Circular No. 36/2015/TT-BYT amending and supplementing certain provisions of Circular No. 40/2014/TT-BYT dated November 17, 2014 on the issuance and guidance for implementing the list of essential medicines within the scope of health insurance fund reimbursement.

CIRCULAR

Amending and supplementing certain Articles of TCircular No. 40/2014/TT-BYT

dated November 17, 2014 promulgating and guiding the implementation of the list of new drugs within the scope of payment by the health insurance fund

thuộc phạm vi thanh toán của quỹ bảo hiểm y tế

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Pursuant to the Social Insurance Lawn l3. Data format:

Pursuant to DecreeNo. Decision No. 63/2012/NĐ-CP dated August 31, 2012 of the Government detailing the functions, tasks, and regulations"b) In addition to the lists of public services issued according to the provisions of Clause 2, Article 4 of this Decree, specialized agencies under provincial People's Committees shall report to the provincial People's Committee for decision-making on amending, supplementing, or issuing the list of public services funded by the state budget within their jurisdiction and consistent with the local budget capacity within the approved budget by the Provincial People's Assembly, and send it to the Ministry of Finance and relevant ministries and sectors for supervision during implementation."hereinafter referred to as the DecreeDeputy ministers of ministerial-level agencies, stipulating functions, tasks, regulationsonof the State Treasury;, amended and supplemented by Decree No. 109/2025/NĐ-CP and Decree No. 193/2025/NĐ-CP transmission within the scope of payment of the health insurance fund.

Pursuant to Decreeand amended and supplemented by certain articles related to conditions for investment and business and administrative procedures in the field of information and communications on November 7, 2018Decision No. 05/2014/NĐ-CP dated November 115, 2014 of the Government under the Health Insurance Law;y This Circular includes "Technical Regulations for the Operation of Automatic Meteorological and Hydrological Stations".i c) Records of chemicals in laboratories; Safety data sheets;FUNCTIONS, DUTIES, POWERS, ORGANIZATIONAL STRUCTURE, OPERATIONAL REGULATIONS, AND RELATIONSHIPS OF MANAGEMENT BOARDS; DUTIES, POWERS OF THE CHAIRPERSON, VICE CHAIRPERSON (IF ANY), SECRETARY, AND MEMBERS OF MANAGEMENT BOARDSManaged by the central government.No. provisions of the Law onDeputy ministers of ministerial-level agencies,a của Luật bảo hiểm y tế;

Minister of theinThe Ministry of Health issued Circular No. 40/2014/TT-BYT dated November 17, 2014 to amend and supplement certain provisionsNo. of Circular No.No. 40/2014/2014/TT-BYT dated November 17,amend2014 promulgating and guiding the implementation of the list of new drugs within the scope of payment by the health insurance fundDeputy ministers of ministerial-level agencies,a quỹ bảo hiểmdevelopmenty tế.

Article 1. Amend and supplement some articles of Circular No. 40/2014/TT-BYT dated November 17, 2014 as follows:

1. The list of new drugs promulgated together with Circular No. 40/2014/TT-BYT dated November 17, 2014 shall be amended and supplemented as follows:

a) Adjust the name of the drug "Anti-human thymocyte immunoglobulin" (item number 340, column 2) to "Anti thymocyte globulin";

b) Adjust the name of the drug "Hydroxycarbamid" (item number 370, column 2) to "Hydroxycarbamid / Hydroxyurea";

c) Adjust the name of the drug "Methoxy polyethylene glycol epoietin beta" (item number 474, column 2) to "Methoxy polyethylene glycol epoetin beta";

d) Adjust the name of the drug "S-bioballthrin + piperonylbutoxid" (item number 605, column 2) to "S-bioallethrin + piperonyl butoxid";

đ) Adjust the name of the drug "Attapulgit mormoivon activated + mixture of magnesium carbonate-aluminum hydroxide" (item number 663, column 2) to "Attapulgit mormoiron activated + mixture of magnesium carbonate-aluminum hydroxide";

e) Adjust the name of the drug "Acid thioctic; Meglumin thioctat" (item number 940, column 2) to "Acid thioctic/ Meglumin thioctat";

g) Amend the sentence "The health insurance fund pays for treatment of stroke, post-trauma, and neurosurgical trauma surgery and post-neurosurgical trauma surgery" (Column 9 of the Peptid (Cerebrolysin concentrate) drug, item number 561, column 2; Choline alfoscerat, item number 562, column 2 and Citicolin drug, item number 563, column 2) to "The health insurance fund pays for treatment of acute stroke, post-trauma, and neurosurgical trauma surgery and post-neurosurgical trauma surgery";

h) Amend the sentence "The health insurance fund pays for treatment of pain due to arterial inflammation (claudication); visual disorders (diabetic retinopathy); peripheral sensory nerve disorder due to ischemia; Raynaud's syndrome" (Column 9 of the Ginkgo biloba drug, item number 566, column 2) to "The health insurance fund pays for treatment of pain due to arterial inflammation (claudication); visual disorders (diabetic retinopathy); ear, nose, and throat disorders (vertigo, tinnitus, hearing loss), peripheral sensory nerve disorder due to ischemia; Raynaud's syndrome";

i) Amend the sentence "The health insurance fund pays for treatment of hyperammonemia and brain-liver disease when there are clear signs of illness, cancer patients with chemotherapy indication or history of viral hepatitis" (Column 9 of the L-Ornithin - L-aspartat drug, item number 747, column 2) to "The health insurance fund pays for treatment of hyperammonemia in brain-liver disease when there are clear signs of illness; cancer patients with chemotherapy indication; cancer patients with history of viral hepatitis";

k) Amend the sentence "The health insurance fund pays for treatment of idiopathic thrombocytopenic purpura, Guillain-Barre syndrome, Kawasaki disease; replacement therapy for patients with IgG deficiency, hand-foot-mouth disease treatment according to the diagnosis and treatment guidelines of the Ministry of Health; severe infection treatment" (Column 9 of the Immune globulin drug, item number 821, column 2) to "The health insurance fund pays for treatment of idiopathic thrombocytopenic purpura, Guillain-Barre syndrome, Kawasaki disease; replacement therapy for patients with IgG deficiency, hand-foot-mouth disease treatment according to the diagnosis and treatment guidelines of the Ministry of Health; severe infection treatment";

l) Amend the sentence "The health insurance fund pays: Ringer acetate; Ringer acetate; Ringerfundin" (Column 9 of the Ringer lactate drug, item number 1026, column 2) to "The health insurance fund pays: Ringer lactate; Ringer acetate; Ringerfundin";

m) Limit the indications and hospital level for the Alendronat sodium + cholecalciferol (Vitamin D3) oral form drug (item number 66, column 2): The health insurance fund pays for osteoporosis treatment at orthopedic departments of special class and class I hospitals;

n) Remove the Gatifloxacin eye drops drug (item number 863, column 2) from the list of drugs promulgated together with Circular No. 40/2014/TT-BYT dated November 17, 2014.

2. Supplement Clause 4 of Article 5 as follows:

“4.

…

In cases where a combination drug contains multiple active ingredients, including one ingredient with limited conditions and payment indications, it will be paid according to the ingredient with limited conditions and payment indications.

In cases where a combination drug contains two or more active ingredients with limited conditions and payment indications, all such limitations and payment indications shall be applied simultaneously.

3. Amending and supplementing Clause 1 and Clause 2 of Article 7 as follows:

a) Supplement Clause 1 of Article 7 as follows:

“1.

…

For cancer patients using four drugs: Pegylated liposomal Doxorubicin injection; Erlotinib oral; Gefitinib oral; Sorafenib oral at healthcare facilities before Circular No. 40/2014/TT-BYT dated November 17, 2014 took effect and discharged after January 1, 2015, the health insurance fund will continue to pay 100% of costs according to Circular No. 31/2011/TT-BYT dated July 11, 2011 in the following situations:

- Until the end of the treatment course (from the time the patient is diagnosed and begins treatment until the end of treatment).

- If after treatment at a healthcare facility, the patient transfers to another healthcare facility and is prescribed to continue using this medication within the treatment course, the health insurance fund will continue to pay 100% of costs within the scope of benefits (excluding out-of-network outpatient treatment).

- If the patient experiences side effects or the healthcare facility runs out of the medication and the doctor prescribes a different medication (Switching from oral Erlotinib to oral Gefitinib and vice versa).

- If the patient's condition stabilizes temporarily and stops treatment, and the condition recurs, the doctor may prescribe the previously used medication.

- During the treatment process with one of the four aforementioned drugs, if the patient does not return for follow-up examination as scheduled and discontinues medication therapy.

b) Amend Clause 2 of Article 7 as follows:

“2. For medicines within the scope of health insurance fund payment as prescribed in Circular No. 31/2011/TT-BYT dated July 11, 2011, Circular No. 10/2012/TT-BYT dated June 8, 2012 amending and supplementing some articles of Circular No. 31/2011/TT-BYT dated July 11, 2011, and cancer medicines and anti-rejection medicines outside the list of medicines prescribed in Clause 4 of Article 7 of Circular Joint Circular No. 09/2009/TTLT-BYT-BTC dated August 14, 2009, the health insurance fund shall continue to pay until the quantity of medicines won through bidding for supply has been exhausted, and such medicines have been contracted for supply by healthcare facilities with suppliers before January 1, 2015.

For medicines within the scope of health insurance fund payment as prescribed in Circular No. 31/2011/TT-BYT dated July 11, 2011, Circular No. 10/2012/TT-BYT dated June 8, 2012 amending and supplementing some articles of Circular No. 31/2011/TT-BYT dated July 11, 2011, and cancer medicines and anti-rejection medicines outside the list of medicines prescribed in Clause 4 of Article 7 of Joint Circular No. 09/2009/TTLT-BYT-BTC dated August 14, 2009, which were transferred to Circular No. 40/2014/TT-BYT dated November 17, 2014 but limited to certain levels of hospitals, the health insurance fund shall continue to pay according to the hospital level prescribed in Circular No. 31/2011/TT-BYT dated July 11, 2011, Circular No. 10/2012/TT-BYT dated June 8, 2012 amending and supplementing some articles of Circular No. 31/2011/TT-BYT dated July 11, 2011, and Joint Circular No. 09/2009/TTLT-BYT-BTC dated August 14, 2009 until the quantity of medicines won through bidding for supply has been exhausted, and such medicines have been contracted for supply by healthcare facilities with suppliers before January 1, 2015.

For medicines Lysine hydrochloride + Calcium glycerophosphate + Glycerophosphoric acid + Vitamin B1 + B2 + B6 + E + PP, oral (item number 1116, column 2); medicine Iron sulfate + Lysine hydrochloride + Vitamin A + B1 + B2 + B3 + B6 + B12 + D + Calcium glycerophosphate + Magnesium gluconate, oral (item number 1118, column 2), and medicine Vitamin A + B1 + B2 + B6 + C + D3 + Calcium gluconate + Zinc + Lysine + PP, oral (item number 1135, column 2) at Circular No. 31/2011/TT-BYT dated July 11, 2011, the health insurance fund shall continue to pay for their use for all ages of adults and children according to the hospital level prescribed in Circular No. 31/2011/TT-BYT dated July 11, 2011 until the quantity of medicines won through bidding for supply has been exhausted, and such medicines have been contracted for supply by healthcare facilities with suppliers before January 1, 2015.

For medicine Lysine hydrochloride + Calcium glycerophosphate + Glycerophosphoric acid + Vitamin B1 + B2 + B6 + E + PP, oral (item number 1116, column 2) at Circular No. 31/2011/TT-BYT dated July 11, 2011: Is medicine Lysine + Vitamin + Mineral, oral (item number 1042, column 2) at Circular No. 40/2014/TT-BYT dated November 17, 2014, the health insurance fund shall pay for treatment for children under six years old suffering from malnutrition, applicable to special class, Class I, and Class II hospitals according to the provisions of Circular No. 40/2014/TT-BYT dated November 17, 2014 based on the results of bidding for supply and such medicines have been contracted for supply by healthcare facilities with suppliers from January 1, 2015.

Article 2. Effective date: January 02, 2017.ệnto effecitselffor implementation

This Circular takes effect from December 15, 2015.

In the course of implementation, if there are difficulties or obstacles, units are requested to report to the Ministry of Health (Health Insurance Department) for consideration and resolution./