DigitrustHow medicines are paid
The NHIS pays for services by G-DRG and for medicines fee-for-service, item by item, against the NHIS Medicines List. The 2025 edition lists 551 medicines, each with a code, a unit of pricing, a price and a prescribing level.
Three things decide whether a medicine line is paid in full:
- the medicine is on the list;
- it was prescribed at a facility of the right prescribing level;
- it is claimed at the list price for its unit of pricing, not your own selling price.
Vetters also check that the medicine fits the diagnosis under the Ghana Standard Treatment Guidelines.
Prescribing levels
Each medicine carries a prescribing level. A medicine can be prescribed at its own level and every level above it, so a district hospital (level C) may prescribe everything at levels A, M, B1, B2 and C. Counts are from the 2025 list.
| Level | Prescribers | Medicines at this level | Prescribable at this level and below | Examples |
|---|---|---|---|---|
A | CHPS compounds | 96 | 96 | Acetylsalicylic Acid Tablet, 300 mg; Activated Charcoal Powder, 50 g |
M | Midwives | 39 | 135 | Adrenaline Injection, 1 mg/1mL (1:1000); Adrenaline Injection, 1:10,000 |
B1 | Health centres without a doctor | 81 | 216 | Acetylcysteine Injection, 200 mg/mL; Allopurinol Tablet, 100 mg |
B2 | Health centres with a doctor | 99 | 315 | Acetylsalicylic Acid Tablet, 75 mg (Dispersible); Acyclovir Suspension, 200 mg/5 mL |
C | District hospitals | 126 | 441 | Acetazolamide Injection, 500 mg; Acetazolamide Tablet, 250 mg |
D | Secondary and tertiary hospitals | 82 | 523 | 5-Fluorouracil Injection, 50 mg/mL; Actinomycin D Injection 0.5 mg Intravenous |
Specialist medicines (SM, 28 medicines, for example Amiodarone Tablet, 200 mg; Anastrozole Tablet, 1 mg) sit outside this ladder. They are restricted to qualified specialists, whatever the facility.
The medicine deductions to avoid
- Off-list medicines. A medicine not on the list is not paid. Offer the patient a listed alternative, or bill it privately with their agreement.
- Above your level. A level D medicine prescribed at a health centre is deducted even if it was clinically right.
- Wrong price. The unit price on the claim must be the list price for the listed unit of pricing.
- Incoherent with the diagnosis. An antibiotic on a claim with no infection recorded invites a query.
- Quantity beyond the course. Quantities well beyond the Standard Treatment Guidelines course are queried.
Keep the right edition
NHIA revises the Medicines List periodically, and prices and levels change between editions. Price every claim against the edition in force on the date of service, and update your catalogue when a new edition is published rather than editing prices by hand.
See also: the 12 most common NHIS deductions.