Circular No. 01/2020/TT-BYT amends and supplements Circular No. 30/2018/TT-BYT dated October 30, 2018, issued by the Minister of Health on the List and payment ratio for chemical drugs, biological products, radioactive drugs, and labeling substances within the scope of health insurance beneficiaries.

CIRCULAR

AMENDMENTS AND SUPPLEMENTS TO CIRCULAR NO. 30/2018/TT-BYT OF OCTOBER 30, 2018 ISSUED BY THE MINISTER OF HEALTH ON THE LIST AND PAYMENT RATIOS, CONDITIONS FOR PAYMENT OF CHEMICAL DRUGS, BIOPRODUCTS, RADIOACTIVE DRUGS, AND MARKING SUBSTANCES WITHIN THE SCOPE OF BENEFITS FOR HEALTH INSURANCE PARTICIPANTS

Pursuant to the Health Insurance Law No. 25/2008/QH12 dated November 14, 2008, which has been amended and supplemented by certain Articles pursuant to Law No.Decree No. 11 in 2008 has been amended and supplemented with some Articles pursuant to Law No. 46/2014/QH13 dated June 13, 2014;

Pursuant to Decree No. 75/2017/NĐ-CP dated June 20, 2017 of the Government on the functions, tasks, powers, and organizational structure of the Ministry of Health,6 in 2017 of the Government stipulating functions, tasks, powers, and organizational structure of the Ministry of HealthHealth inspection,u organ Circular No. 30/2018/TT-BYT dated October 30, 2018 issued by the Minister of Health on the List and ratio, conditions for payment regarding chemical drugs, biological products, radioactive drugs, and labeled substances within the scope;

At the request of the Director of the Health Insurance Department,of health insurance coverage for participants in health insurance.

The Minister of Health hereby promulgates this Circular amending and supplementing Circular No. 30/2018/TT-BYT dated October 30, 2018 issued by the Minister of Health on the List and Payment Ratios, Conditions for Payment of Chemical Drugs, Bioproducts, Radioactive Drugs, and Marking Substances within the scope of benefits for health insurance participants (hereinafter referred to as Circular No. 30/2018/TT-BYT). 30/2018/TT-BYT dated October 30, 2018, issued by the Minister of Health promulgating the List and rates, conditions for payment regarding chemical drugs, biological drugs, radioactive drugs, and contrast agents within the scope of benefits for health insurance participants.i với thuốc hóa dược, sinh phẩm, thuốc phóng xạ và chất đánh dấu thuộc phạm vi được hưởng của người tham gia bảo hiểm y tế.

Article 1. Amend and supplement certain guiding contents of Circular No. 30/2018/TT-BYT dated October 30, 2018 issued by the Minister of Health on the List and Payment Ratios, Conditions for Payment of Chemical Drugs, Bioproducts, Radioactive Drugs, and Marking Substances within the scope of benefits for health insurance participants (hereinafter referred to as Circular No. 30/2018/TT-BYT) as follows:

1. Amend and supplement Clause d Point 1 Clause 1 Article 2 as follows: "In cases where medical examination and treatment facilities implement technical services approved by competent authorities, they may use drugs to perform such technical services (including those specified in higher hospital categories). Medical examination and treatment facilities shall submit the drug list to the social insurance agency for payment purposes."

2. Amend and supplement Point c Clause 1 Article 5 as follows: "Propose and submit to the Minister of Health for issuance of principles and criteria for building the Drug List; update and adjust the Drug List to ensure it meets treatment needs and is consistent with the payment capacity of the Health Insurance Fund."

Article 2. Amend and supplement the names, routes of administration, and notes of certain drugs, and expand the hospital category of certain drugs in Appendix 01 of the List of Chemical Drugs and Bioproducts within the scope of benefits for health insurance participants issued together with Circular No. 30/2018/TT-BYT as follows:

1. Amend and supplement five drug names as follows:

a) Amend the name of drug number 330 (column 2) as follows: "Prothionamid";

b) Amend the name of drug number 425 (column 2) as follows: "Pinene + camphene + cineol + fenchone + borneol + anethol";

c) Amend the name of drug number 449 (column 2) as follows: "Etamsylat";

d) Amend the name of drug number 518 (column 2) as follows: "Felodipin + metoprolol tartrat";

e) Amend the name of drug number 799 (column 2) as follows: "Thiamazol".

2. Amend the route of administration of three drugs as follows:

a) Amend the route of administration of drug Imatinib number 390 (column 3) as follows: "oral";

b) Amend the route of administration of drug Nilotinib number 391 (column 3) as follows: "oral";

c) Amend the route of administration of drug Dialysis solution for artificial kidney (bicarbonate or acetate) number 889 (column 3) as follows: "dialysis solution".

3. Amend and supplement the note content of sixteen drugs as follows:

a) Amend the note content of drug Imatinib number 390 (column 8) as follows: "The Health Insurance Fund will pay for the treatment of chronic myeloid leukemia (CML) or gastrointestinal stromal tumor (GIST); pay 80%."

b) Amend the note content of drug Nilotinib number 391 (column 8) as follows: "The Health Insurance Fund will pay when treating chronic myeloid leukemia (CML) that is intolerant or resistant to Imatinib; pay 80%."

c) Supplement the note content of drug Lansoprazol number 670 (column 8) as follows: "The Health Insurance Fund will pay according to the instructions in the drug usage guide attached to the drug registration file that has been approved or the diagnosis and treatment guidelines of the Ministry of Health or for prophylaxis of peptic ulcer disease, upper gastrointestinal bleeding due to stress in intensive care patients."

d) Amend the note content of drugs Omeprazole number 675, Esomeprazole number 676, Pantoprazole number 677, Rabeprazole number 678 (column 8) as follows: "The Health Insurance Fund will pay according to the instructions in the drug usage guide attached to the drug registration file that has been approved or the diagnosis and treatment guidelines of the Ministry of Health or for prophylaxis of peptic ulcer disease, upper gastrointestinal bleeding due to stress in intensive care patients."

đ) Amend the note content of drug Hydroxyethyl Starch (HES) number 474 (column 8) as follows: "The Health Insurance Fund will pay for the treatment of hypovolemia due to acute blood loss when using single fluid infusion does not improve clinically; treat severe dengue fever according to the Ministry of Health's Diagnosis and Treatment Guidelines for Dengue Fever."

e) Supplement the note content of three drugs, including Atorvastatin number 566, Fenofibrate number 571, Simvastatin number 577 (column 8) as follows: "For commune health stations, the Health Insurance Fund will pay according to the Ministry of Health's Diagnosis and Treatment Guidelines for Lipid Disorders."

g) Amend the note content of drug L-Ornithine-L-Aspartate number 729 (column 8) as follows: "The Health Insurance Fund will pay for the treatment of hepatic encephalopathy from stage 2 onwards according to the West Haven Classification System."

h) Amend the note content of drug Liraglutide number 787 (column 8) as follows:

"The Health Insurance Fund will pay 30% for type 2 diabetes patients who meet the following criteria simultaneously:

- Over 40 years old, BMI > 23, have type 2 diabetes, and have cardiovascular disease or hypertension;

- Uncontrolled blood glucose (HbA1C > 9) after three months;

- Renal insufficiency with CrCl < 59 ml/min."

i) Amend the content of the Immune globulin drug note, serial number 803 (column 8) as follows: "The Health Insurance Fund shall pay for the treatment of immune thrombocytopenia unresponsive to corticosteroids, Guillain-Barre syndrome, Kawasaki disease; severe infections with reduced IgG; replacement therapy for patients with IgG deficiency; hand-foot-and-mouth disease treatment; measles exposure treatment, measles treatment when there is a severe infection condition or rapidly progressing respiratory failure or encephalitis according to the Ministry of Health's measles diagnosis and treatment guidelines."

k) Amend the content of the Ranibizumab drug note, serial number 856 (column 8) as follows: "The Health Insurance Fund shall pay for treatment in ophthalmology departments of special-class hospitals; first and second-class specialized eye hospitals; Vietnam Friendship Hospital, Thong Nhat Hospital, and Da Nang Hospital for subjects registered for initial health insurance medical examination and treatment at hospitals according to Guidance No. 52-HD/BTCTW dated December 2, 2005 of the Central Organization Department."

l) Amend the content of the Galantamine, injection form, drug note, serial number 938 (column 8) as follows:

"The Health Insurance Fund shall pay for the following treatments:

- Peripheral neuropathy related to motor dysfunction in inpatient cases;

- Post-spinal cord injury motor paralysis;

- Loss of motor function after stroke, cerebral palsy in children;

- Postoperative bowel and bladder paralysis;

- Atropine and atropine-like substance detoxification."

Article 3. Effective Date.

This Circular takes effect from March 1, 2020.

Article 4. Transitional Provisions

In cases where patients have health insurance cards admitted as inpatients after December 31, 2018 but before March 1, 2020 and are still undergoing treatment at healthcare facilities, they shall be subject to the provisions of Circular No. 30/2018/TT-BYT until discharge; including prescribing medication for patients immediately after completing inpatient treatment. During implementation, if there are difficulties or obstacles, please report in writing to the Ministry of Health for consideration and resolution.

During the implementation process, if there are difficulties or obstacles, it is requested that agencies, organizations, and individuals report them in writing to the Ministry of Health for consideration and resolution./.