1
NATIONAL HEALTH INSURANCE MANAGEMENT AUTHORITY PRESS RELEASE
LUSAKA, FRIDAY, 3rd JANUARY 2020
RELEASE OF BENEFIT PACKAGE FOR THE NATIONAL HEALTH INSURANCE SCHEME The National Health Insurance Management Authority (NHIMA) is pleased to inform the public that the first ever Benefit Package for the National Health Insurance scheme (NHIS) has been completed and released to the public. The Benefit Package is a result of a participatory process that involved several stakeholders and experts including the Ministry of Health and other Government line Ministries, Academia, Professional bodies, Regulators, Private sector, informal sector, Cooperating partners, Civil Society, Trade Unions and members of the public to whom we offer our sincere gratitude on this significant milestone. This is another bold step in fulfilling our pledge towards Universal Health Coverage and ensuring that all eligible citizens and established residents will have access to affordable and quality healthcare under the National Health Insurance Scheme as outlined in the NHI Act No 2 of 2018. 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. The Benefit Package essentially outlines the insured health services that members will be able to access at accredited public and private healthcare providers under the NHIS. It will also serve as a reference point and standardisation of claims that will be made by accredited healthcare providers for reimbursement from NHIMA for services utilized by members of the NHIS. The Benefit Package covers standard, high cost, premium and fast track services in accredited public health facilities. The covered services include Consultations, Registration, Hospitalisation, Intensive Care Unit (ICU), Minor and Major Surgery, Maternity and Neonatal care, Eye Care Services, Oral Health Services, Pharmaceuticals, Blood products and Physiotherapy
2
The following is the Detailed Benefit package of the National Health Insurance Scheme offered to esteemed beneficiaries. Health care benefits in this package include but not limited to the following:- S/N Programme / Services Description
1 Outpatient Department (OPD) Registration and Consultation
This covers for costs related to Registration and Consultation of patients. Limited to 3 visits per health event unless condition is classified as Chronic
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.
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
3
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 from 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, High Dependency Unit and ICU beyond stipulated period in the schedule
SCHEDULE 1. Second and Third Level Hospital – Providers to be paid using Diagnosis-Related Groups (DRG) Tariffs Each condition listed includes cover for Drugs, Investigations, medical consumables, Non-Clinical (catering, laundry and cleaning), Capital maintenance
4
In patient Department (IPD)
Programme Condition
Communicable Uncomplicated Malaria
Complicated Malaria
Pneumocystis Carinii Pneumonia
Diarrhoeal diseases (non-bloody/bloody diarrhoea)
Bacterial meningitis
Non-Communicable Acute Asthma
Asthma Life Threatening
Diabetes ketoacidosis
Pulmonary Oedema
Heart failure
Hypertension
Infarctive Stroke (CVA)
Haemorrhagic Stroke (CVA)
Ischemic heart Disease
Diabetes Type 1
Diabetes Type 2
Internal Medicine Peptic Ulcer Disease (PUD)
Hepatitis B
Pneumonia
Arthritis
Sickle Cell Anaemia
Epilepsy
Pulmonary Embolism
STI (Ulcerative)
STI (Discharge)
Dialysis per session (includes heparin and consumables)
UTI
Reproductive & Maternal Health Normal labour
Caesarean section (Spinal)
5
Pelvic Inflammatory Disease
Pelvic abscess
Ectopic pregnancy
Postpartum Haemorrhage
Episiotomy Repair
Deep vein thrombosis (DVT)
ANC Mng.Pre-eclampsia and eclampsia
Ruptured Uterus/Emergency Hysterectomy
APH (Abruptio)
APH (Placenta praevia)
Cervical cerclage
Urinary tract infections (UTI)
Bartholin Cyst/Abscess marsupialization
Fibroids
Paediatrics Congenital Heart Disease (CHD) and Acquired heart disease Rheumatic Heart disease
Heart Failure
Simple Diarrhoea (non-infectious diarrhoea)
Infectious Diarrhoea (Non-bloody or Bloody)
ARI (Pneumonia)
Severe Pneumonia
Malaria(uncomplicated)
Complicated Malaria
Prematurity
Epilepsy
Acute Otitis Media
Pharyngitis/ Tonsillitis
Sickle Cell Anaemia
Neonatal Jaundice
Asthma
6
Neonatal Sepsis
Diabetes Mellitus
Cancer Biopsy or local excision of cervical lesion
Loop Electrosurgical Excision Procedure
Breast Biopsy
Prostate Biopsy
Eye / Vision Care Small Incisional Cataract Surgery
Glaucoma
Glaucoma-trabeculectomy with trabeculotomy-Children
Glaucoma-Goniotomy-children
Refractive Errors (Spectacles)
Corneal Conditions
Ocular Trauma
Foreign Body removal (corneal repair)
Eyelid mass/growth excision
Enucleation
Evisceration
Exenteration
Nasal Lacrimal Duct Obstruction- Surgery (External Dacryocystorhinostomy)
Paediatric Cataract (Paediatric Lens Aspiration + Intraocular Lens + Primamry Posterior Capsulotmy + Anterior Vitrectomy)
Paediatric Cataract Surgery (Paediatric Anterior Segment Reformation Surgery)
Laser Photocoagulation /trabeculoplasty
Strabismus
Examination Under Anaesthesia
Oral Health Dental Carries-Temporal Fillings
Dental Carries-Permanent Fillings
Root canal treatment
7
Simple extraction
Surgical extraction
Apicectomy
Alveolar osteitis
Gingivitis
Fungal infections-oral candidiasis
Viral infections- (Herpes Simplex, Varicella Zoster, Oral Hairy leukoplakia)
Mouth ulcers
Fractures-Mandibular Fractures
Infection- Odontogenic and Non-Odontogenic-Abscesses
Gingival Hyperplasia
Dental Scaling -whole mouth (Must be medically indicated)
Frenulum Attachment
ENT Otitis Media-Uncomplicated
Foreign body ear /nose/throat
Acute Rhinosinusitis
Chronic Rhinosinusitis with and without polyposis
Adenotonsillitis
Laryngeal papilloma
Epistaxis (cauterization)
Mental Health (Tariffs cover 180 days treatment)
Acute Schizophrenia/Relapsed Schizophrenia/substance induced psychotic disorder
Affective disorders-severe mania/mania
Depression - moderate/severe
Minor Surgery under LA Male Circumcision
Foreign Body Removal
Biopsy
Excision
Debridement and Suturing (minor)
Lumpectomy
8
Intercostal Drainage
Manipulation Under Anaesthesia + POP
Joint dislocation reduction
Sloughectomy
Incision and Drainage
Diagnosis Surgical Procedures Cystoscopy/Urethroscopy
Proctoscopy/Sigmoidoscopy
Colonoscopy with polypectomy
Colonoscopy
Endoscopy
Examination Under Anaesthesia
Major under GA Gastrostomy
Jejunostomy
hemorrhoidectomy
Hydrocelectomy
Amputation finger or toe
Extraperitoneal abscess drainage
Orchidectomy
Debridement and Suturing (major trauma)
Tracheostomy
Herniorrhaphy/plasty
Appendicectomy
Gastrectomy
Abdominal Perineal Resection
Laparotomy
Cholecystectomy
Thyroidectomy
Mastectomy
Parotidectomy
Colostomy
9
Splenectomy
Colectomy
Pancreatectomy
Skin graft
Nephrectomy
Prostatectomy
Craniectomy
Orthopaedics ORIF Plate and screws
ORIF K-Nail
External Fixation
K wiring
Tendon Repair
Arthrotomy
Amputation
PMR Club foot
Ponseti Club foot
Intra Articular Injection
Sequestrectomy
Exercise therapy (120 min session) General Exercise
Pre & Post-natal
Pre & Post-Operative
Specialized Exercise Training
Keep fit/group exercise
Manipulative Therapy-reduction of joints, fractures and POP immobilization/splinting
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 rate will cover for everything, no other charges will be accepted
10
High Dependency Unit (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
Accommodation Premium/Private Wards fee per day
Per night up to standard Length of Treatment (LoT) and Maximum of 7 days per event. Cost includes accommodation, Nursing care, Oxygen therapy. Extension beyond 7 days requires Pre-Authorisation
OPD Registration & Consultation Initial Visit
Subsequent Visit (limited to 2 review visits for health event)
Chronic conditions after initial and two subsequent visits (e.g. Hypertension, Diabetes, Asthma, Arthritis, sickle cell, epilepsy etc)
Blood Products Unit whole Blood
11
SCHEDULE 2. District Hospital Tariffs Standardised based on expected Capitated Utilisation per facility.
Type of Visit
Per Outpatient (OPD) Visit
Per Inpatient (IPD) Visit
SCHEDULE 3. Laboratory Services.
Type of Laboratory Test
Serology Immunology, virology
RPR test for syphilis
Rapid syphilis test
Rapid HIV Test - Determine
Rapid HIV Test - SD Bioline
Rapid HIV Test - Wantai
Rapid duo HIV /syphilis test - SD Bioline
Rapid Hepatitis C
Rapid Hepatitis B
Rheumatoid Factor
CD4,CD8 Count
HIV Viral load Analysis
HIV DNA PCR
Biochemistry, Tumour Markers, Hormones, Immunochemistry, Cardiac Makers
Magnesium
Calcium
Phosphorus
Cholesterol
Auto-Creatinine
12
Type of Laboratory Test
HDL cholesterol
LDL cholesterol
Glucose
Urea
Albumin
Total protein
Acid phosphatase
Uric acid
Triglycerides
Auto-BILIRUBIN D
Auto-BILIRUBIN T
Lipase
Pancreas-amylase
LDH liquid
CK NAC activated
GOT (ASAT
GPT (ALAT)
G-GT
Alkaline phosphatase
A-AMYLASE
Alkaline phosphatase
Ck mb
Iron tptz
Electrolytes
Blood Glucose using accucheck
Glycated HB
CSF Total Protein
13
Type of Laboratory Test
CSF Glucose
Total Protein - Pleural Tap '-Effusion, etc
C-reactive Protein
Brain natriuretic peptide (BNP)
ACTH test
AFP Test
Anti-HAV IgM
Anti-HAV
Anti-HBc
Anti-HBc IgM
Anti-HBe
Anti-HBs
Anti-HBs
Anti-HCV
Vitamin B12
Cancer Antigen (CA) 125
Cancer Antigen CA 15
Cancer Antigen CA 19-9
Cancer Antigen CA 72-4
Carcinoembryonic Antigen CEA
CK-MB STAT
CMV IgG
CMV IgM
Cortisol
DHEA-S
Digoxin
Estradiol
14
Type of Laboratory Test
Ferritin
Free HCG beta
Folate
Folate RBC
free PSA
Follicle-stimulating hormone
Free T3
Free T4
Triiodothyronine (T3)
Thyroxine (T4)
HBeAg
HBsAg
HCG
HCG+beta
Human Growth Hormone
IgE
Insulin
Myoglobin
Progesterone
Prolactin
proBNP
Total PSA
Rubella IgG
Rubella IgM
Troponin I
Troponin T
Toxo IgG
15
Type of Laboratory Test
Toxo IgM
Thyroid Stimulating Hormone
Serum Vitamin D
Serum Vitamin B12
Haematology, immunohematology
Full Blood Count FBC
Haemoglobin (HB)
Differential Count
Solubility Test (for Sickling)
HB Electrophoresis
Reticulocyte Count
Bleeding time
Clotting Time
Activated Partial Prothrombin Time
Prothrombin Time
INR
Antinuclear Factor
Bone Marrow Aspiration Procedure
Bone Marrow May-Grunwald stain
Bone Marrow special stains
Coagulation Factor Assays, each
Fibrinogen antigen test
Fibrinogen Degradation Products (FDP) Test
D-Dimer test
Grouping ABO (Blood)
Rhesus Factor
Cross-Matching
16
Type of Laboratory Test
Bacteriology
Culture & Sensitivity Urine
Culture & Sensitivity - Stool
Culture & Sensitivity-cerebral spinal
Culture & Sensitivity - Pus
Culture & Sensitivity - Blood
Culture & Sensitivity - sputum
Culture & Sensitivity HVS
Culture & Sensitivity Urethral swab
Culture & Sensitivity - other body fluids
Microbia identification (API 20e)
Microscopy sputum
Microscopy - Pus
Microscopy Urine
Microscopy - Stool
Microscopy CSF
Microscopy- other body fluids
Gram Stains - All specimens
Urea breath test
Cryptococcal Antigen Latex - CSF/serum
Chlamydia Test
Sputum Gene Xpert
Parasitology
Occult Blood
Blood parasites
Malaria Blood slide
Malaria RDT
Toxoplasma antibodies - serum
17
Type of Laboratory Test
Pregnancy Test (Urine)
Urinalysis 10 parameter
Urinalysis Glucose and Protein
Histology, Cytology and Immunohistochemistry
Single block from a specimen
Hematoxylin and eosin single slide staining
Ziel Neelsen stain for a single slide
Masson trichrome stained slide
Periodic Acid Schiff Stain
Alcian Blue Stain
Grocott-Methenamine Silver Stain
Immunohistochemistry stain single slide
Histology Large Surgical Specimen (6-10 blocks) e.g. uterus with fallopian tubes and ovaries, mastectomy
Histology Medium sized surgical specimen (3-5 blocks) e.g. prostatectomies
Histology small surgical specimen (1-2 blocks) e.g. skin ellipse
Histology small biopsies (1-2 blocks) e.g. Trucut Biopsies/ needle biopsies
Liver biopsy histology (H & E) to include special stains (masson trichrome, silver, PAS)
Renal biopsy histology (H & E) to include special stains (masson trichrome, silver, PAS)
Cervical Papanicolaou smear
Fine Needle Aspirate
Fluid cytology (1 PAP and 1 Giemsa)
Arterial Blood gas
18
SCHEDULE 4. Radiology / Imaging.
Type of Imaging
Plain film X-Ray (Analog or Digital)
Skull
Neck
Chest
Abdomen
Limb
Joint
Spine (per region)
Intraoral Xray
Any other region
Ultrasound
Ultrasound scan
Doppler
ECHO
US guided interventions(e.g. biopsy, aspiration etc)
Contrast studies: (Digital OR Analogue)
Ba swallow
Ba meal
Ba meal follow through
Small bowel enema(SBE)
Ba enema
IVU
Cystogram
Urethrogram
MCUG
HSG
Sinogram
19
Type of Imaging
Fistulogram
Mammogram:(Analog or Digital) - Diagnosis
- Screening
Computed Tomography Per region without contrast
Per region with contrast
MRI: Per region without contrast
Per region with contrast
Cathlab
Diagnosis Coronary angiogram
Coronary Ballooning & Stenting
Pacemaker Placement
Nuclear Medicine
Bone scan
Thyroid scan
Renal scintigraphy
Cardiac scintigraphy
Brain scan
Q/V scan
Inflammatory/infection
Liver scan
Venogram
Gastrointestinal (scan)
Gastrointestinal (reflux)
Salivary glands
Milk Scan
I 131 therapy
20
SCHEDULE 5. Prosthetics.
TYPE OF PROSTHETIC
Prosthetics- Lower Limbs
Hip Prosthesis Polypropylene
Modular (Laminated)
Transfemoral Prosthesis
polypropylene
Modular without Silicon liner (Laminated)
Modular with silicon (Laminated)
Transtibial Prosthesis
polypropylene
Modular with silicon (laminated)
Modular without Silicon liner (Laminated)
Knee Disarticulation
polypropylene
Modular Without silicon (Laminated)
Modular with silicon (Laminated)
Symes Prosthesis polypropylene
Modular
Ortho prosthesis Polypropylene
Modular
Partial Foot Prosthesis Laminated/Polypropylene
Orthotics – Spine
Cervical Collar Adult
Child
Lumbar Brace Adult
Child
Thoracolumbar Brace Adult
21
TYPE OF PROSTHETIC
Child
Cervical-Thoracal - lumbar sacral orthosis
Adult
Child
Medical and Orthopedic Appliances
Axillary Crutch (Each)
Hearing Aid (Pair)
Neck Collar with shin support
Knee Braces
Lumbar Belt and Trunk Corset
Drop foot splint
Elbow crutch (each)
Triangular arm sling
Kneecap
Knee support
Ankle /Wrist support
Denture per tooth
Orthodontic appliance fixing per jaw ( procedure and material)
Varicose stocking – full
Varicose stocking -below knee
22
SCHEDULE 6. Orthopaedic Implants (Requires Pre-Authorization)
TYPE OF ORTHOPEDIC IMPLANTS
ORIF plate and Screw
Pedicle Screws + plugs
Rods
cervical plates + screws
peek Cage spacer
10 hole and below plate
11 hole and above plate
Per screw
ORIF K Nail Ordinary
interlocking
External fixation
Rush pin
Ortho fix/set
Ex fix/set for Tibia
K wiring per wire
malleable wires
HIP replacement
Thompson
Austin Moore
total cemented
Total uncemented
Knee Replacement
Bone Cement
23
SCHEDULE 7. Drugs.
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
MEDICINES FOR INFECTIONS
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
1.0 ANTIBIOTICS
PENICILLINS
Ampicillin (sodium salt) 500mg injection Each Vial I - IV
Amoxycillin (trihydrate) 250mg Capsule Tablet HP - IV
Amoxycillin (trihydrate) 100ml 125mg/5ml suspension Bottle HP - IV
Amoxycillin(trihydrate) Combined with Clavulanate 500mg/125 mg capsule capsule I - IV
Amoxycillin(trihydrate) Combined with Clavulanate 125/31 mg suspension Bottle I - IV
Amoxycillin + Clavulenic acid 625mg Tablet Tablet I - IV
Benzathine Benzylpenicillin(sodium) 2.4 mega injection Each Vial HP- IV
Benzyl Penicillin Sodium 5mega injection Each Vial HC - IV
Phenoxymethyl Penicillin (as potassium salt) 100ml 125mg/ml suspension Each Bottle HC - IV
Phenoxymethy Penicillin (as potassium salt) 250mg tablet Each Tablet HC - IV
Procaine Penicillin 3MU injection Each Vial I - IV
Cloxacillin 250mg capsule Each Tablet HP - IV
Cloxacillin(sodium) 500mg injection Each Vial II - IV
Cloxacillin 125mg/5ml suspension Each Bottle I - IV
CEPHALOSPORINS
Cefotaxime Sodium 1g injection Each Vial II - IV
Ceftriaxone (sodium) 250mg injection Each Vial II - IV
24
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
Ceftriaxone Sodium 1g injection Each Vial I - IV
Cephalexin 100ml 125mg/5ml suspension Each Bottle I - IV
Cephalexin 250mg tablet Each Tablet I - IV
Cefuroxime 100ml 125mg/5ml suspension Each Bottle II - IV
Cefuroxime 250mg tablet Each Bottle II - IV
Cefixime 200mg tablet Each Bottle II - IV
Cefixime 30ml 100mg/5ml suspension Each Bottle II - IV
Imipenem 1gm Injection Each Vial III - IV
CHLORAMPHENICOL
Chloramphenicol (sodium succinate), 100ml 125mg/5ml suspension Each Bottle II - IV
Chloramphenicol 250mg capsule Each Tablet II - IV
Chloramphenicol Sodium Succinate 1g injection Each Vial II - IV
Vancomycin hydrochloride 1g injection Each Vial IV
Vancomycin hydrochloride 500mg injection Each Vial IV
QUINOLONES
Ciprofloxacin (hydrochloride) 250mg tablet Each tablet HC - IV
Nalidixic Acid,100ml 300mg/5ml suspension Each Bottle I - IV
Nalidixic Acid 500mg tablet Each Tablet I - IV
Ofloxacin 200mg tablet Each Tablet I - IV
TETRACYCLINES
Doxycycline(hyclate) 100mg tablet Each Tablet All
AMINOGLYCOSIDES
Gentamycin Sulphate 40mg/ml injection Each Ampoule I - IV
Kanamycin 1g injection Each Vial I - IV
AMOEBICIDES
Metronidazole, 100ml 5mg/ml injection Each Bottle I - IV
25
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
Metronidazole benzoate, 100ml 125mg/5ml suspension Each Bottle I - IV
Metronidazole 200mg tablet Each Tablet HP - IV
Tinidazole 500mg tablet Each Tablet II - IV
Metronidazole oral gel, 30g tube Oral Gel Each tube of Oral gel
I - IV
SULPHONAMIDES
Co-Trimoxazole, 100ml 240mg/5ml suspension Each Bottle HC - IV
Co-Trimoxazole 480mg tablet Each Tablet HC - IV
Cotrimoxazole 96mg/ml I.V injection Each Ampoule III- IV
NITRO-FURAN DRUGS
Nitrofurantoin 50mg 50mg tablet Each Tablet I - IV
MACROLIDES
Azithromycin Tablet 250mg tablet Each tablet II - IV
Azithromycin Oral, 30ml 200mg/5ml suspension Each Bottle II - IV
Clarithromycin 250mg tablet Each Tablets II - IV
Erythromycin Ethyl Succinate 100ml 125mg/5ml suspension Each Bottle I - IV
Erythromycin Stearate 250mg tablet Each Tablet I - IV
ANTIFUNGALS
Fluconazole 200mg Tablet Each Tablet III - IV
Miconazole, 30g Tube Oral Gel Each tube of Oral gel
III - IV
Miconazole Nitrate 2% 30g Tube Cream Each tube of cream
I - IV
Griseofulvin 125mg Tablet Each Tablet HP - IV
Clotrimazole Pessaries 500mg Pessaries Each pessary HP - IV
Nystatin Oral Susp, 30ml Btl 100,000iu/Ml Suspension Each Bottle HP - IV
26
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
Amphotericin B, 50mg/vial injection Each Vial II - IV
ANTI-VIRALS
Acyclovir 200mg tablet Each Tablet HP - IV
Acyclovir, Tab 400mg 400mg tablet Each Tablet HP - IV
Ganciclovir Powder for Inj 500mg injection Each Vial II - IV
2.0. DRUGS USED FOR PAIN AND INFLAMATION
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
UNIT PACK LEVEL OF ACCESS
ANTI-PYRETICS-NON-STEROIDAL ANTI INFLAMMATORY
Acetylsalicylic Acid 300mg Tablet Each Tablet HP - IV
Diclofenac sodium 50mg Tablet Each tablet HC - IV
Diclofenac sodium 75mg/3ml Injection Each Ampoule HC - IV
Ibuprofen 200mg Tablet Each Bottle HP - IV
Ibuprofen 100mg/5ml syrup Each Bottle HP - IV
Paracetamol 500mg Tablet Each Tablet HP - IV
Paracetamol 100mg Tablet Each Tablet HP - IV
Paracetamol 120mg suppositories Each suppository
HP - IV
Aceclofenac +Paracetamol 100mg+500mg tablets Each Tablet HC - IV
ANTI-GOUT
Allopurinol 100mg Tablet Each Tablet II - IV
NARCOTIC ANALGESICS
Morphine Sulphate 30mg Tablet Each Tablet II - IV
Morphine sulphate 10mg Tablet Each Tablet II - IV
Morphine Sulphate 10mg/ml Injection Each Ampoule II - IV
Morphine Sulphate, 5g Powder Each Bottle II - IV
27
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
Morphine Sulphate 5mg/5ml syrup Each Bottle II - IV
Pethidine 100mg/2ml Injection Each Ampoule I - IV
Pethidine 50mg/ml Injection Each Ampoule I - IV
Tramadol 50mg Tablet Each tablet II - IV
Fentanyl 12.5mcg Transdermal Patch
Each Patch II - IV
Fentanyl 25mcg Transdermal Patch
Each Patch II - IV
Fentanyl 50mcg Transdermal Patch
Each Patch II - IV
Fentanyl 75mcg Transdermal Patch
Each Patch II - IV
Paracetamol + Codeine Phosphate 500mg+30mg Tablet Each Tablet II - IV
3.0 DRUGS ACTING ON THE GASTROINTESTINAL SYSTEM
ANTI DIARRHOEAL
Loperamide 2mg Tablet Each Tablet I - IV
Oral Rehydration Salt 27.9g sachet Each Sachet HP - IV
Zinc Sulphate 10mg Tablet Each Tablet HP - IV
ANTI ACIDS
Omeprazole 20mg 20mg Capsule Each tablet II - IV
LAXATIVES
Bisacodyl 5mg Tablet Each Tablet II - IV
Lactulose 3.1-3.7g/5ml Solution Each Bottle II - IV
ANTI SPASMODICS
Hyoscine Butyl Bromide 10mg Tablet Each tablet I - IV
Hyoscine Butyl Bromide 20mg/ml Injection Each Ampoule I - IV
28
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
ANTI EMETICS
Metoclopramide 10mg Tablet Each Tablet I - IV
Metoclopramide 10mg/2ml Injection Each ampoule I - IV
Ondansetron (as hydrochloride) 2mg/2ml Injection Each ampoule II - IV
Ondansetron (as hydrochloride) 2mg/ml,30mls Solution Each bottle of 30 ml
II - IV
Ondansetron (as hydrochloride) 4mg Tablet Each Tablet II - IV
Ondansetron Mouth dissolving 8mg Tablet Each tablet III - IV
4.0 DRUGS USED IN THE TREATMENT OF DIABETES
ANTIDIABETIC
Insulin, long acting, biphasic, 10ml vial 100IU Injection Each Vial II - IV
Insulin, intermediate and long acting, (30/70), 10ml vial 100IU Injection Each Vial II - IV
Insulin, short acting, soluble, 10ml vial 100IU Injection Each Vial II - IV
Glibenclamide 5mg Tablet Each Tablet HC - IV
Gliclazide 80mg Tablet Each tablet II - IV
Glimepiride 2mg Tablet Each Tablet II - IV
Glimepiride/Metformin 2mg/500mg Tablet Each Tablet II - IV
Metformin B.P 500mg Tablet Each Tablet HC - IV
Glucagon Hydrochloride with lactose, PWD for Reconstitution
1mg/unit Injection Each Vial II - IV
5.0 DRUGS USED IN THROMBOEMBOLIC DISORDERS ANTICOAGULANTS
Heparin Sodium, Usp 5ml 5000iu/ml Inj Each Vial II - IV
Warfarin Sodium, 5mg Tablet Each tablet II - IV
Acetylsalicylic acid 75mg Tablet Each Tablets I - IV
Enoxaparin Sodium Syringe (Pre-Fill) 40mg/0.4ml Inj Each Ampoule II - IV
29
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
6.0 DRUGS ACTING ON THE CARDIOVASCULAR SYSTEM CARDIOVASCULAR
Digoxin,2ml Amp 0.25mg/ml Injection Each Ampoule II - IV
Digoxin 0.25mg Tablet Each Tablet II - IV
Hydrochlorothiazide 25mg Tablet Each Tablet II - IV
Frusemide, 2ml Amp 10mg/ml Injection Each ampoule I - IV
Frusemide 40mg Tablet Each tablet I - IV
Amiloride + Hydrochlorothiazide 5mg/50mg Tablet Each tablet HC - IV
Atenolol 50mg Tablet Each tablet I - IV
Glyceryl Trinitrate 500mcg 500mcg Tablet Each tablet II - IV
Isosorbide Dinitrate 20mg 20mg Tablet Each tablet II - IV
Isosorbide Mononitrate 10mg Tablet Each tablet II - IV
Nifedipine Retard 20mg Tablet Each tablet HC - IV
Nifedipine Retard 20mg Tablet Each tablet HC - IV
Nifedipine, Sublingual 10mg Tablet Each tablet II - IV
Spironolactone 25mg Tablet Each tablet I - IV
Propranolol Hydrochloride 40mg Tablet Each tablet I - IV
Carvedilol 6.25mg Tablet Each tablet II - IV
Hydralazine, 1ml Amp 25mg/ml Injection Each Ampoule II - IV
Hydralazine 25mg Tablet Each Tablets II - IV
Enalapril 10mg Tablet Each Tablets HC - IV
Losartan Potassium 50mg Tablet Each tablet II - IV
Verapamil 20mg Tablet Each tablet II - IV
Amlodipine 5mg Tablet Each tablet II - IV
Simvastatin 20mg Tablet Each tablet II - IV
Telmisartan 40mg Tablet Each tablet II - IV
30
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
Methyldopa, film coated 250mg Tablet Each tablet HC - IV
Dobutamine 250mg/20ml Injection Each Ampoule II - IV
Dopamine 40mg/ml Injection Each Ampoule II - IV
Lisinopril 5mg Tablet Each Tablet II - IV
Captopril 25mg Tablet Each Tablet II - IV
Losartan + Hydrochlorothiazide 50mg/12.5mg Tablet Each tablet II - IV
Bisoprolol fumarate 2.5mg/ml tablet each tablet II - IV
Tadalafil tablets 20mg Tablet each tablet II - IV
labetalol hydrochloride 50mg tablet each tablet II - IV
doxazosin 2mg Tablet each tablet II - IV
Alteplase 2mg (1.16 million units)
vial each vial II - IV
Streptokinase 250 000 units vial each vial II - IV
tranexamic acid 100mg/ml injection each injection of 5ml
II - IV
Urokinase 10000 units injection each injection II - IV
Etamsylate 500mg tablet each tablet II - IV
Clopidogrel 75mg tablets each tablet II - IV
Diazoxide injection 15mg/ml injection each ampoule of 20ml
II - IV
mannitol injection 10% injection each infusion,250ml
II - IV
Amiodarone HCL 100mg Tablet Each Tablet III - IV
7.0 DRUGS ACTING ON THE HAEMAPOETIC SYSTEM HAEMATINICS
Ferrous Sulphate 200 mg Tablet Each Tablet HP - IV
31
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
Folic Acid 5 mg Tablet Each Tablet HP - IV
Folic Acid 0.4mg Tablet Each Tablet HP - IV
Heparin Sodium, in 5ml 25000iu Injection Each ampoule II - IV
Heparin Sodium in 5ml 5000iu Injection Each Vial II-IV
Erythropoietin, 0.5ml Prefilled Syringes 4000iu Injection Each prefilled syringe
III - IV
Erythropoietin, 0.5ml Prefilled Syringes 2000iu Injection Each prefilled syringe
III - IV
Iron Sucrose (venofer) 100mg/5ml Injection Each Vial III - IV
8.0 DRUGS USED TO TREAT HELMINTIC INFESTATIONS ANTITHELMITICS
Mebendazole 500mg Tablet Each tablet HP - IV
Mebendazole 100mg Tablet Each Tablets HP - IV
Albendazole 400mg Tablet Each tablet HP - IV
Pyrantel Pamoate 125mg Tablet Each tablet HP - IV
Praziquantel 600mg Tablet Each tablet HP - IV
9.0 DRUG ACTING ON THE CENTRAL NERVOUS SYSTEM
ANTIPSYCHOTIC MEDICATIONS
Fluphenazine Decanoate, 1ml 25mg/ml Injection Each ampoule I - IV
Haloperidol, 1ml 5mg/ml Injection Each ampoule I - IV
Haloperidol 5mg Tablet Each tablet I - IV
Trifluoperazine 5mg Tablet Each tablet I - IV
Chlorpromazine Hcl 1ml 25mg/ml Injection Each Ampoule I - IV
Chlorpromazine Hcl, Tab 100mg 100mg Tablet Each tablet I - IV
Risperidone 1ml 25mg/ml Injection Each Ampoule II - IV
Risperidone 2mg Tablet Each Tablet II - IV
32
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
Quetiapine 25mg Tablet Each Tablet II - IV
Quetiapine 100mg Tablet Each Tablet II - IV
Clozapine 50mg Tablet Each Tablet III - IV
Flupentixol Decanoate 1ml 100mg/ml Injection Each Ampoule II - IV
Zuclopenthixol Decanoate 1ml 200mg/ml Injection Each Ampoule II - IV
MOOD STABILIZERS AND ANTI-EPILEPTIC MEDICATIONS
Phenobarbitone Sodium 1ml 200mg/ml Injection Each Ampoule I - IV
Phenobarbitone 30mg Tablet Each Tablet I - IV
Phenytoin Sodium 100mg Tablet Each Tablet II - IV
Sodium Valproate 200mg Tablet Each Tablet II - IV
Divalproex (Sodium Valp + Valproic Acid) 500mg Tablet Each Tablet II - IV
Sodium Valproate 200mg/5ml Susp Each bottle of 5 ml
II - IV
Carbamazepine 200mg Tablet Each Tablet I - IV
Lithium Carbonate 300mg Tablet Each Tablet IV
ANXIOLYTICS AND HYPNOTIC
Diazepam 2ml 5mg/ml Inj Each Ampoule HP - IV
Diazepam 5mg Tablet Each tablet I - IV
Alprazolam 0.25mcg Tablet Each tablet III - IV
Lorazepam 2mg/ml Injection Each Ampoule III - IV
Lorazepam 2mg Tablet Each tablet III - IV
Nitrazepam 5mg Tablet Each Tablet III - IV
Midazolam 5mg/ml Injection Each Ampoules
III - IV
ANTIDEPRESSANTS
Fluoxetine 20mg Tablet Each Tablet I-IV
33
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
Imipramine 25mg Tablet Each Tablet I-IV
Amitriptyline Hydrochloride 25mg Tablet Each Tablet I - IV
Escitalopram Oxalate 10mg Tablet Each Tablet IV
10 DRUGS ACTING ON THE EYE
EYE PREPARATIONS
Gentamycin Sulphate, 5ml 0.003 ear drops Each bottle of 5 ml
HP - IV
Acyclovir Eye 4.5gm 0.03 eye ointment Each tube of eye ointment
I - IV
Amethocaine 0. 5ml 0.01 eye drops Each bottle of 5 ml
I - IV
Atropine Sulphate, 5ml Eye Drops 0.01 eye drops Each bottle of 5 ml
I - IV
Betamethasone 0.001 eye drops Each bottle of 5 ml
I - IV
Betamethasone 0.001 eye/ ear drops
Each bottle of 5 ml
I - IV
Betaxolol 0.5% Drops 0.005 eye drops Each bottle of 5 ml
III - IV
Brinzolamide 10mg/ml eye drops Each bottle of 5 ml
III - IV
Brimonidine +Timolol 5ml 0.2% +0.5% eye drops Each bottle of 5 ml
III - IV
Chloramphenicol ,10ml 0.5% 10ml eye/ear drops
Each bottle of 5 ml
HP - IV
Chloramphenicol ,5ml 0.005 eye/ear drops
Each bottle of 5 ml
HP - IV
34
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
Ciprofloxacin Hcl Usp, 5ml 0.003 eye drops Each bottle of 5 ml
I - IV
Dexamethasone, 5ml 0.001 eye drops Each bottle of 5 ml
I - IV
Dexamethasone / Gentamycin Sulphate, 5ml 0.1%/0.3% eye drops Each bottle of 5 ml
III - IV
Dexamethasone / Neomycin Sulphate, 5ml 0.1%/0.35% eye drops Each bottle of 5 ml
III - IV
Dorzolamide 0.02 eye drops Each bottle of 5 ml
III - IV
Econazole 5g 0.02 eye ointment Each tube of eye ointment
II - IV
Fluorometholone, 5ml 0.001 eye drops Each bottle of 5 ml
III - IV
Gentamycin + Hydrocortisone, 5ml 0.03 eye/ear drops
Each bottle of 5 ml
II - IV
Gentamycin Sulphate Eye/Ear Drops, 5ml 0.003 eye/ear drops
Each bottle of 5 ml
HP - IV
Hydrocortisone, 5g 0.01 eye ointment Each tube of eye ointment
II - IV
Hydrocortisone 5ml 0.01 eye drops Each bottle of 5 ml
II - IV
Hydroxyethlcellulose +sodium chloride 0.5ml 0.44%+0.35% eye drops Each bottle of 5 ml
II - IV
Hypromellose Eye Drops 0.003 eye drops Each bottle of 5 ml
III - IV
35
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
Latanoprost 50mcg/ml eye drops Each bottle of 5 ml
III - IV
Lignocaine ,0.5ml Drop 0.04 eye drops Each bottle of 5 ml
III - IV
Pilocarpine Nitrate Eye Drops, 5ml 0.5%. eye drops Each bottle of 5 ml
II - IV
Prednisolone Acetate, 5ml 0.01 eye drops Each bottle of 5 ml
III - IV
Sodium Cromoglycate, 5ml 0.02 eye drops Each bottle of 5 ml
I - IV
Tetracaine HCL 0.5% eye drops Each bottle of 5 ml
III - IV
Tetracycline Eye Ointment 0.03 eye ointment Each tube of eye ointment
HP - IV
Timolol Drop 0.005 eye drops Each bottle of 5 ml
III - IV
Travoprost 40mcg/ml eye drops Each bottle of 5 ml
III - IV
Tropicamide 0.005 eye drops Each bottle of 5 ml
III - IV
11. DRUGS ACTING ON THE SKIN
LOCAL APPLICATIONS
Acyclovir, Topical 5g Tube 0.03 Cream Each tube of cream
II - IV
Acyclovir, Tropical Solid 10g Tube 0.05 Cream Each tube of cream
II - IV
36
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
Benzocaine (Anaesthestic+Analgestic) Oral Spray 0.2 Spray Each bottle of spray
II - IV
Benzyl Benzoate Lotion, 1 litre 25%/litre Lotion Each bottle of Lotion
HP - IV
Betamethasone Valerate 30g 0.001 Cream Each tube of cream
II - IV
Calamine Lotion, 1 Litre Btl Lotion Each bottle of Lotion
HP - IV
Clotrimazole Vaginal Tablet 500mg Pessary Each pessary HP - IV
Clotrimazole, 20g Tube 0.01 Cream Each tube of cream
HP - IV
Hydrocortisone Cream15g Tube 0.01 Cream Each tube of cream
HP - IV
Miconazole 30g 0.02 Cream Each tube of cream
HP - IH
Silver Sulphadiazine 30g 0.01 Cream Each tube of cream
HP - IV
ANTIHISTAMINE
Chlorpheniramine Maleate 4mg Tablet Each tablet HP - IV
Chlorpheniramine 2mg/5ml Syrup Each 100ml bottle
HP - IV
Promethazine Hcl 25mg/ml Injection Each Ampoules
HP - IV
Promethazine 25mg Tablet Each Tablet HP - IV
12.DRUGS USED IN OBSTETRICS AND GYNAECOLOGICAL DISORDERS
DRUGS USED IN OBSTETRICS & GYNAECOLOGY
Oxytocin 10iu/ml Injection Each Ampoule HP - IV
37
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
Magnesium Sulphate 0.5 Injection Each Ampoule II - IV
Misoprostol 200mcg Tablet Each tablet I - IV
Mifepristone + Misoprostol 200mcg/800mcg Tablet Each tablet I - IV
13.DRUGS ACTING ON THE ENDOCRINE SYSTEM
CORTICOSTEROIDS
Prednisolone 5mg Tablet Each Tablet II - IV
Hydrocortisone 100mg Injection Each Ampoule HC - IV
Dexamethasone 4mg Tablets Each tablet II - IV
Dexamethasone 4mg/ml Injection Each Ampoule II - IV
Methylprednisolone 40mg/ml Injection Each Ampoule II - IV
ANTITHYROID DRUGS
Carbimazole 5mg Tablet Each tablet II-IV
Propylthiouracil 50mg Tablet Each tablet III-IV
Levothyroxine Sodium 25mg Tablet Each tablet II - IV
14. DRUGS ACTING ON THE RESPIRATORY SYSTEM
BRONCHODILATORS
Aminophylline 25ml/ml Injection Each Ampoule I - IV
Aminophylline 100mg Tablets Each tablet I - IV
Salbutamol 2mg Tablets Each tablet I - IV
Salbutamol 2.5mg Nebules Each nebule II - IV
Salbutamol 0.1mg Inhaler Each Canister I - IV
Beclomethasone 50mcg Inhaler Each Canister I - IV
15. ANTIMALARIALS
Artemether + Lumefantrine 20/120 mg (6) Tablet Each box of 6 tablets
HP, HC, I - IV
38
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
Artemether + Lumefantrine 20/120 mg (12) Tablet Each box of 12 tablets
HP, HC, I - IV
Artemether + Lumefantrine 20/120 mg (18) Tablet Each box of 18 tablets
HP, HC, I - IV
Artemether + Lumefantrine 20/120 mg (24) Tablet Each box of 24 tablets
HP, HC, I - IV
Quinine di-HCL, 300mg/ml,2ml Amp IV Inj. Each vial HP, HC, I - IV
Quinine Sulphate, Sugar coated 300 mg Tablet Each tablet HP, HC, I - IV
Sulphadoxine / Pyrimethamine 500/25 mg Tablet Each Tablet HP, HC, I - IV
Artesunate 50mg +Amodiaquine Hydrochloride 150mg 50mg/150mg Tablet Each Tablet I - IV
Artesunate 60mg 60mg Inj. Each Ampoule HP, HC, I - IV
16. REPRODUCTIVE HEALTH
Ethinyloestradiol/Levonorgestrel Blister of 28 Tabs 130mg/150mcg Tablet 1 cycle of 28 tablets
HP, HC, I - IV
Levonogestrel Implant Contraceptive 10 rods 750mcg/rod Sub-dermal Each implant HP, HC, I - IV
IUD Copper T, 380A, 10 Pieces N/A Device Each Device HP, HC, I - IV
Levonogestrel 0.03mg Tablet 1 cycle of 28 tablets
HP, HC, I - IV
Levonogestrel 0.75mg Tablet Each Tablet HP, HC, I - IV
39
PRODUCT DESCRIPTION STRENGTH DOSAGE FORM
Basic Unit LEVEL OF ACCESS
Medroxyprogesterone Acetate 150mg Injection Each vial HP, HC, I - IV
Norethisterone Enanthate, 1ML Amp 200mg/ml Injection Each ampoule HP, HC, I - IV
Etonogestrel single rod subdermal contraceptive implant 68mg Sub-dermal Each implant HP, HC, I - IV
17. OTHERS
Anti-rabies Vaccine injection injection each vial I - IV
Dextrose 50% injection injection each vial I - IV
ultravist injection(iopromide) 300/ml injection each vial of 20ml
I - IV
Anti-snake venom 10ml 10ml Injection 1 vial I - IV
Tetanus Toxoid Vaccine 0.5ml 0.5ml Injection Each vial I - IV
EXCLUDED SERVICES Health Care Services not listed in this package are not covered by the NHIS. These include but not limited to the following:-
• Public health care services under government or Donor vertical programs, epidemic and disasters,
• Purchases of cosmetic items, wheelchairs or prosthetic appliances not listed,
• Illegal abortion and illicit drug use,
• Employment injuries or illness arising from occupational hazards which are compensated under other schemes,
• Cosmetic surgery and aesthetic treatments (unless where medically required),
• All costs for operations, medicines, treatment and procedures for cosmetic purposes,
• Holidays for recuperative purposes, and
• Medicines and consumables not registered with ZAMRA including;
40
• Toiletries, perfumes, deodorants and other beauty preparations,
• Slimming products,
• Homemade remedies, and
• Alternative medicines.
• 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,
• Costs of services rendered by or in respect of;
• Persons not registered with recognized professional body in terms of legislation,
• Any institutions not registered in terms of legislation,
• Any procedure or treatment not supported by National treatment protocols or scheme protocols, and
• 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.
• Trans-sexual surgery,
• Long-term in-patient nursing care (over 90 days per admission and 180 days per year for the insured person),
• Medical treatment of motor vehicle accident injuries covered by other insurance/funds arrangements, such as motor vehicle insurance and a Motor Vehicle Accident Fund,
• Treatment of occupational accidents and illness covered by Worker’s Compensation Fund,
• Treatment of injuries resulting from declared national disasters in collaboration with the National Disaster Management and Mitigation Unit,
• Fertility treatment according to set criteria,
• Telephone charges, and
• Treatment Abroad.
41