Clarification regarding issue of Medicine under CGHS

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CGHS withdraws the Office Memorandum dated 25-08-2014 regarding issue of Medicine / reimbursement of expenditure on investigations / treatment procedures / implants and other medical devices

G.I., M.H., O.M.No. 2-2/2014/CGHS(HQ)/PPTY/CGHS(P), dated 13.03.2015

Subject: Clarification regarding issue of Medicine under CGHS

With reference to the above mentioned subject the under signed is directed to state that the situation arising out of issue of office memorandum NO 2-2/2014/CGHS(HQ)/PPTY/CGHS(P) dated the 25th August, 2014 has been engaging the attention of government for quite some time. Although the guidelines were modified subsequently vide Office Memorandum of even number date 01.10.2014 and 23.12.2014, this Ministry is in receipt of representations seeking clarifications. The matter has been reviewed and it has now been decided to withdraw the OM of even no. dated 25.08.2014.

Source: CGHS
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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.

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