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Issue of Medicines, reimbursement under CGHS – Instructions issued by Department of Health and Family Welfare
No. 2-2/2014/CGI-IS. HQ/PPT/CGHS(P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi
Dated: the 25th August , 2014
Sub- Issue of medicines / reimbursement of expenditure on investigations / treatment procedures / implants and other medical devices under CGHS- regarding
With reference to the above mentioned subject the undersigned is directed to state that this Ministry has examined the matter in detail and with a View to streamlines the procedures regarding issue of medicines, reimbursement of expenditure on investigations, treatment procedures, implants and medical devices and with a View to plug the loopholes in the system, it has now been decided that:
a) CGHS shall supply / indent only those medicines, which are included in the CGHS formulary, except for para (b) below. However, for medicines prescribed outside formulary, medicines with identical formulations and /or similar therapeutic effect may be supplied from CGHS formulary against such medicines. CGHS formulary containing 1447 generic and 622 branded medicines is available on CGHS Website at http://msotransparentnic.in/cghsnew/index.asp
b) Anti Cancer and other similar medicines are however supplied on a case to case basis. Only the medicines approved by DCGI for use in India shall be supplied. In case an Indian version is available, which is cheaper than the imported medicine, only the Indian medicine shall be supplied even if, an imported medicine has been prescribed.
c) Medicines shall be supplied for a maximum period of one month.
d)In case of CGHS beneficiaries going abroad, issue of medicines shall be restricted for a maximum period of three months.
e) CGHS shall hereinafter allow only the listed investigations / treatment procedures for which there are prescribed CGHS rates, to be under taken in CGHS empanelled diagnostic centres and hospitals.
f) Similarly, only listed implants / medical devices with a CGHS prescribed ceiling rate shall be permitted for treatment / reimbursement under CGHS.
g) In those cases where any unlisted investigation / treatment procedure is undertaken the reimbursement shall be limited to the rate of nearest similar investigation / treatment procedure under CGHS. Addl. Director of the city /zone shall take a decision based on justification in such cases, in consultation with experts in the field, if necessary.
h) In those cases where any unlisted implant / device is installed reimbursement shall be limited to the CGHS rate of nearest similar implant / device. Addl. Director of the city / zone shall take a decision based on justification in such cases in consultation with experts in the field, if necessary.
i) Registration of Mobile number with CGHS has been made compulsory as a guard against misuse of CGHS Card.
j) In order to provide a mechanism to update the investigations / treatment procedures / implants , etc., as an ongoing process , a Technical Committee is being constituted to consider inclusion / exclusion of investigations /treatment procedures / implants , etc., under CGHS.
Under Secretary to Government of India