Informational Guide: CGHS Post-Transplant Medicine Purchase Guidelines
Circular Number:
F.No Z15025/27/2023/DIR/CGHS
Published By:
Min. of Health & Family Welfare, Directorate of CGHS
Date:
September 12, 2023
English: This circular provides special permission for organ transplant patients to buy medicines from local chemists and seek reimbursement for up to six months post-surgery.
Hindi: यह परिपत्र अंग प्रत्यारोपण के रोगियों को सर्जरी के बाद छह महीने तक स्थानीय स्तर पर दवाएं खरीदने और उनके पुनर्भुगतान का दावा करने की विशेष अनुमति प्रदान करता है।
Official Subject
Guidelines regarding Purchase of Medicines by Post-Organ Transplant Surgery Patients under CGHS –reg.
Important Extracts from the Circular
"CGHS beneficiaries, who are recovering from Organ transplant surgery shall be permitted to purchase OPD medicines, based on the advice of the treating Specialist for up to a period of six months..."
"The reimbursement in respect of other medicines for which there is no rate contract under CGHS, shall be limited to 85% of MRP or actual expenditure incurred, whichever is lower..."
Simplified Explanation
- New Flexibility: Patients recovering from transplant surgeries often cannot travel to CGHS Wellness Centres. They are now allowed to buy medicines locally.
- Time Limit: This specific relaxation is available for a duration of six months following the transplant surgery.
- Cost Calculation: Reimbursement is capped at CGHS rates or 85% of the MRP (to account for standard chemist discounts) to ensure fair pricing.
Who Is Affected
- CGHS beneficiaries (Serving and Pensioners) recovering from organ transplant surgery.
- Family members or authorized representatives of such patients.
- CGHS Wellness Centres and administrative departments handling medical claims.
Practical Implications
- Claim Submission: Serving employees must submit their bills to their respective departments, while pensioners submit to their Wellness Centres.
- Restriction: One cannot claim for food supplements, vitamins (prescribed as supplements), or cosmetic products.
- Prescription: Only medicines advised by a recognized treating Specialist are eligible for this reimbursement path.
Frequently Asked Questions (FAQs)
Q1. Can I buy medicines from any local pharmacy?
Answer: Yes, if you are unable to visit a CGHS Wellness Centre post-transplant, you can purchase them locally and apply for reimbursement.
Q2. Why is reimbursement limited to 85% of MRP?
Answer: This is because 15% is the standard minimum discount prescribed for local chemists under CGHS arrangements.
Q3. Does this apply to Ayurvedic medicines?
Answer: No, Ayurvedic preparations or food supplements advised by Allopathic doctors are not reimbursable under this order.
Q4. What happens after the six-month period ends?
Answer: After six months, the standard procedure for obtaining medicines through CGHS Wellness Centres usually resumes unless further extensions are granted.
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This is an unofficial, independent informational summary created for educational purposes only.
For authoritative and legally binding information, please refer to the original circular published by the concerned authority.
