Instructions for Issuance of Restricted Medicines to Beneficiaries under CGHS

 Instructions for Issuance of Restricted Medicines to Beneficiaries under CGHS 

F. No. Z15025/19/2024/DIR/CGHS/I/3721886/2024 (Comp No.8281286 )

dated-12-11-2024

                                                           OFFICE ORDER

 Subject: Instructions for Issuance of Restricted Medicines to Beneficiaries under CGHS

In order to streamline the process of issuing restricted medicines to beneficiaries (all beneficiaries eligible for OPD services in CGHS) under the Central Government Health Scheme (CGHS), the following guidelines are issued for strict compliance by all Medical Officers:

Definition of Restricted Medicines:

 i.   Anti-cancer medicines (Chemotherapeutic, immunotherapeutic medicines)

ii.   Drugs used for the treatment of other terminal illnesses like CKD, Enzyme deficiencies, Hemophilia, rare diseases, etc.

iii.   Limited/Specialized use drugs with prohibitive cost eg: Intra-ocular, intra-articular injections, etc.

iv.   Cost of restricted medicine More than Rs. 10,000/unit of administration or more; or Rs. 50,000/month or more.

 Standard Operating Procedure for Issue of Restricted Medicine.

 1.   CGHS shall maintain only two lists of Restricted medicines, i.e. Online Restricted Medicines and ‘STC’ Restricted Medicines which shall be displayed on the CGHS Website for information of beneficiaries.

2.   Immunotherapy of Medicine shall remain in the STC Restricted Medicine list.

3.   CGHS shall issue guidelines for the use of STC Restricted Medicines as per established CDSCO approval/guidelines. O/o Additional Director MSD/City shall be authorized to issue the medicine without the scrutiny of the Standing Technical Committee in case the disease is covered under the issued guideline.

4.   In case there are no guidelines available, or the medicine has been prescribed for an indication not covered under the guidelines, the same shall be subject to the recommendation of the Standing Technical Committee.

5.   In case, an STC Restricted Medicine, has been advised and approved for more than 20 cases in 6 months, the same shall be included in the Online list except for Immunotherapy Medicines.

6.   The application for Restricted Medicines is to be submitted by the beneficiary to the Medical Officer along with the following documents:

a.   Duly filled Restricted Medicine Form (Annexure 1) by the main cardholder.

b.   Photocopy of Prescription of treating Specialist.

c.   Authorization Letter in case the beneficiary is unable to collect the medicine in person.

d.   CGHS Issued Prescription (Print out) of Restricted Medicine. 

7.   The Medical Officer shall only use  the Online module of the CGHS application for prescribing the Restricted Medicine. In the case of STC Restricted Medicine, the Authorised Medical Officer (CMO Drugs/Additional Director) at the Central Store/Medical Store shall prescribe the medicines using the online module.

8.   It is reiterated that the beneficiary may submit the request for Restricted medicine to any Wellness Centre across the country, however, the beneficiary must be informed that the medicine shall be available at the concerned (based on place of indent) Medical Store/Central Store/designated Wellness Centre.

9.   The Online request shall be processed by the Medical Stores/Central Store of the city on the same day for medicine available in the Online Restricted List. 10.    In the case of STC/Offline Restricted Medicines, the use of ‘Offline Indent Vouchers’ shall be discontinued, and the applications shall only be submitted on the prescribed form along with all relevant reports chronically arranged, with copies of imaging reports if any. A separate record shall be maintained at the level of the Wellness Centre for the same.

11.    The Supplier of the medicine shall supply the medicine at the Medical Store/Central Store of the city/wellness centres as per arrangement made by the Additional Director of the City/MSD.

12.    The Medicine shall be distributed by the Pharmacist using the Online module of CGHS application; at the place of supply of medicine.

13.    The beneficiary shall collect the medicine from the designated place within 15 days from the date of Supply (i.e. date of reicept of the medicines in MSD/WC).

 

 Encl: As Above To,

(Dr. Satheesh Y. H.) Director (CGHS)

Tel No. 011-26872280

1.   Additional Directors CGHS, Cities/Zone(s)

      2.   All CMO I/c

       3.   MCTC CGHS with directions to upload the form (Annexure 1) on CGHS Website.