Clarification regarding issue of medicines under CGHS
No.2-2/2014/CGHS(HQ)/PPTY/CHGS(P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, Maulana Azad Road
New Delhi 110108
Dated: the 23rd December, 2014
OFFICE MEMORANDUM
Subject: Clarification regarding issue of medicines under CGHS
With reference to the above mentioned subject the undersigned is directed to state that the situation arising out of issue of Office Memorandum No.2-2/2014/CHGS(HQ)/PPTY/CGHS(P) dated the 25th August, 2014 has been engaging the attention of Government for quite some time. Various representations about the difficulties being encountered have been received from different stakeholders i.e. beneficiaries and doctors, necessitating a review of the matter. It was accordingly considered by a Committee under the Chairmanship AS&DG, CGHS. After careful review and keeping the recommendations of the Committee in mind, the following guidelines are issued to streamline the functioning of the Wellness Centres:
(i) The medicines are to be issued as per the CGHS Formulary and guidelines issued by this Ministry in this behalf.
(ii) In case the prescribed medicines are not available in CGHS Formulary, but are essential for the treatment of the patient, they can be issued / indented by the doctors of the CGHS Wellness Centre on the basis of a valid prescription of the authorized specialist subject to the condition that such medicines are neither dietary supplements/ food items nor banned drugs. Instructions on this issue i.e. non-admissibility of food items etc. vide OM No. 39-3/2003-04/CHGS/MSD/RS dated 23rd July, 2009 and 3rd August, 2009 must be followed.
(iii) In case of anti-cancer drugs and other life saving drugs that are not approved by the DCGI for use in India, each case should be considered by the Expert Committee under the Chairmanship of Special DG (DGHS).
(iv) The Technical Standing Committee constituted vide 2-2/2014/CGHS(HQ)/PPTY/CGHS(P) dated 27.08.2014 of this Ministry will review addition or deletion of drugs in the CGHS Formulary/ list of Treatment procedures/ investigations/ listed implants. The Technical Committee will meet once in three months or as per need, whichever is earlier. In the meantime re-imbursement for unlisted procedures/ implants will be made at the rates approved by AIIMS/ GB Pant Hospital / actuals, whichever is less.
2. The O.M. of even number dated 25.08.2014 is superseded to the above extent while O.M. of even number dated 1.10.2014 is withdrawn.
(Bindu Tiwari)
Director, CGHS(P)
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The struggle of All India DRDO Technical Officers’ Association & Confederation of Central Government Gazetted Officers Organisations (CCGGOO) along with All Pensioners & Retired Persons Association (APRPA) and other orgns. for better medical facilities under CGHS led to the withdrawal of OM dt.25/08/2014 on 13/03/2015 which is against the interests of 36,67,795 CGHS beneficiaries.
In the name of streamlining the procedures regarding issue of medicines, reimbursement of expenditure on investigations, treatment procedures, implants and medical devices under CGHS and on the pretext of plugging the loopholes in the system, Ministry of Health & Family Welfare issued OM dt.25/08/2014 restricting the facilities as follows:
a) CGHS shall supply / indent only those medicines, which are included in the CGHS formulary.
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.
The Govt.tried to pacify us by modifying OM on 01/10/2014 and 23/12/2014.But due to relentless efforts,finally MH&FW had to withdraw the draconian OM.
You are aware that CCGGOO & AIDTOA were partially successful previously in getting medicines from the treating private hospital at the time of discharge for a period upto 7 days.
AIDTOA & CCGGOO thank all those who contributed directly or indirectly in the efforts for betterment of medical facilities to CGHS beneficiaries.
Let us fight unitedly against reduction in welfare measures and for better living conditions.
If we all stand together, we are a force that can shake the whole world”.
Together ………. we can