national health insurance scheme · 2020. 3. 6. · scheme with the goal of providing health...

Republic of Zambia

Ministry of Health

NATIONAL HEALTH INSURANCE SCHEME

TARIFF AND BENEFITS PACKAGE

OPERATIONAL MANUAL

Towards Universal Health Coverage in Zambia

2019

ii

TABLE OF CONTENTS

1. DEFINITION OF TERMS ....................................................................................... 1 2. INTRODUCTION .................................................................................................... 3 3. PURPOSE OF OPERATIONAL MANUAL ........................................................... 3 4. CONCEPTUAL FRAMEWORK ............................................................................ 4

5. WHAT IS THE NHI BENEFIT PACKAGE? ......................................................... 5 6. EXCLUDED SERVICES ........................................................................................ 6 7. PROVIDER PAYMENT MECHANISMS .............................................................. 7

7.1 Fee for Service ......................................................................................................... 7 7.2 Diagnosis Related Groups (DRG) ............................................................................ 8

7.3 Capitation ................................................................................................................. 8 8. HOW WILL THE PAYMENT METHODS BE IMPLEMENTED? ...................... 8

8.1 Tertiary and Second Level Hospital Services. ......................................................... 8

8.2 District Hospital Services. ........................................................................................ 8 9. TARIFF SCHEDULES ............................................................................................ 9

9.1 Schedule 1. Second and third level Hospital DRG Tariffs ...................................... 9 9.2 Schedule 2. District Hospital Tariffs ...................................................................... 13 9.3 Schedule 3. Laboratory Services. ........................................................................... 13

9.4 Schedule 4. Radiology / Imaging. .......................................................................... 17

9.5 Schedule 5. Prosthetics. .......................................................................................... 19 9.6 Schedule 6. Orthopedic Implants (Requires Pre Authorization) ............................ 20

9.7 Schedule 7. Drugs. ................................................................................................. 20

iii

Foreword The Government of Zambia is implementing the National Health Insurance

Scheme with the goal of providing health insurance cover to all Zambians by

the year 2021. With the enactment into law of the National Health Insurance

Act No. 2 of 2018, and the subsequent commencement of the compulsory

National Health Insurance Scheme, the Ministry of Health believes that this

important milestone will propel Zambia in attaining its national goal of

Universal Health Coverage (UHC) by 2030.

It is however understood, that the success of the National Health Insurance

Scheme (NHIS) requires the development of a defined benefit package, which

is essentially a subset of an exhaustive package of health services, and a tariff structure that assures the

Ministry of Health’s commitment to providing quality and affordable personal health services to all

Zambians.

The design of this first ever Tariff and Benefit Package Operational Manual took into account the

disease burden in the country as informed by our Demographic Health Surveys, and our National

Health Priorities and the Ten (10) Legacy Goals as outlined in our National Health Strategic Plan 2017-

2021. Further consideration into the feasibility, sustainability and cost effectiveness of the various

health interventions that contributions into the NHI Scheme can currently support was also made.

This Tariff and Benefit Package Operational Manual is but one of the various avenues that the

Government is using in rolling out Universal Health Care in the country. A Strong political and social

support from all Zambians is required if we want to reach our UHC 2030 goal and we are confident that

this document will facilitate that process.

iv

Acknowledgements

The Ministry of Health through a consultative and multi-stakeholder participatory process prepared this

operational manual for the benefit package of the National Health Insurance Scheme. The Health Care

Financing Department coordinated the process through a series of meetings with all key stakeholders.

In this regard, the Ministry expresses gratitude to the core team at the MoH Headquarters for their

leadership and commitment in the process of formulating this operational manual. They include the

following members of staff in the Health Care Financing Unit; the Director Dr. Anita Kaluba; the

Assistant Director, Mr. Wesley Mwambazi, the Planners Ms. Chanda Chisanga and Ms. Chilweza

Muzongwe, and the Director – Special Duties, Dr. Mpuma Kamanga.

Further gratitude goes to Mr. Henry Kansembe and Mr. Patrick Banda from the Department of Planning

and Budgeting, Dr. Alex Makupe, Dr Daniel Makawa and all the other key contributors from the

Department of Clinical Care and Diagnosis Services for their unwavering support.

The Ministry would also like to thank a number of people and institutions that made significant

contributions to the development of this document. Special gratitude goes to the University of Zambia -

Department of Economics Staff; Dr. Bona Chitah, Dr Felix Masiye, and Dr. Miriam Chitalu- Chiliba.

We also wish to acknowledge the important roles played by Mr. Solomon Kagulula from WHO and Mr.

Warren Simangolwa from CHAI by providing both technical support and financial support towards the

process of developing this manual. Special tribute goes to our cooperating partners in particular Clinton

Health Access Initiative (CHAI) and the World Health Organisation (WHO).

v

Glossary of acronyms

Synonym Description/Definition ALOS Average length of stay

DRGs Diagnosis Related Groups

GRZ Government of the Republic of Zambia

HCPs Healthcare Providers

HDU High Dependency Unit

ICD International Classification of Diseases

ICU Intensive Care Unit

IPD Inpatient Department

MOH Ministry of Health

MRI Magnetic Resonance Image

NHIMA National Health Insurance Management Authority

NHIS National Health Insurance Scheme

OPD Outpatients Department

POM Prescribed Only Medicine

UHC Universal Health Coverage

ZAMRA Zambia Medicine Regulatory Authority

1

1. DEFINITION OF TERMS

Inpatient is a hospital patient who occupies a hospital bed for at least one night in the

course of treatment, examination, or observation OR patient who is admitted to a hospital or

health facility for treatment that requires at least one overnight stay.

Inpatient Services these are medical services rendered to patients whose treatments require

an overnight or more stay in a hospitals or any other approved admitting medical facility.

Outpatient is a patient who does not require an overnight stay in health facility in the

course of treatment.

Outpatient Services These are medical services treatment that does not require an

overnight stay in a hospital or medical facility. It involves a diagnosis or treatment to a

patient who does not occupy a hospital bed overnight.

Average Length of Stay. This refers to the average number of days that patients spend in

hospital. It is generally measured by dividing the total number of days stayed by all

inpatients during a year by the number of admissions or discharges.

Registration means opening of patient file and documentations.

Consultation per visit refers to all patient workups made for history and examination of

the patient; order for Diagnosis services required to properly evaluate the patient’s need for

a procedure and to render a professional opinion; and prescription.

Formulary is a list of prescription medicines, both in generic and brand names that are

preferred by the NHIS. The NHIS shall pay only for medications that are approved by

ZAMRA and are on this preferred list. These medicines are Prescribed Only Medicines

(POM), which are medicines dispensed under a pharmacist supervision on prescriptions

issued by a Medical Doctor or other suitably qualified health care professionals

Medical and Orthopaedic appliance and Prosthesis are devices or apparatus used to

support, align, prevent or correct deformities or to improve the function of movable parts of

the body.

Optical/Vision care/ Eye Services This service involves provision of general treatments to

eye related problems and provision of reading glasses.

Tariff. Set of fixed price list created under NHIMA to control charges

International Classification of Diseases. International Classification of Diseases (ICD)

refers to a Diagnosis tool that is used to classify and monitor causes of injury and death,

maintains information for health analyses, such as the study of mortality (death) and

morbidity (illness) trends.

Gate Keeping. This term is used to describe the role of primary health care level in

streamlining the referral of patients to higher access levels of health care. Further,

gatekeeping:

2

Ensures that patients receive the appropriate care.

Promotes and safeguards the efficient use of resources.

Ensures timely and appropriate referral of patients.

Pre-Authorization is a certification or authorization that the National Health Insurance

Management Authority (NHIMA) provides to its beneficiaries and or accredited providers

prior to accessing a certain service. This can be done online.

3

2. INTRODUCTION

The National Health Insurance Scheme (NHIS) established through the National Health Insurance Act

No. 2 of 2018 on 5th April 2018 mandates all Zambians and established residents to register with the

NHIS. The scheme accords all Zambians access to a sustainably financed quality health care without

facing the risk of catastrophic health expenditure or impoverishment because of paying out of pocket

for health care services. Furthermore, the Act provides for the creation of National Health Insurance

Management Authority (NHIMA) whose mandate is to manage and implement the NHIS.

The Ministry of Health through the health care financing department constituted a multi sectoral

committee consisting of clinicians, academicians, line ministries, regulating authorities, cooperating

partners, civil society organization, trade unions and other stakeholders to develop a benefits package

and tariffs for services covered by the NHIS as a key milestone.

3. PURPOSE OF OPERATIONAL MANUAL

This manual is to guide the implementation of the claims process and to create standards of operation

between NHIMA and healthcare providers (HCPs). The manual also gives a guide as the beneficiaries’

entitlements under the NHIS. The manual describes the scope, purpose and structure of the NHIS tariff.

The document further provides detailed description of the classification of the Diagnosis Related

Groups (DRGs). It includes how they have been formed, what factors have been taken into

consideration in their development, examples of their use as well as benefits.

The manual is to be used as a technical and reference resource for personnel involved in health services

delivery particularly those involved in the claims and reimbursement process, both at the health

facilities and NHIMA.

4

4. CONCEPTUAL FRAMEWORK

The principal function of the NHIS is to provide a predetermined set of benefits through pooling of both

contributions on one-end and health risks on the other. The scheme operates on a tariff based provider

payment mechanism to reimburse healthcare providers for insured health services provided to the

beneficiaries.

The conceptual framework consists of the following:

S/N Description Explanation

A Tariffs 1. The tariffs should encourage efficiency - it should be able to

provide incentives for quality improvement in health care facilities.

The tariff should be linked to National standard treatment

guidelines that incentivise health care providers to practice good

health care

2. The Tariffs should be simple and easy to administer. Simplicity,

ease of use and user friendliness should be a cardinal feature of the

tariffs. It should be such as to allow for rapid data compilation by

health providers and for quick processing and re-imbursement. As

most staff involved in claims management may not be health

personnel, the tariff should be such that those with minimal

knowledge of health terminology should be able to process claims

efficiently and effectively. The tariff structure should be easy to

follow and able to be administered in business rules that can be

built into a robust hospital and claims administration system to

manage risk.

3. The tariff should ensure uniformity in claims for conditions

within a DRG. It should not allow patients with the same

condition/principal diagnosis to have different charges because

slightly different procedures or treatments were done/given. Thus,

detailed fee for service tariff was ruled out.

4. The tariff should ensure equity and fairness. No health facility at

one level of care should be reimbursed at a lower rate than another

at the same level. This is also to ensure improved efficiency, as it

will encourage health facilities to reduce their costs of providing

services as they learn from comparable facilities who are utilizing

resources in a more efficient manner.

5. The Tariff should be based on the principal diagnosis for each

patient. To this end average consumption of hospital resources for

each principal diagnosis are to be calculated and used to determine

the tariff. The average length of stay (ALOS), the costs of

investigations, the average direct costs, etc. are to be computed for

each principal diagnosis. To this end, national guidelines and

protocols for management of conditions are to be followed in

consultation with Clinicians from the various disciplines.

6. The tariff should reflect the total costs, both direct and indirect

incurred in patient care to form the basis for reimbursement.

The cost includes drugs, medical consumables, investigations,

medical procedures, non-clinic costs and capital maintenance costs.

Consideration of other variables maybe considered during future

revision of the package.

B Minimum Health

care benefits covered

by the scheme

1. The tariffs structure should be in accordance with Statutory

Instrument (SI) No. 63 of 2019, which stipulates the minimum

healthcare benefits as well as exclusions.

2. The coverage of the benefits should meet at least the basic and

5

S/N Description Explanation

the commonest health needs of the majority of Zambians. The

NHIS shall cover a selected package of services accessible at

district hospitals, central and provincial hospitals, teaching and

specialized hospitals. The NHIS Benefits package will be accessed

at both the public and private health facilities that are accredited to

NHIMA. Primary health care services shall continue to be provided

free of charge in line with the Health Policy.

3. The tariff should encourage the implementation of the

gatekeeper principle. Services covered under the scheme shall be

accessible on referral from primary health care. However, the

gatekeeper principle shall not apply in case where a bypass fee has

been paid.

4. Grouping of the diseases, procedures and operations should be

clinically coherent and by the extent to which they use health

resources. That is Diagnosis Related Groups or other case mix

measures should be used.

5. WHAT IS THE NHI BENEFIT PACKAGE?

This is the benefit package of the National Health Insurance Scheme offered to esteemed beneficiaries.

The requirement for a benefits package is provided under Part III of the NHI Act No. 2 of 2018 and

Section 10 of the SI 63 of 2019. Health care benefits in this package include the but not limited to the

following:-

S/N Programme / Services Description

1 OPD Registration and

Consultation

This covers for costs related to Registration and Consultation of

patients

2 Pharmaceuticals and blood

products

It covers for the costs of medicines prescribed in Generic

names and medical consumables as per the National Essential

Medicines List. It includes a medicine list recommended from

time to time to meet members evolving needs. The benefit

package provides for whole blood where indicated as part of

the treatment protocol.

3 Investigations It provides for the costs of Investigations and Diagnosis tests as

per the Investigation List in the benefits package.

4 Surgical Services It covers for the cost of Minor, Major, Orthopaedic, ENT and

Diagnosis surgical procedures as per the listed interventions

and tariffs. The surgical costs will cover for anaesthesia costs;

disposables; medicines and medical consumables, dressing and

other medical expendables used during the operation.

5 Maternal, New-born and

Paediatric Services

It provides for cost of deliveries both normal and caesarean,

obstetric and gynaecological interventions, New-born and

paediatric services as listed in the package

6 Inpatient Care Services This covers for the costs of daily patient admission in private or

ordinary ward, Intensive Care Unit, High Dependent Unit

Services for the daily admission costs depending on the level of

the facility and the agreed daily rates as per the tariff schemes,

Investigations, Nursing care, Oxygen therapy, Medicines and

Medical Consumables dispensed while the member is admitted.

At 2nd and 3rd Level facilities, Diagnosis related Groups

(DRGs) will be used to pay providers for inpatient conditions

listed. DRGs are a bundled cost for each condition that include

Drugs, investigations, medical consumables, Non- clinical costs

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(catering, laundry, cleaning and disinfection) and Capital

maintenance of building and equipment

7 Physiotherapy and

rehabilitation services

This is provided to inpatients and outpatients where the facility

has been accredited for these services.

8 Vision care and Spectacles The Fund also pays for visual corrective spectacles to the

member once for every three years. Vision care services have

been included in the package and include interventions for

conditions such as Cataract, Glaucoma and trauma

10 Dental and Oral health

Services

It covers for inpatients and outpatients related to oral health as

per the listed interventions and tariffs. This includes dental

conservation surgeries (e.g. dental filling), gum diseases, dental

extractions and root canal treatment

11 Cancer/Oncology services A limited number of investigations and interventions have been

included for cervical, prostate, breast and Colon cancer.

12 Mental Health

It covers the cost of chronic conditions such as schizophrenia

and affective disorders such as Mania and depression and other

conditions as the NHIS will determine form time to time.

13 Medical /

Orthopaedic

Appliances and

Prosthesis

It is provided for supportive orthopaedic and medical

appliances that are determined by the NHIS from time to time.

14 Services that require Pre-

Authorization approval

CT – Scan (with or without contrast), MRI, Dialysis services,

CATHLAB services- angiogram, balloon & Stenting,

Pacemaker placement, Orthopaedic Implants & Prosthesis,

Spectacles, HDU and ICU beyond stipulated period in the

schedule

6. EXCLUDED SERVICES

Health Care Services not listed in this package are not covered by the NHIS. These include but not

limited to the following:-

1. Public health care services under government or Donor vertical programs,

epidemic and disasters

2. Purchases of cosmetic items, wheel chairs or prosthetic appliances not listed

3. Illegal abortion and illicit drug use

4. Employment injuries or illness arising from occupational hazards which are compensated under other schemes

5. Cosmetic surgery and aesthetic treatments (unless where medically required)

6. All costs for operations, medicines, treatment and procedures for cosmetic purposes

7. Holidays for recuperative purposes

8. Medicines and consumables not registered with ZAMRA including

a. Toiletries, perfumes, deodorants and other beauty preparations

b. Slimming products

c. Homemade remedies

d. Alternative medicines

9. Where a beneficiary is required to pay a penalty to any service provider which penalty

is levied by health provider due to beneficiary not keeping an appointment

7

10. Costs of services rendered by or in respect of;

a. Persons not registered with recognized professional body in terms of legislation

b. Any institutions not registered in terms of legislation

c. Any procedure or treatment not supported by National treatment protocols or

scheme protocols,

d. Any procedure, treatment or medication that is provided to members in the

course of a clinical trial unless authorized by the scheme subsequent to an

authorization request from a member. Treatment or participation in any health

service deemed to be experimental. Experimental, for this policy, refers to

treatment, medicine or other procedures that are a part of a research

programme and have not been approved by the relevant medical board and/or

accreditation authority.

11. Trans-sexual surgery

12. Long-term in-patient nursing care (over 90 days per admission and 180 days per year

for the insured person).

13. Medical treatment of motor vehicle accident injuries covered by other insurance/funds

arrangements, such as motor vehicle insurance and a Motor Vehicle Accident Fund.

14. Treatment of occupational accidents and illness covered by Worker’s Compensation

Fund.

15. Treatment of injuries resulting from declared national disasters in collaboration with

the National Disaster Management and Mitigation Unit.

16. Fertility treatment according to set criteria.

17. Telephone charges

18. Treatment Abroad

7. PROVIDER PAYMENT MECHANISMS

The Provider payment method is “The mechanism used to transfer funds from the purchaser of

health care services (NHIMA) to the accredited healthcare providers.” Several different methods

can be used to pay providers under a health insurance scheme. These include Fee for service (this

is often itemized), Diagnosis Related Groups (DRG) and Capitation.

There is no one perfect method and each method has advantages and disadvantages. Typically,

therefore most successful health insurance schemes use a combination of methods. Each method

has advantages and disadvantages, and a skilful mix of methods, taking into account each unique

country context, including economics and history, is the best approach. Effectively and efficiently

managed health insurance schemes therefore provide often for a mix of provider payment methods,

in a way that allows the advantages and disadvantages of the different methods to balance each

other. These methods are explained below.

7.1 Fee for Service

In a fee for service provider payment method, the provider typically lists the different

services that they have provided for the client and the cost of each service and requests

payment. To use an illustration from day to day life, it is rather like picking up the items you

want from a supermarket shelf and then going to the payment counter for the individual cost

of each item to be entered into the cash register and added up so that you pay your final bill.

The difference between purchasing health care services by fee for service and purchasing

items in the supermarket is that because of the specialized knowledge of the health service

provider, which the client or patient often does not share, the service provider chooses the

“items” for the client.

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The advantage of the fee for service payment method is that the provider has no incentive to

leave anything off the “shopping list”. The disadvantage is that precisely for this reason,

since the provider is also often the “owner” of the shop and the one choosing the items to be

purchased for the client (because of the issues related to specialized knowledge); it is

possible for the provider to provide unnecessary services to maximize profit. It does not

mean that the provider will do this, but it is a known weakness of this system. Experience all

over the world over time shows that it is a system that can lead to very rapid inflation of

costs and threaten the sustainability of health insurance.

7.2 Diagnosis Related Groups (DRG)

In the DRG payment method, related diagnoses are grouped together and the average cost of

treatment in that group determined. Providers are therefore paid according to the diagnosis

they give their client. Many developed countries e.g. USA and U.K, use DRG as part of their

payment systems Under the DRG system providers have to fill claims forms for

reimbursement after providing the services. The claims made by the providers are then

checked (vetted) for accuracy and genuineness before payment. The DRG for services also

still holds some incentives for cost escalation though they are less than under itemized fee for

service. As costs of drugs, investigations, medical consumables, and non-clinical and capital

maintenance costs are bundled into one DRG cost to be paid per condition, the providers are

requested to submit proof of drugs and investigations to quality for the full DRG payment.

Under servicing or failure to provide, proof will lead to a downward adjusted payment being

made to the provider.

7.3 Capitation

Capitation is a provider payment mechanism in which providers in the payment system are

paid, a pre-determined fixed rate to provide a defined set of services for each individual

enrolled with the provider for a fixed period. The Capitation rate will include registration,

consultation, investigations, deliveries, surgical procedures, in patient services, referral

services, medical consumables, non-clinical and capital maintenance costs.

8. HOW WILL THE PAYMENT METHODS BE IMPLEMENTED?

Provider payment methods that will be used in the NHIS at different levels of care are as

follows;

8.1 Tertiary and Second Level Hospital Services.

Capitation will be used for outpatient services and case-based payment (DRGs) for inpatient

referrals will be adopted. The DRGs are a bundled fee that will include the cost of drugs,

investigations, medical consumables, non-clinical (Catering, Laundry, cleaning and

disinfection) and Capital maintenance costs. Fee for service would be used for dialysis, CT

and MRI scan, other imaging services, CATHLAB interventions, Nuclear medicine and blood

products

8.2 District Hospital Services.

It is acknowledged that the current free primary healthcare policy extends to services at

District hospital and as such, they plan to receive grants to cover these costs. The NHI

therefore will supplement funding to accredited District Hospitals using a per-capita rate for

outpatient and inpatient services. Adjustment coefficients will be considered once real-world

data is collected under the scheme. Further, a capped fee-for-service as incentives payments

for adherence to performance targets, appropriate referrals and quality targets will be

considered for District Hospitals.

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9. TARIFF SCHEDULES

The tariffs below specifically apply to government and faith based health care providers. Tariffs for

private health care providers will include an adjustment for human resource and other overhead costs.

9.1 Schedule 1. Second and third level Hospital DRG Tariffs

Drugs, Investigations, medical consumables, Non Clinical (catering, laundry and cleaning),

Capital maintenance

IPD Programme Condition DRG

CODE

ZMW

Communicable Uncomplicated Malaria 98

Complicated Malaria 536

Pneumocystis Carinii Pneumonia 536

Diarrhoeal diseases(non-bloody/bloody

diarrhoea)

782

Bacterial meningitis 721

Non

Communicable

Acute Asthma 670

Asthma Life Threatening 1,277

Diabetes ketoacidosis 1,741

Pulmonary Oedema 601

Heart failure 441

Hypertension 346

Infarctive Stroke (CVA) 688

Haemorrhagic Stroke (CVA) 412

Ischemic heart Disease 1,888

Diabetes Type 1 3,241

Diabetes Type 2 2,000

Internal

Medicine

Peptic Ulcer Disease (PUD) 817

Hepatitis B 2,051

Pneumonia 859

Arthritis 1,182

Sickle Cell Anaemia 1,567

Epilepsy 547

Pulmonary Embolism 2,160

STI (Ulcerative) 162

STI (Discharge) 206

Dialysis per session (includes heparin and

consumables)

1,500

UTI 227

Reproductive &

Maternal Health

Normal labour 469

Caesarean section (Spinal) 1,941

Pelvic Inflammatory Disease 412

Pelvic abscess 1,844

Ectopic pregnancy 1,819

Postpartum Haemorrhage 1,554

Episiotomy Repair 73

Deep vein thrombosis(DVT) 1,986

ANC Mng.Pre-eclampsia and eclampsia 1,103

10


CODE

ZMW

Ruptured Uterus/Emergency Hysterectomy 2,239

APH (Abruptio) 1,900

APH (Placenta praevia) 1,792

Cervical circlage 1,500

Urinary tract infections (UTI) 242

Bartholin Cyst/Abscess marsuplisation 1,250

Fibroids 1,465

Paediatrics Congenital Heart Disease (CHD) and Aquired

heart disease Rheumatic Heart disease

715

Heart Failure 2,022

Simple Diarrhoea (non infectious diarrhoea) 522

Infectious Diarrhoea (Non blood or Bloody) 752

ARI (Pneumonia) 329

Severe Pneumonia 600

Malaria(uncomplicated) 357

Complicated Malaria 793

Prematurity 888

Epilepsy 539

Acute Otitis Media 157

Pharyngitis/ Tonsilitis 154

Sickle Cell Anaemia 175

Neonatal Jaundice 121

Asthma 401

Neonatal Sepsis 124

Diabetes Mellitus 1,279

Cancer Biopsy or local excision of cervical lesion 250

Loop Electrosurgical Excision Procedure 950

Breast Biopsy 200

Prostate Biopsy 500

Eye / Vision

Care

Small Incisional Cataract Surgery 2,481

Glaucoma 1,262

Glaucoma-trabeculectomy with

trabeculotomy-Children

2,647

Glaucoma-Goniotomy-children 2,647

Refractive Errors (Spectacles) 1,141

Corneal Conditions 893

Ocular Trauma 2,216

Foreign Body removal (corneal repair) 500

Eyelid mass/growth excision 1,136

Enucleation 1,134

Evisceration 878

Exeteration 706

Nasal Lacrimal Duct Obstruction- Surgery

(External Dacryocystorhistomy)

771

Paediatric Cataract (Paediatric Lens

Aspiration + Intraocular Lens + Primamry

Posterior Capsulotmy + Anterior Vitrectomy)

2,790

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CODE

ZMW

Paediatric Cataract Surgery (Paediatric

Anterior Segment reformation Surgery)

1,683

Laser Photocoagulation /trabeculoplasty 1,200

Strabismus 1,016

Examination Under Anaesthesia 1,038

Oral Health Dental Carries-Temporal Fillings 237

Dental Carries-Permanent Fillings 375

Root canal treatment 622

Simple extraction 206

Surgical extraction 505

Apicectomy 397

Alveolar ostitis 107

Gingivitis 205

Fungal infections-oral candidiasis 69

Viral infections-(Herpes Simplex,Varicella

Zoster, Oral Hairy leucoplkia)

126

Mouth ulcers 173

Fractures-Mandibular Fractures 558

Infection- Odontogenic and Non Odontogenic-

Abscesses

449

Gingival Hyperplasia 178

Dental Scaling -whole mouth (Must be

medically indicated)

250

Frenulum Attachment 86

ENT Otitis Media-Uncomplicated 235

Foreign body ear /nose/throat 604

Acute Rhinosinusitis 897

Chronic Rhinosinusitis with and without

polyposis

765

Adenotonsillitis 1,544

Laryngeal papilloma 1,395

Epistaxis (cauterization) 1,501

Mental Health

(Tariffs cover

180 days

treatment)

Acute Schizophrenia/Relapsed

Schizophrenia/substance induced psychotic

disorder

2,092

Affective disorders-severe mania/mania 2,459

Depression - moderate/severe 2,229

Minor Surgery

under LA

Male Circumcision 370

Foreign Body Removal 370

Biopsy 370

Excision 370

Debridement and Suturing (minor) 370

Lumpectomy 370

Intercostal Drainage 370

Manipulation Under Anaesthesia + POP 370

Joint dislocation reduction 370

Sloughectomy 370

Incision and Drainage 370

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CODE

ZMW

Diagnosis

Surgical

Procedures

Cystoscopy/Urethroscopy 296

Proctoscopy/Sigmoidoscopy 296

Colonoscopy with polypectomy 1,200

Colonoscopy 296

Endoscopy 296

Examination Under Anaesthesia 296

Major under GA Gastrostomy 1,344

Jejunostomy 1,344

hemorrhoidectomy 1,344

Hydrocoelectomy 1,344

Amputation finger or toe 1,344

Extraperitoneal abscess drainage 1,344

Orchidectomy 1,344

Debridement and Suturing (major trauma) 1,344

Tracheostomy 1,344

Herniorrhaphy/plasty 1,344

Appendicectomy 1,344

Gastrectomy 1,344

Abdominal Perineal Resection 1,344

Laparotomy 1,344

Cholecystectomy 1,344

Thyroidectomy 1,344

Mastectomy 1,344

Parotidectomy 1,344

Colostomy 1,344

Splenectomy 1,344

Colectomy 1,344

Pancreatectomy 1,344

Skin graft 1,344

Nephrectomy 1,344

Prostatectomy 1,344

Craniectomy 1,344

Orthopaedics ORIF Plate and screws 1,824

ORIF K-Nail 1,476

External Fixation 1,664

K wiring 1,352

Tendon Repair 1,344

Arthrotomy 1,344

Amputation 1,344

PMR Club foot 1,344

Ponseti Club foot 370

Intra Articular Injection 150

Sequestrectomy 370

Exercise therapy

(120 min

session)

General Exercise 111

Pre & Post natal 111

Pre & Post Operative 111

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CODE

ZMW

Specialized Exercise Training 111

Keep fit/group exercise 111

Manipulative Therapy-reduction of joints,

fractures and POP immobilization/splinting

111

ICU

Accommodation

fee per day (First

7 days after

which revert to

HDU tariff)

The set prices for the ICU services include

Consultation and Registration fees; Admission

fees, Resuscitation services, Investigations,

Radiological investigations, Medicines,

Medical Consumable, Nursing care and

monitors services. The above mentioned rate

will cover for everything, No other charges

will be accepted

3,000

HDU

Accommodation

fee per day

The set prices for the HDU services includes

charges for Resuscitation services given at

Causality Department, Consultation and

Registration fees, Admission fee, Nursing

care, Ventilator and monitors services. Covers

a Maximum of 5 days. Extensions beyond 5

days requires Pre Authorization

375

Accommodation

Premium/Private

Wards fee per

day

Per night up to standard LoT and Maximum of

7days per event. Cost includes

accommodation, Nursing care, Oxygen

therapy. Extension beyond 7 days requires Pre

Authorisation

200

OPD

Registration &

Consultation

Initial Visit 200

Subsequent Visit (limited to 2 review visits) 150

Chronic conditions after initial and two

subsequent visits (e.g. Hypertension, Diabetes,

Asthma, Arthritis, sickle cell, epilepsy etc)

35

Blood Products Unit whole Blood 45

9.2 Schedule 2. District Hospital Tariffs

Standardised based on expected Capitated Utilisation per facility.

Type of Visit ZMW

Per OPD visit 35

Per IPD case 105

9.3 Schedule 3. Laboratory Services.

Type of Laboratory Test ZMW

Serology Immunology,

virology

RPR test for syphilis 33.68

Rapid syphilis test 38.28

Rapid HIV Test - Determine 40.78

Rapid HIV Test - SD Bioline 40.98

Rapid HIV Test - Wantai 40.78

14


Rapid duo HIV /syphilis test - SD Bioline 47.78

Rapid Hepatitis C 42.78

Rapid Hepatitis B 41.98

Rheumatoid Factor 37.58

CD4,CD8 Count 107.78

HIV Viral load Analysis 173.78

HIV DNA PCR 173.78

Bio Chemistry, Tumor

Markers, Hormones,

Immunochemistry, Cardic

Makers

Magnesium 43.85

Calcium 36.19

Phosphorus 42.19

Cholesterol 42.94

Auto-Creatinine 38.3

HDL cholesterol 60.14

LDL cholesterol 88.34

Glucose 37.3

Urea 40.44

Albumin 37.67

Total protein 36.5

Acid phosphatase 72.43

Uric acid 42.17

Triglycerides 40.58

Auto-BILIRUBIN D 39.36

Auto-BILIRUBIN T 41.04

Lipase 95.85

Pancreas-amylase 68.42

LDH liquid 41.87

CK NAC activated 55.18

GOT (ASAT 37.72

GPT (ALAT) 37.98

G-GT 43.6

Alkaline phosphatase 39.18

A-AMYLASE 43.58

Alkaline phosphatase 39.03

Ck mb 62.48

Iron tptz 46.74

Electrolytes 44.78

Blood Glucose using accucheck 36.91

Glycated HB 85.97

CSF Total Protein 36.5

CSF Glucose 37.3

Total Protein - Pleural Tap '-Effusion, etc 36.5

C-reactive Protein 52.32

Brain natriuretic peptide (BNP) 457.58

ACTH test 71.91

AFP Test 71.2

Anti-HAV IgM 107.4

15


Anti-HAV 87.89

Anti-HBc 66.13

Anti-HBc IgM 81.61

Anti-HBe 67.11

Anti-HBs 54.74

Anti-HBs 47.33

Anti-HCV 65.58

Vitamin B12 52.78

Cancer Antigen (CA) 125 59.67

Cancer Antigen CA 15 166.16

Cancer Antigen CA 19-9 166.16

Cancer Antigen CA 72-4 166.16

Carcinoembryonic Antigen CEA 86.21

CK-MB STAT 45.31

CMV IgG 60.18

CMV IgM 64.45

Cortisol 59.56

DHEA-S 84.04

Digoxin 87.44

Estradiol 50.16

Ferritin 51.09

Free HCGbeta 83.56

Folate 56.95

Folate RBC 45.64

free PSA 61.13

Follicle-stimulating hormone 54.13

Free T3 38.9

Free T4 42.18

Triiodothyronine (T3) 51.92

Thyroxine (T4) 52.89

HBeAg 73.69

HBsAg 61.15

HCG 54.71

HCG+beta 61.45

Human Growth Hormone 66.7

IgE 63.5

Insulin 67.4

Myoglobin 129.46

Progesterone 46.29

Prolactin 54.51

proBNP 208.94

Total PSA 58.74

Rubella IgG 69.09

Rubella IgM 69.09

Troponin I 68.97

Troponin T 68.98

16


Toxo IgG 56.37

Toxo IgM 58.72

Thyroid Stimulating Hormone 46.54

Serum Vitamin D 77.96

Serum Vitamin B12 77.96

Haematology,

immunohaematology

Full Blood Count FBC 48.08

Haemoglobin (HB) 37.78

Differential Count 82.78

Solubility Test (for Sickling) 117.78

HB Electrophoresis 117.78

Reticulocyte Count 82.78

Bleeding time 122.78

Clotting Time 122.78

Activated Partial Prothrobin Time 122.78

Prothrobin Time 122.78

INR 122.78

Antinucleic Factor 272.78

Bone Marrow Aspiration Procedure 232.78

Bone Marrow May-Grunwald stain 232.78

Bone Marrow special stains 232.78

Coagulation Factor Assays, each 132.78

Fibrinogen antigen test 132.78

Fibrinogen Degradation Products (FDP) Test 132.78

D-Dimer test 132.78

Grouping ABO (Blood) 132.78

Rhesus Factor 132.78

Cross-Matching 132.78

Bacteriology

Culture & Sensitivity Urine 169.79

Culture & Sensitivity - Stool 169.79

Culture & Sensitivity-cerebral spinal 169.79

Culture & Sensitivity - Pus 169.79

Culture & Sensitivity - Blood 169.79

Culture & Sensitivity - sputum 169.79

Culture & Sensitivity HVS 169.79

Culture & Sensitivity Urethral swab 169.79

Culture & Sensitivity - other body fluids 169.79

Microbia identification (API 20e) 279.79

Microscopy sputum 92.29

Microscopy - Pus 129.79

Microscopy Urine 129.79

Microscopyy - Stool 129.79

Microscopy CSF 129.79

Microscopy- other body fluids 129.79

Gram Stains - All specimens 96.05

Urea breath test 199.79

17


Cryptococcal Antigen Latex - CSF/serum 87.01

Chlamydia Test 388.99

Sputum Gene Xpert 186.79

Parasitology

Occult Blood 213.49

Blood parasites 83.29

Malaria Blood slide 52.79

Malaria RDT 51.79

Toxoplasma antibodies - serum 100.53

Pregnancy Test (Urine) 51.51

Unialysis 10 parameter 50.52

Unialysis Glucose and Protein 50.52

Histology, Cytology and

Immunohistochemistry

Single block from a specimen 82.78

Hematoxylin and eosin single slide staining 107.78

Ziel Neesen stain for a single slide 177.78

Masson trichrome stained slide 297.78

Periodic Acid Schiff Stain 177.78

Alcian Blue Stain 175.28

Grocott-Methenamine Silver Stain 317.78

Immunohistochemistry stain single slide 747.78

Histology Large Surgical Specimen (6-10 blocks) e.g uterus

with fallopian tubes and ovaries, mastectomy 1,177.78

Histology Medium sized surgical specimen (3-5 blocks) e.g

prostatectomies 607.78

Histology small surgical specimen (1-2 blocks) e.g skin

ellipse 227.78

Histology small biopsies (1-2 blocks) e.g Trucut Biopsies/

needle biopsies 227.78

Liver biopsy histology (H & E) to include special stains

(masson trichrome, silver, PAS) 907.78

Renal biopsy histology (H & E) to include special stains

(masson trichrome, silver, PAS) 907.78

Cervical Papanicolaou smear 258.78

Fine Needle Aspirate 261.72

Fluid cytology (1 PAP and 1 Giemsa) 261.81

Arterial Blood gas 184.53

9.4 Schedule 4. Radiology / Imaging.

Type of Imaging ZMW

Plain film X-Ray (Analog or Digital)

Skull 180

Neck 180

Chest 180

Abdomen 180

Limb 180

18

Type of Imaging ZMW

Joint 180

Spine (per region) 180

Intraoral Xray 100

Any other region 180

Ultrasound

Ultrasound scan 400

Doppler 500

ECHO 450

US guided interventions(e.g biopsy, aspiration etc)

500

Contrast studies: (Digital OR

Analogue)

Ba swallow 500

Ba meal 500

Ba meal follow through 500

Small bowel enema(SBE) 500

Ba enema 500

IVU 500

Cystogram 500

Urethrogram 500

MCUG 500

HSG 500

Sinogram 500

Fistulogram 500

Mammogram:(Analog or Digital) - Diagnosis 100

- Screening 100

Computed Tomography Per region without contrast 2,000

Per region with contrast 2,600

MRI: Per region without contrast 1,800

Per region with contrast 3,125

Cathlab

Diagnosis Coronary angiogram 13,520

Coronary Balloning & Stenting 30,000

Pace Maker Placement 85,600

Nuclear Medicine

Bone scan 850

Thyroid scan 850

Renal scintigraphy 850

Cardiac scintigraphy 850

Brain scan 850

Q/V scan 850

Inflammatory/infection 850

Liver scan 850

Venogram 850

Gastrointestinal (scan) 850

Gastrointestinal (reflux) 850

Salivary glands 850

Milk Scan 850

I 131 therapy 1,000

19

9.5 Schedule 5. Prosthetics.

TYPE OF PROSTHETIC ZMW

Prosthetics- Lower Limbs

Hip Prosthesis Polypropylene 7,000.00

Modular (Laminated) 11,000.00

Transfemoral Prosthesis

polypropylene 4,500.00

Modular without Silicon liner (Laminated) 7,000.00

Modular with silicon (Laminated) 9,000.00

Transtibial Prosthesis


Modular with silicon (laminated) 7,000.00

Modular without Silicon liner (Laminated) 5,000.00

Knee Disarticulation


Modular Without silicon (Laminated) 7,000.00

Modular with silicon (Laminated) 8,000.00

Symes Prosthesis polypropylene 2,500.00

Modular 5,000.00

Orthoprosthesis Polypropylene 2,600.00

Modular 5,000.00

Partial Foot Prosthesis Laminated/Polypropylene 1,200.00

Orthotics – Spine

Cervical Collar Adult 500.00

Child 300.00

Lumbar Brace Adult 1,600.00

Child 800.00

Thoracolumbar Brace Adult 3,000.00

Child 1,500.00

Cervical-Thoracal - lumbar

sacral orthosis

Adult 3,500.00

Child 1,750.00

Medical and Orthopedic Appliances

Axillary Crutch (Each) 250

Hearing Aid (Pair) 370

Neck Collar with shin support 250

Knee Braces 500

Lumbar Belt and Trunk Corset 190

Drop foot splint 300

Elbow crutch (each) 250

Triangular arm sling 125

Knee cap 100

Knee support 100

Ankle /Wrist support 100

Denture per tooth 160

Orthodontic appliance fixing per jaw ( procedure and material) 1600

20

TYPE OF PROSTHETIC ZMW

Varicose stocking – full 315

Varicose stocking -below knee 125

9.6 Schedule 6. Orthopedic Implants (Requires Pre Authorization)

TYPE OF ORTHOPEDIC IMPLANTS ZMW

ORIF plate and Screw

Pedicle Screws + plugs 4,650

Rods 1,750

cervical plates + screws 6,950

peek Cage spacer 6,200

10 hole and below plate 400

11 hole and above plate 650

Per screw 150

ORIF K Nail Ordinary 500

inter locking 1,650

External fixation

Rush pin 150

Ortho fix/set 8,500

Ex fix/set for Tibia 3,500

K wiring per wire 80

malleable wires 100

HIP replacement

thompson 8,000

Austin Moore 10,000

total cemented 16,000

Total uncemented 21,000

Knee Replacement 21,000

Bone Cement 1,500

9.7 Schedule 7. Drugs.

PRODUCT DESCRIPTION STRENGTH DOSAGE FORM

Basic Unit Price LEVEL OF ACCESS

MEDICINES FOR INFECTIONS


Basic Unit Price

(ZMW) LEVEL OF ACCESS

1.0 ANTIBIOTICS

PENICILLINS

Ampicillin (sodium salt) 500mg injection Each Vial 5.00 I - IV

Amoxycillin (trihydrate) 250mg Capsule Tablet 0.30 HP - IV

Amoxycillin (trihydrate) 100ml 125mg/5ml suspension Bottle 9.00 HP - IV

Amoxycillin(trihydrate) Combined With Clavulanate 500mg/125 mg capsule capsule 4.30 I - IV

Amoxycillin(trihydrate) Combined With Clavulanate 125/31 mg suspension Bottle 40.00 I - IV

Amoxycillin+Clavulenic acid 625mg Tablet Tablet 4.30 I - IV

Benzathine Benzylpenicillin(sodium) 2.4 mega injection Each Vial 9.00 HP- IV

Benzyl Penicillin Sodium 5mega injection Each Vial 9.00 HC - IV

21



Phenoxymethyl Penicillin (as potassium salt) 100ml 125mg/ml suspension Each Bottle 17.00 HC - IV

Phenoxymethy Penicillin (as potassium salt) 250mg tablet Each Tablet 0.40 HC - IV

Procaine Penicillin 3MU injection Each Vial 9.00 I - IV

Cloxacillin 250mg capsule Each Tablet 0.40 HP - IV

Cloxacillin(sodium) 500mg injection Each Vial 6.00 II - IV

Cloxacillin 125mg/5ml suspension Each Bottle 17.00 I - IV

CEPHALOSPORINS

Cefotaxime Sodium 1g injection Each Vial 12.00 II - IV

Ceftriaxone (sodium) 250mg injection Each Vial 8.00 II - IV

Ceftriaxone Sodium 1g injection Each Vial 8.00 I - IV

Cephalexin 100ml 125mg/5ml suspension Each Bottle 30.00 I - IV

Cephalexin 250mg tablet Each Tablet 1.00 I - IV

Cefuroxime 100ml 125mg/5ml suspension Each Bottle 35.00 II - IV

Cefuroxime 250mg tablet Each Bottle 2.80 II - IV

Cefixime 200mg tablet Each Bottle 6.50 II - IV

Cefixime 30ml 100mg/5ml suspension Each Bottle 26.00 II - IV

Imipenem 1gm Injection Each Vial 280.00 III - IV

CHLORAMPHENICOL

Chloramphenicol (sodium succinate), 100ml 125mg/5ml suspension Each Bottle 30.00 II - IV

Chloramphenicol 250mg capsule Each Tablet 1.00 II - IV

Chloramphenicol Sodium Succinate 1g injection Each Vial 30.00 II - IV

Vancomycin hydrochloride 1g injection Each Vial 250.00 IV

Vancomycin hydrochloride 500mg injection Each Vial 150.00 IV

QUINOLONES

Ciprofloxacin (hydrochloride) 250mg tablet Each tablet 0.60 HC - IV

Nalidixic Acid,100ml 300mg/5ml suspension Each Bottle 30.00 I - IV

Nalidixic Acid 500mg tablet Each Tablet 1.00 I - IV

Ofloxacin 200mg tablet Each Tablet 10.00 I - IV

TETRACYCLINES

Doxycycline(hyclate) 100mg tablet Each Tablet 0.50 All

AMINOGLYCOSIDES

Gentamycin Sulphate 40mg/ml injection Each Ampoule 4.00 I - IV

Kanamycin 1g injection Each Vial 7.00 I - IV

AMOEBICIDES

Metronidazole , 100ml 5mg/ml injection Each Bottle 10.00 I - IV

Metronidazole benzoate, 100ml 125mg/5ml suspension Each Bottle 9.00 I - IV

Metronidazole 200mg tablet Each Tablet 0.15 HP - IV

Tinidazole 500mg tablet Each Tablet 3.00 II - IV

Metronidazole oral gel , 30g tube Oral Gel Each tube of Oral gel

17.00 I - IV

SULPHONAMIDES

Co-Trimoxazole, 100ml 240mg/5ml suspension Each Bottle 9.00 HC - IV

Co-Trimoxazole 480mg tablet Each Tablet 0.20 HC - IV

Cotirmoxazole 96mg/ml I.V injection Each Ampoule 120.00 III- IV

22



NITRO-FURAN DRUGS

Nitrofurantion 50mg 50mg tablet Each Tablet 0.30 I - IV

MACROLIDES

Azithromycin Tablet 250mg tablet Each tablet 2.50 II - IV

Azithromycin Oral , 30ml 200mg/5ml suspension Each Bottle 15.00 II - IV

Clarithromycin 250mg tablet Each Tablets 10.00 II - IV

Erythromycin Ethyl Succinate 100ml 125mg/5ml suspension Each Bottle 19.00 I - IV

Erythromycin Stearate 250mg tablet Each Tablet 0.50 I - IV

ANTIFUNGALS

Fluconazole 200mg Tablet Each Tablet 10.00 III - IV

Miconazole, 30g Tube Oral Gel Each tube of Oral gel

25.00 III - IV

Miconazole Nitrate 2% 30g Tube Cream Each tube of cream

13.00 I - IV

Griseofulvin 125mg Tablet Each Tablet 5.00 HP - IV

Clotrimazole Pessaries 500mg Pessaries Each pessaries 4.20 HP - IV

Nystatin Oral Susp, 30ml Btl 100,000iu/Ml Suspension Each Bottle 15.00 HP - IV

Amphotericin B, 50mg/vial injection Each Vial 180.00 II - IV

ANTI-VIRALS

Acyclovir 200mg tablet Each Tablet 0.60 HP - IV

Acyclovir, Tab 400mg 400mg tablet Each Tablet 7.50 HP - IV

Ganciclovir Pwdr For Inj 500mg injection Each Vial 750.00 II - IV

2.0. DRUGS USED FOR PAIN AND INFLAMATION


UNIT PACK PATIENT COURSE

LEVEL OF ACCESS

ANTI-PYRETICS-NON STEROIDAL ANTI INFLAMMATORY

Acetylsalicylic Acid 300mg Tablet Each Tablet 3.00 HP - IV

Diclofenac sodium 50mg Tablet Each tablet 12.50 HC - IV

Diclofenac sodium 75mg/3ml Injection Each Ampoule 10.00 HC - IV

Ibuprofen 200mg Tablet Each Bottle 0.20 HP - IV

Ibuprofen 100mg/5ml syrup Each Bottle 20.00 HP - IV

Paracetamol 500mg Tablet Each Tablet 0.20 HP - IV

Paracetamol 100mg Tablet Each Tablet 9.00 HP - IV

Paracetamol 120mg suppositories Each suppository

65.00 HP - IV

Aceclofenac +Paracetamol 100mg+500mg tablets Each Tablet 1.00 HC - IV

ANTI-GOUT

Allopurinol 100mg Tablet Each Tablet 1.40 II - IV

NARCOTIC ANALGESICS

Morphine Sulphate 30mg Tablet Each Tablet 5.00 II - IV

Morphine sulphate 10mg Tablet Each Tablet 10.00 II - IV

Morphine Sulphate 10mg/ml Injection Each Ampoule 4.00 II - IV

Morphine Sulphate, 5g Powder Each Bottle 300.00 II - IV

Morphine Sulphate 5mg/5ml syrup Each Bottle 30.00 II - IV

Pethidine 100mg/2ml Injection Each Ampoule 40.00 I - IV

Pethidine 50mg/ml Injection Each Ampoule 25.00 I - IV

23



Tramadol 50mg Tablet Each tablet 12.00 II - IV

Fentanyl 12.5mcg Transdermal Patch

Each Patch 10.00 II - IV

Fentanyl 25mcg Transdermal Patch






Paracetamol + Codeine Phosphate 500mg+30mg Tablet Each Tablet 6.50 II - IV

3.0 DRUGS ACTING ON THE GASTROINTESTINAL SYSTEM

ANTI DIARRHOEAL

Loperamide 2mg Tablet Each Tablet 0.30 I - IV

Oral Rehydration Salt 27.9g sachet Each Sachet 2.00 HP - IV

Zinc Sulphate 10mg Tablet Each Tablet 0.85 HP - IV

ANTI ACIDS

Omeprazole 20mg 20mg Capsuls Each tablet 0.30 II - IV

LAXATIVES

Biscodyl 5mg Tablet Each Tablet 0.30 II - IV

Lactulose 3.1-3.7g/5ml Solution Each Bottle 45.00 II - IV

ANTI SPASMODICS

Hyoscine Butyl Bromide 10mg Tablet Each tablet 1.80 I - IV

Hyoscine Butyl Bromide 20mg/ml Injection Each Ampoule 12.00 I - IV

ANTI EMETICS

Metoclopramide 10mg Tablet Each Tablet 1.25 I - IV

Metoclopramide 10mg/2ml Injection Each ampoule 6.00 I - IV

Ondansetron (as hydrochloride) 2mg/2ml Injection Each ampoules 8.00 II - IV

Ondansetron (as hydrochloride) 2mg/ml,30mls Solution Each bottle of 30 ml

17.00 II - IV

Ondansetron (as hydrochloride) 4mg Tablet Each Tablet 17.00 II - IV

Ondansetrone Mouth dissolving 8mg Tablet Each tablets 17.00 III - IV

4.0 DRUGS USED IN THE TREATMENT OF DIABETES

ANTIDIABETIC

Insulin, long acting, biphasic, 10ml vial 100IU Injection Each Vial 160.00 II - IV

Insulin, intermediate and long acting, (30/70), 10ml vial 100IU Injection Each Vial 160.00 II - IV

Insulin, short acting, soluble, 10ml vial 100IU Injection Each Vial 160.00 II - IV

Glibenclamide 5mg Tablet Each Tablet 0.30 HC - IV

Gliclazide 80mg Tablet Each tablet 2.00 II - IV

Glimepiride 2mg Tablet Each Tablet 2.00 II - IV

Glimepiride/Metformin 2mg/500mg Tablet Each Tablet 8.30 II - IV

Metformin B.P 500mg Tablet Each Tablet 0.30 HC - IV

Glucagon Hydrochloride with lactose, PWD for Reconstitution 1mg/unit Injection Each Vial 10.00 II - IV

5.0 DRUGS USED IN THROMBOEMBOLIC DISORDERS

ANTICOAGULANTS

Heparin Sodium, Usp 5ml 5000iu/ml Inj Each Vial 50.00 II - IV

Warfarin Sodium, 5mg Tablet Each tablet 1.90 II - IV

Acetylsalicylic acid 75mg Tablet Each Tablets 0.63 I - IV

24



Enoxaparin Sodium Syringe (Pre-Fill) 40mg/0.4ml Inj Each Ampoule 100.00 II - IV

6.0 DRUGS ACTING ON THE CARDIOVASCULAR SYSTEM

CARDIOVASCULAR

Digoxin,2ml Amp 0.25mg/ml Injection Each Ampoule 20.00 II - IV

Digoxin 0.25mg Tablet Each Tablet 0.30 II - IV

Hydrochlorthiazide 25mg Tablet Each Tablet 0.15 II - IV

Frusemide, 2ml Amp 10mg/ml Injection Each ampoules 4.00 I - IV

Frusemide 40mg Tablet Each tablets 5.00 I - IV

Amiloride + Hydrochlorthiazide 5mg/50mg Tablet Each tablets 2.00 HC - IV

Atenolol 50mg Tablet Each tablets 0.18 I - IV

Glyceryl Trinitrate 500mcg 500mcg Tablet Each tablets 1.20 II - IV

Isosorbide Dinitrate 20mg 20mg Tablet Each tablets 4.00 II - IV

Isosorbide Mononitrate 10mg Tablet Each tablets 2.10 II - IV

Nifedipine Retard 20mg Tablet Each tablets 0.35 HC - IV

Nifedipine Retard 20mg Tablet Each tablets 2.00 HC - IV

Nifedipine, Sublingual 10mg Tablet Each tablets 0.35 II - IV

Spironolactone 25mg Tablet Each tablets 0.80 I - IV

Propranolol Hydrochloride 40mg Tablet Each tablets 0.35 I - IV

Carvedilol 6.25mg Tablet Each tablets 1.90 II - IV

Hydralazine, 1ml Amp 25mg/ml Injection Each Ampoule 1.96 II - IV

Hydralazine 25mg Tablet Each Tablets 45.00 II - IV

Enalapril 10mg Tablet Each Tablets 2.30 HC - IV

Losartan Potassium 50mg Tablet Each tablets 0.38 II - IV

Verapamil 20mg Tablet Each tablets 1.54 II - IV

Amlodipine 5mg Tablet Each tablets 0.40 II - IV

Simvastatin (Simcard) 20mg Tablet Each tablets 1.42 II - IV

Telmisartan 40mg Tablet Each tablet 4.70 II - IV

Methydopa, film coated 250mg Tablet Each tablets 10.00 HC - IV

Dobutamine 250mg/20ml Injection Each Ampoule 120.00 II - IV

Dopamine 40mg/ml Injection Each Ampoule 50.00 II - IV

Lisinopril 5mg Tablet Each Tablet 35.00 II - IV

Captopril 25mg Tablet Each Tablet 40.00 II - IV

Losartan + Hydrochlorthiazide 50mg/12.5mg Tablet Each tablet 1.30 II - IV

Bisoprolol fumarate 2.5mg/ml tablet each tablet 90.00 II - IV

Tadalafil tablets 20mg Tablet each tablet 20.00 II - IV

labetalol hydrochroride 50mg tablet each tablet 50.00 II - IV

doxazosin 2mg Tablet each tablet 5.00 II - IV

Alteplase 2mg(1.16 million units) vial each vial 810.00 II - IV

Streptokinase 250 000 units vial each vial 290.00 II - IV

tranexamic acid 100mg/ml injection each injection of 5ml

36.00 II - IV

urokinase 10000 units injection each injection 650.00 II - IV

Etamsylate 500mg tablet each tablet 2.00 II - IV

Clopidogrel 75mg tablets each tablet 3.00 II - IV

25



Diazoxide injection 15mg/ml injection each ampoule of 20ml

300.00 II - IV

mannitol injection 10% injection each infusion,250ml

50.00 II - IV

Amiodarone HCL 100mg Tablet Each Tablet 6.50 III - IV

7.0 DRUGS ACTING ON THE HAEMAPOETIC SYSTEM

HAEMATINICS

Ferrous Sulphate 200 mg Tablet Each Tablet 2.00 HP - IV

Folic Acid 5 mg Tablet Each Tablet 3.00 HP - IV

Folic Acid 0.4mg Tablet Each Tablet 2.00 HP - IV

Heparin Sodium, in 5ml 25000iu Injection Each ampoules 10.00 II - IV

Heparin Sodium in 5ml 5000iu Injection Each Vial 20.00 II-IV

Erythropoetin, 0.5ml Prefilled Syringes 4000iu Injection Each prefilled syringe

300.00 III - IV

Erythropoetin, 0.5ml Prefilled Syringes 2000iu Injection Each prefilled syringe

150.00 III - IV

Iron Sucrose (venofer) 100mg/5ml Injection Each Vial 60.00 III - IV

8.0 DRUGS USED TO TREAT HELMINTIC INFESTATIONS

ANTITHELMITICS

Mebendazole 500mg Tablet Each tablet 6.00 HP - IV

Mebendazole 100mg Tablet Each Tablets 9.00 HP - IV

Albendazole 400mg Tablet Each tablets 30.00 HP - IV

Pyrantel Pamoate 125mg Tablet Each tablet 1.00 HP - IV

Praziquantel 600mg Tablet Each tablet 5.00 HP - IV

9.0 DRUG ACTING ON THE CENTRAL NERVOUS SYSTEM

ANTIPSYCHOTIC MEDICATIONS

Fluphenazine Decanoate, 1ml 25mg/ml Injection Each ampoule 35.00 I - IV

Haloperidol, 1ml 5mg/ml Injection Each ampoule 20.00 I - IV

Haloperidol 5mg Tablet Each tablet 1.00 I - IV

Trifluoperazine 5mg Tablet Each tablet 30.00 I - IV

Chlorpromazine Hcl 1ml 25mg/ml Injection Each Ampoule 25.00 I - IV

Chlorpromazine Hcl, Tab 100mg 100mg Tablet Each tablet 0.60 I - IV

Risperidone 1ml 25mg/ml Injection Each Ampoule 2000.00 II - IV

Risperidone 2mg Tablet Each Tablet 2.50 II - IV

Quetiapine 25mg Tablet Each Tablet 4.10 II - IV

Quetiapine 100mg Tablet Each Tablet 35.00 II - IV

Clozapine 50mg Tablet Each Tablet 3.00 III - IV

Flupenthixol Decanoate 1ml 100mg/ml Injection Each Ampoule 120.00 II - IV

Zuclopenthixol Decanoate 1ml 200mg/ml Injection Each Ampoule 400.00 II - IV

MOOD STABILIZERS AND ANTI-EPILEPTIC MEDICATIONS

Phenobarbitone Sodium 1ml 200mg/ml Injection Each Ampoule 4.00 I - IV

Phenobarbitone 30mg Tablet Each Tablet 4.00 I - IV

Phenytoin Sodium 100mg Tablet Each Tablet 0.90 II - IV

Sodium Valproate 200mg Tablet Each Tablet 2.80 II - IV

Divalporex (Sodium Valp + Valproeic Acid) 500mg Tablet Each Tablet 7.60 II - IV

Sodium Valproate 200mg/5ml Susp Each bottle of 5 ml

30.00 II - IV

26



Carbamazepine 200mg Tablet Each Tablet 0.54 I - IV

Lithium Carbonate 300mg Tablet Each Tablet 2.00 IV

ANXIOLYTICS AND HYPNOTIC

Diazepam 2ml 5mg/ml Inj Each Ampoule 25.00 HP - IV

Diazepam 5mg Tablet Each tablet 1.00 I - IV

Alprazolam 0.25mcg Tablet Each tablet 30.00 III - IV

Lorazepam 2mg/ml Injection Each Ampoule 25.00 III - IV

Lorazepam 2mg Tablet Each tablet 10.00 III - IV

Nitrazepam 5mg Tablet Each Tablet 20.00 III - IV

Midazolam 5mg/ml Injection Each Ampoules 60.00 III - IV

ANTIDEPRESSANTS

Fluoxetine 20mg Tablet Each Tablet 2.30 I-IV

Imipramine 25mg Tablet Each Tablet 1.25 I-IV

Amitryptiline Hydrochloride 25mg Tablet Each Tablet 1.25 I - IV

Escitalopram Oxalate 10mg Tablet Each Tablet 5.30 IV

10 DRUGS ACTING ON THE EYE

EYE PREPARATIONS

Gentamycin Sulphate, 5ml 0.003 ear drops Each bottle of 5 ml

6.00 HP - IV

Acyclovir Eye 4.5gm 0.03 eye ointment Each tube of eye ointment

12.00 I - IV

Amethocaine 0. 5ml 0.01 eye drops Each bottle of 5 ml

15.00 I - IV

Atropine Sulphate, 5ml Eye Drops 0.01 eye drops Each bottle of 5 ml

20.00 I - IV

Betamethasone 0.001 eye drps Each bottle of 5 ml

7.00 I - IV

Betamethasone 0.001 eye/ ear drps Each bottle of 5 ml

7.00 I - IV

Betaxolol 0.5% Drops 0.005 eye drops Each bottle of 5 ml

200.00 III - IV

Brinzolamide 10mg/ml eye drops Each bottle of 5 ml

150.00 III - IV

Bromonidine +Timolol 5ml 0.2% +0.5% eye drops Each bottle of 5 ml

90.00 III - IV

Chloramphenicol ,10ml 0.5% 10ml eye/ear drops Each bottle of 5 ml

9.00 HP - IV

Chloramphenicol ,5ml 0.005 eye/ear drops Each bottle of 5 ml

15.00 HP - IV

Ciprofloxacin Hcl Usp, 5ml 0.003 eye drops Each bottle of 5 ml

16.00 I - IV

Dexamethasone , 5ml 0.001 eye drops Each bottle of 5 ml

7.00 I - IV

Dexamethasone / Getamycin Sulphate , 5ml 0.1%/0.3% eye drops Each bottle of 5 ml

15.00 III - IV

Dexamethasone / Neomycin Sulphate, 5ml 0.1%/0.35% eye drops Each bottle of 5 ml

9.00 III - IV

Dorzolamide 0.02 eye drops Each bottle of 5 ml

150.00 III - IV

Econazole 5g 0.02 eye ointment Each tube of eye ointment

30.00 II - IV

Fluorometholone , 5ml 0.001 eye drops Each bottle of 5 ml

60.00 III - IV

Gentamycin + Hydrocortisone, 5ml 0.03 eye/ear drops Each bottle of 5 ml

20.00 II - IV

Gentamycin Sulphate Eye/Ear Drops, 5ml 0.003 eye/ear drops Each bottle of 5 ml

9.00 HP - IV

Hydrocortisone , 5g 0.01 eye ointment Each tube of eye ointment

12.00 II - IV

Hydrocortisone 5ml 0.01 eye drops Each bottle of 5 20.00 II - IV

27



ml

Hydroxyethlcellulose +sodium chloride 0.5ml 0.44%+0.35% eye drops Each bottle of 5 ml

40.00 II - IV

Hypromellose Eye Drops 0.003 eye drops Each bottle of 5 ml

40.00 III - IV

Latanoprost 50mcg/ml eye drops Each bottle of 5 ml

296.00 III - IV

Lignocain ,0.5ml Drop 0.04 eye drops Each bottle of 5 ml

20.00 III - IV

Pilocarpine Nitrate Eye Drops, 5ml 0.5%. eye drops Each bottle of 5 ml

20.00 II - IV

Prednisolone Acetate , 5ml 0.01 eye drops Each bottle of 5 ml

29.00 III - IV

Sodium Cromoglycate , 5ml 0.02 eye drops Each bottle of 5 ml

29.00 I - IV

Tetracaine HCL 0.5% eye drops Each bottle of 5 ml

30.00 III - IV

Tetracycline Eye Ointment 0.03 eye ointment Each tube of eye ointment

6.00 HP - IV

Timolol Drop 0.005 eye drops Each bottle of 5 ml

29.00 III - IV

Travoprost 40mcg/ml eye drops Each bottle of 5 ml

40.00 III - IV

Tropicamide 0.005 eye drops Each bottle of 5 ml

38.00 III - IV

11. DRUGS ACTING ON THE SKIN

LOCAL APPLICATIONS

Acyclovir, Topical 5g Tube 0.03 Cream Each tube of cream

10.00 II - IV

Acyclovir, Tropical Solid 10g Tube 0.05 Cream Each tube of cream

120.00 II - IV

Benzocaine(Anaesthestic+Analgestic)Oral Spray 0.2 Spray Each bottle of spray

150.00 II - IV

Benzyl Benzoate Lotion, 1 litre 25%/litre Lotion Each bottle of Lotion

12.00 HP - IV

Betamethasone Valerate 30g 0.001 Cream Each tube of cream

15.00 II - IV

Calamine Lotion, 1 Litre Btl Lotion Each bottle of Lotion

12.00 HP - IV

Clotrimazole Vaginal Tablet 500mg Pessary Each pessarie 16.00 HP - IV

Clotrimazole, 20g Tube 0.01 Cream Each tube of cream

29.00 HP - IV

Hydrocortisone Cream15g Tube 0.01 Cream Each tube of cream

12.00 HP - IV

Miconazole 30g 0.02 Cream Each tube of cream

12.00 HP - IH

Silver Sulphadiazine 30g 0.01 Cream Each tube of cream

16.00 HP - IV

ANTIHISTAMINE

Chlorpheniramine Maleate 4mg Tablet Each tablet 0.18 HP - IV

Chlorpheniramine 2mg/5ml Syrup Each 100ml bottle

9.00 HP - IV

Promethazine Hcl 25mg/ml Injection Each Ampoules 3.00 HP - IV

Promethazine 25mg Tablet Each Tablet 0.10 HP - IV

12.DRUGS USED IN OBSTETRICS AND GYNAECOLOGICAL DISORDERS

DRUGS USED IN OBSTETRICS & GYNAECOLOGY

Oxytocin 10iu/ml Injection Each Ampoule 15.00 HP - IV

Magnesium Sulphate 0.5 Injection Each Ampoule 15.00 II - IV

Misoprostol 200mcg Tablet Each tablet 4.00 I - IV

Mifepristone + Misoprostol 200mcg/800mcg Tablet Each tablet 10.00 I - IV

13.DRUGS ACTING ON THE ENDOCRINE SYSTEM

28



CORTICOSTEROIDS

Prednisolone 5mg Tablet Each Tablet 3.00 II - IV

Hydrocortisone 100mg Injection Each Ampoule 8.00 HC - IV

Dexamethasone 4mg Tablets Each tablet 0.40 II - IV

Dexamethasone 4mg/ml Injection Each Ampoule 4.00 II - IV

Methylprednisolone 40mg/ml Injection Each Ampoule 90.00 II - IV

ANTITHYROID DRUGS

Carbimazole 5mg Tablet Each tablet 0.40 II-IV

Propylthiouracil 50mg Tablet Each tablet 5.00 III-IV

Levothyroxine Sodium 25mg Tablet Each tablet 2.00 II - IV

14. DRUGS ACTING ON THE RESPIRATORY SYSTEM

BRONCHODILATORS

Aminophylline 25ml/ml Injection Each Ampoule 7.00 I - IV

Aminophylline 100mg Tablets Each tablet 0.30 I - IV

Salbutamol 2mg Tablets Each tablet 200.00 I - IV

Salbutamol 2.5mg Nebules Each nebule 10.00 II - IV

Salbutamol 0.1mg Inhaler Each Canister 40.00 I - IV

Beclomethasone 50mcg Inhaler Each Canister 55.00 I - IV

15. ANTIMALARIALS

Artemether + Lumefantrine 20/120 mg (6) Tablet Each box of 6 tablets

30.00 HP, HC, I - IV


45.00 HP, HC, I - IV


55.00 HP, HC, I - IV


65.00 HP, HC, I - IV

Quinine di-HCL, 300mg/ml,2ml Amp IV Inj. Each vial 55.00 HP, HC, I - IV

Quinine Sulphate, Sugar coated 300 mg Tablet Each tablet 630.00 HP, HC, I - IV

Sulphadoxine / Pyrimethamine 500/25 mg Tablet Each Tablet 3.00 HP, HC, I - IV

Artesunate 50mg +Amodiaquine Hydrochloride 150mg 50mg/150mg Tablet Each Tablet 1.00 I - IV

Artesunate 60mg 60mg Inj. Each Ampoule 50.00 HP, HC, I - IV

16. REPRODUCTIVE HEALTH

Ethinyloestradiol/Levonorgestrel Blister of 28 Tabs 130mg/150mcg Tablet 1 cycle of 28 tablets

8.30 HP, HC, I - IV

Levonogestrel Implant Contraceptive 10 rods 750mcg/rod Sub-dermal Each implant 5000.00 HP, HC, I - IV

IUD Copper T, 380A, 10 Pieces N/A Device Each Device 50.00 HP, HC, I - IV

Levonogestrel 0.03mg Tablet 1 cycle of 28 tablets

20.00 HP, HC, I - IV

Levonogestrel 0.75mg Tablet Each Tablet 20.00 HP, HC, I - IV

Medroxyprogesterone Acetate 150mg Injection Each vial 20.00 HP, HC, I - IV

Norethisterone Enanthate , 1ML Amp 200mg/ml Injection Each ampoule 25.00 HP, HC, I - IV

Etonogestrel single rod subdermal contraceptive implant 68mg Sub-dermal Each implant 25.00 HP, HC, I - IV

17. OTHERS

Anti-rabies Vacccine injection injection each vial 160.00 I - IV

Dextrose 50% injection injection each vial 8.00 I - IV

ultravist injection(iopromide) 300/ml injection each vial of 20ml 400.00 I - IV

Anti-snake venom 10ml 10ml Injection 1 vial 800.00 I - IV

Tetanus ToxoidVaccine 0.5ml 0.5ml Injection Each vial 15.00 I - IV

national health insurance scheme · 2020. 3. 6. · scheme with the goal of providing health...

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