facilities, or medical facilities with the same technical expertise in Hanoi City or Ho Chi Minh City.

- The Social Security office will deduct the health insurance payment costs of the medical facility where the patient is treated as follows:

+ In case the cost of drugs and medical devices is included in the price of medical examination and treatment services: Deduct from the health insurance cost of medical examination and treatment services of the medical facility at the payment level prescribed in clause 1 and 2 of this Article;

+ In case the cost of drugs and medical devices is not included in the price structure of medical examination and treatment services: Do not deduct from the health insurance cost of medical examination and treatment services of the medical facility.

+ The cost of drugs and medical devices directly paid by the Social Security office to the patient will be included in the projected expenditure of the medical facility.

Direct payment documents, procedures
The Circular stipulates that direct payment documents will be implemented according to the regulations in Article 28 of the Government’s Decree No 146/2018/NĐ-CP dated October 17, 2018 detailing and guiding measures to implement a number of articles of the Health Insurance Law (hereinafter referred to as Decree No 146/2018/NĐ-CP). Direct payment procedures are regulated in Article 29 of Decree No 146/2018/NĐ-CP.

The Circular takes effect from January 1, 2025. In case the patient enters the medical facility for examination and treatment before the effective date of the Circular but ends the treatment after the effective date of the Circular, it will be implemented according to the provisions of the Circular.