Unofficial translation
Note!The order was suspended until 31.12.2025 by Order of the Acting Minister of Health of the Republic of Kazakhstan dated 01.08.2023 № 143 (effective ten calendar days after the date of its first official publication).
Note!
The order was suspended until 31.12.2022 by the order of the Acting Minister of Health of the Republic of Kazakhstan dated 05.11.2021 № ҚР ДСМ-109 (effective from the moment of its first official publication).
In accordance with subparagraph 93) of Article 7 of the Code of the Republic of Kazakhstan dated July 7, 2020 “On public health and healthcare system”, I HEREBY ORDER:
1. To approve the attached co-payment rules.
2. To recognize as terminated the order of the Minister of Healthcare of the Republic of Kazakhstan dated December 31, 2019, № ҚР ДСМ-154 “On approval of the Rules for the implementation of co-payment for medicines and medical devices” (registered in the Register of State Registration of Normative Legal Acts under No. 19814).
3. The Department of Pharmaceutical Policy of the Ministry of Healthcare of the Republic of Kazakhstan, in accordance with the procedure established by the legislation of the Republic of Kazakhstan, shall ensure:
1) state registration of this order with the Ministry of Justice of the Republic of Kazakhstan;
2) placement of this order on the Internet resource of the Ministry of Healthcare of the Republic of Kazakhstan after its official publication;
3) within ten working days after the state registration of this order with the Ministry of Justice of the Republic of Kazakhstan, submission to the Legal Department of the Ministry of Healthcare of the Republic of Kazakhstan of information on the implementation of the measures provided for in subparagraphs 1) and 2) of this paragraph.
4. To impose control over the execution of this order on the supervising Vice Minister of Healthcare of the Republic of Kazakhstan.
5. This order shall come into effect after the expiration of ten calendar days after the day of its first official publication.
|
Minister of Healthcare of the Republic of Kazakhstan |
A. Tsoi |
| Annex to the Order of the Minister of Healthcare of the Republic of Kazakhstan dated July 16, 2021, No. ҚР ДСМ -61 |
The Co-payment Rules
Chapter 1. General Provisions
1. These Co-payment Rules have been developed in accordance with subparagraph 93) of Article 7 of the Code of the Republic of Kazakhstan “On public health and healthcare system” (hereinafter referred to as the Code) and shall determine the procedure for making co-payments for medicines and medical devices.
2. The following basic concepts are used in these Rules:
1) an information system for accounting for outpatient drug provision (hereinafter referred to as the ISDP) - an information system determined by the authorized body in the field of healthcare to automate the accounting of prescriptions, the release of goods to suppliers of pharmaceutical services or services for accounting and sales within the framework of the statutory free medical assistance and (or) in the Compulsory Social Health Insurance system;
2) co-payment - payment of the difference in the cost of medicines and (or) medical devices and the established marginal price for their reimbursement within the statutory free medical assistance and (or) in the system of compulsory social health insurance at the outpatient level, carried out voluntarily;
3) objects in the field of circulation of medicines and medical devices - a pharmacy, including those selling via the Internet, a pharmacy in healthcare organizations, a mobile pharmacy for remote rural areas, organized from a pharmacy, a pharmacy (distribution) warehouse, a warehouse for the temporary storage of medicines funds, medical devices, an optics store, a medical device store, a warehouse for medical devices, organizations for the production of medicines and medical devices;
4) international non-proprietary name of the medicinal product (hereinafter referred to as the INN) - the name of the medicinal product recommended by the World Health Organization;
5) marginal price for the INN of a medicinal product or the technical characteristics of a medical device within the framework of the Statutory Free Medical Assistance and (or) in the Compulsory Social Health Insurance system - the price for the INN of a medicinal product or the technical characteristics of a medical device, above which purchases cannot be made within the framework of the SFMC and (or) in CSHI system;
6) marginal price of reimbursement of medicines and medical devices within the framework of the statutory free medical assistance and (or) in the compulsory medical insurance system - the cost of one package of a medicinal product with a certain dosage, the form of release of the medicinal product and (or) with a certain characteristic and composition of a medical device, calculated by multiplying the purchase prices according to the price list of the Unified distributor per unit of measure for the number of units of measure in consumer packaging;
7) trade name of the medicinal product - the name under which the medicinal product is registered;
8) trade name of a medical device - the name under which a medical device is registered.
Chapter 2. Procedure for making co-payments
3. Co-payment for medicines and (or) medical devices shall be carried out with free and (or) preferential outpatient provision of certain categories of citizens of the Republic of Kazakhstan with certain diseases (conditions) within the framework of the SFMC and (or) in the CSHI system.
4. Co-payment shall be made by the patient in case of disagreement to receive a free medicine and (or) a medical device within the framework of the statutory free medical assistance and (or) in the compulsory health insurance system when providing primary health care and specialized medical care on an outpatient basis.
5. The patient on their own will (voluntarily) chooses a more expensive drug under a different trade name and (or) a medical device with an additional payment of the difference in the cost of the selected trade name of the drug, not exceeding the marginal price for the trade name in the object in the field of circulation of medicines and medical products participating in co-payment within the framework of the statutory free medical assistance and compulsory medical insurance.
6. A patient who chooses a medicinal product and (or) a medical device with co-payment, in the objects in the field of circulation of medicines and medical devices, shall be provided in an accessible form with complete and reliable information about the possibility of obtaining medicines and (or) medical devices under the statutory free medical assistance and (or) in the CSHI system.
7. When dispensing a medicinal product and (or) medical device with co-payment, in the facility in the field of circulation of medicines and medical devices, the patient shall be offered all the trade names of medicines and (or) medical devices available in the assortment according to the corresponding INN of the medicinal product, taking into account the dosage form and dosage of the medicinal product and the technical characteristics or configuration of the medical device, starting with the medicinal product or medical device at the lowest price.
8. If the patient chooses the trade name of the medicinal product and (or) medical device with co-payment, the patient shall provide written voluntary consent to additional payment over the maximum reimbursement price for the medicinal product and (or) medical device in any form.
9. When choosing a medicinal product and (or) medical device, the patient shall make a co-payment over the maximum reimbursement price for the medicinal product and (or) medical device.
10. The specialist of the object in the field of drug circulation in the ISDP shall enter information on the trade name of the dispensed medicinal product and (or) medical device, indicating the date of issue.
