Lok Sabha Question No. 3236 (UNSTARRED), answered on 2025-08-08
Subject: Denial of Prescribed Medicines to CGHS Beneficiaries
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Shri Navaskani K, Shri Selvam G, Shri Mani A, Shri C N Annadurai

## GOVERNMENTOFINDIA MINISTRY OFHEALTH AND FAMILY WELFARE DEPARTMENTOFHEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 3236 TO BE ANSWERED ON 08 TH AUGUST, 2025

## DENIALOFPRESCRIBED MEDICINES TO CGHS BENEFICIARIES

## 3236. SHRI MANI A:

SHRI NAVASKANI K:

SHRI SELVAM G:

SHRI C N ANNADURAI:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether the Government is aware that CGHS beneficiaries are often denied life-saving or essential post-operative medicines prescribed by specialist doctors, on the ground that such medicines are not included in the CGHS indent list;
- (b) if so, whether the Government has issued any guidelines allowing CGHS beneficiaries to purchase such medicines from the open market and claim reimbursement, if so, the details thereof;
- (c) whether the Government has laid down any mechanism for timely inclusion of new or essential drugs prescribed by empanelled hospitals or specialists in the CGHS medicine list, if so, the details thereof;
- (d) whether the Chief Medical Officer (CMO) is bound to provide written reasons for denial of prescribed medicines to a patient and if so, the details thereof alongwith the rules or guidelines governing such action;
- (e) whether the Government monitors such denials and any action being taken against the CMO for non-compliance or failure to provide medicines, if so, the details thereof; and
- (f) whether the Government proposes to strengthen the grievance redressal mechanism for CGHS beneficiaries in the country, if so, the details thereof?

## ANSWER

## THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILYWELFARE (SHRI PRATAPRAO JADHAV)

(a) to (f): As per Government guidelines, CGHS medicines are prescribed from the CGHS formulary. Non-formulary medicines costing over ₹1500/week require pre-approval from the respective Additional Director (MSD for Delhi/NCR, City AD for others) before indenting through the Authorized Local Chemist.

As per issued instructions, CGHS supplies prescribed medicines via alternative brands from Wellness Centres if available, or indents the exact brand via ALC if unavailable. CGHS

beneficiaries are not permitted to purchase such medicines from the open market for reimbursement.

Guidelines are established for the issuance of high-cost or restricted medicines (such as anti-cancer and immunotherapy drugs), which include a defined approval mechanism involving the Additional Director, Director CGHS, and the Standing Technical Committee (STC) depending on the cost and type of medicine. Provision also exists for timely inclusion of such drugs into the online restricted medicine list based on frequency of approved cases.

The CGHS has a robust grievance redressal mechanisms in place.

## 1. In-House Grievance Module

- a. CGHS has developed a dedicated online grievance module.
- b. Accessible via the CGHS web portal, this enables direct submission of grievances related to:
- i. Medical reimbursement claims (MRC)
- ii. Medicine availability
- iii. Plastic card issuance delays
- iv. Online appointment issues
- v. General Wellness Centre grievances

## 2. Centralized Call Centre

- a. Toll-Free Number: 1800-208-8900.
- b. Provides immediate response to common issues and registers complaints for follow-up.

## 3. CPGRAMS Integration

CGHS is available with the Centralized Public Grievance Redress and Monitoring System (CPGRAMS): https://pgportal.gov.in

## 4. Physical and Written Submissions

- a. Emails
- b. Letters to CGHS Wellness Centres or Directorate
- c. Walk-in complaints at offices

## 5. CGHS Panchayats

- a. Community grievance resolution forum, conducted in cities under CGHS.
- b. Coordinated by the Additional Director.
- c. Includes open interaction with stakeholders (mainly pensioners) to resolve persistent and systemic issues.

## 6. Advisory Committees

- (a) Local Advisory Committee (LAC)
- i. Constitution: CMO In-Charge, Area Welfare Officer, pensioner representative, Resident Welfare Association (RWA) rep, and chemist.
- ii. Purpose: Resolve grievances locally at the Wellness Centre level.
- iii. Frequency: 2nd Saturday of every month
- (b) Zonal Advisory Committee (ZAC)
- i. Constitution: AD, AWO, pensioner rep, CMO RH, Admin Officer, representative from empanelled hospital.
- ii. Frequency: 4th Saturday of every month

Ministry has undertaken the task of leveraging the use of Information Technology to improve the service delivery . The website features include; availability of Electronic Medical Records (EMR) for beneficiaries, Medicine tracking feature, integration with payment gateway for online payment of CGHS Contribution for Pensioners.

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