892 kinds of traditional Chinese medicine decoction pieces are fully included in the medical insurance payment
Hunan will implement the latest national medical insurance drug catalog next month, and implement medical insurance payment standards for drugs such as “Azivudine Tablets” in April
Xiaoxiang Morning News Changsha News on the 25th, the Provincial Medical Security Bureau and the Provincial Department of Human Resources and Social Security issued the “About the Implementation of the National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog (2022)” (hereinfollowing referred to as the “2022 Drug Catalog”) “Notice”, requiring the province to uniformly and formally implement the “2022 Drug Catalog” from March 1, and make arrangements for related work.
The “2022 Drug Catalog” contains a total of 2967 kinds of Western medicines and Chinese patent medicines, including 1586 kinds of Western medicines and 1381 kinds of Chinese patent medicines. In addition, there are 892 types of decoction pieces of traditional Chinese medicine that can be paid by the fund (the full amount is included in the scope of fund payment, and the self-payment ratio is set to 0%).
According to national regulations, Hunan Province has added a self-payment ratio column to the entry of the “2022 Drug Catalog”, and set a self-payment ratio for each drug. Among them, the self-payment ratio of Class A drugs is set to 0%, and the generic name and dosage form of Class B drugs are consistent with the 2021 version of the drug catalog, the original self-payment ratio will be maintained. The newly added Class B drugs in the “2022 Drug Catalog” have passed expert review and determined the self-payment ratio. The specific drug self-payment ratio is subject to the published catalogue, which will be issued together with the 2022 Drug Catalogue. When payment is limited to work-related injury insurance and maternity insurance, there is no distinction between Class A and B, and the full amount is included in the payment scope of work-related injury insurance or maternity insurance funds.
According to the notice of the National Medical Insurance Administration, the new medical insurance payment standards for “Azvudine Tablets” and “Qingfei Paidu Granules” among the negotiating drugs in the “2022 Drug Catalog” will be implemented from April 1. Temporarily include Remidevir Hydrobromide Tablets (Mindewei) and Cenotavir Tablets/Ritonavir Tablets Combination Package (Xenuoxin) into the basic medical insurance payment scope of Hunan Province. Class management, the outpatient clinic implements the special guarantee policy for the new crown outpatient service, and the payment will end on March 31. The above-mentioned medicines are also included in the scope of payment of industrial injury insurance in Hunan Province and implemented simultaneously. In addition, the Hunan Provincial Bureau of the National Bureau of Economic and Social Security reported that the new crown prevention and treatment drugs, hospital preparations, and drugs included in the outpatient special protection for the temporary inclusion in the medical insurance catalogue, will be implemented according to the original document until March 31, and the work-related injury insurance will also be implemented in accordance with the above-mentioned policies. After the implementation, if there are new national regulations, they will be implemented according to the new national policies, and a separate notice will be issued.
In order to promote the implementation of nationally negotiated drugs, Hunan Province will include all the drugs (including bidding drugs) newly added through negotiation in the “2022 Drug Catalog” in the “drug part of the agreement period” (including bidding drugs) into the “dual channels” of designated medical institutions and designated retail pharmacies in Hunan Province The scope of management is implemented in accordance with the current treatment policy for inpatients, general outpatients and outpatients with chronic and special diseases. Among them, the drugs included in the “dual channel” single payment management in Hunan Province will be issued separately.
Reporter Mei Mei Correspondent Ouyang Zhenhua
Pay attention to what to do if the market price of bidding drugs exceeds the payment standard
According to the notice, during the agreement period, the national unified medical insurance payment standard will be implemented for the negotiated drugs and bidding drugs. For bidding drugs, if the actual market price exceeds the payment standard, the excess part shall be borne by the insured person; if the actual market price is lower than the payment standard, the actual price shall be shared by the medical insurance fund and the insured person.
During the validity period of the agreement, if the negotiating drugs or bidding drugs have specifications not specified in the “2022 Drug Catalog” and need to be included in the scope of medical insurance payment, the enterprise should submit an application to the National Medical Insurance Bureau, and the National Medical Insurance Bureau will determine the payment standard according to the terms of the agreement. Implemented nationwide. During the agreement period, if there is a drug with the same generic name as the negotiated drug on the market, its listed price shall not be higher than the negotiated medical insurance payment standard of the same specification. During the agreement period, if the negotiated drugs or bidding drugs are included in the centralized procurement of drugs organized by the state or priced by the government, it will be implemented in accordance with the new national policy.
In addition, the Provincial Medical Security Bureau and the Provincial Human Resources and Social Security Department emphasized that all localities must strictly implement the “2022 Drug Catalogue”, and must not formulate the catalogues or use flexible methods to increase the drugs in the catalogues, nor adjust the limited payment of drugs in the catalogues. Scope, classification of A and B, self-payment ratio and medical insurance payment standard within the agreement period.
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Enhance drug protection for children and patients with rare diseases
Comprehensive “Chinese medical insurance” and health reports The province’s unified and official implementation of the new national medical insurance drug list is a major concern of the public. This is directly related to which drugs can be reimbursed, which in turn affects the whole process of patients seeing a doctor. So, what benefits will the adjustment bring to the public?
Doctors and patients have more clinical choices
It is reported that in the medical insurance catalog that Hunan will implement this time, most of the newly added drugs are new drugs that have been launched within 5 years, and 23 of them will be newly launched in 2022.
Compared with before, 2 drugs for the treatment of COVID-19 including Azivudine Tablets and Qingfei Paidu Granules, as well as 7 drugs for rare diseases and 22 drugs for children were successfully included in the catalog; in the field of lung cancer, not only Lorati In the field of diabetes, the newly added insulin degludec liraglutide is the first in China. The compound preparation of insulin and GLP-1 has greatly improved the compliance of patients; in the field of rare diseases, dimethyl fumarate for the treatment of multiple sclerosis, treprostinil for the treatment of pulmonary arterial hypertension, and neuromyelitis optica have been added With drugs such as inelizumab, doctors and patients have more clinical choices.
It is worth noting that 21 of the 25 marketed drugs involved in the tenth edition of the new coronavirus infection diagnosis and treatment plan have been officially included in the medical insurance catalogue. It is understood that the negotiation result of Azivudine Tablets is that it will be included in the medical insurance at the price of 11.58 yuan/tablet (the specification is 3mg/tablet), that is, the price will be reduced from 270 yuan/bottle to regarding 175 yuan/bottle.
A large number of varieties cancel payment restrictions
One of the major changes in this adjustment is the cancellation or reduction of the original payment limits for many drugs, and many drugs have been “unbanned” as a result.
The limited scope of these medical insurance payments is commonly called “medical insurance suffix” by the industry because it is in the remarks column of the catalogue.
The suffix in the remarks column limits the scope of payment for medicines. Either limit the indications, or limit the level of hospitals used or specific medical scenarios. In short, only the expenses that meet the limited range can be paid by medical insurance. Although drugs can be used clinically in theory, more payment restrictions will more or less affect the scope of drug use.
The removal of payment restrictions on some medicines and the expansion of beneficiaries are also to make hospital prescriptions and patients more convenient.
“Previously, under specific historical conditions, the payment restrictions for medical insurance drugs played a very good role in maintaining the safety of medical insurance funds, avoiding clinical abuse, and the emergence of unreasonable large prescriptions.” Liao Zangyi, an associate professor at the School of Politics and Public Administration, China University of Political Science and Law, pointed out In recent years, with the acceleration of new drug approval, many innovative drugs have been included in the medical insurance catalog shortly following being approved for marketing. Clinicians and hospital managers do not know enough regarding drugs. And cancel the payment limit of medicines, so that the scope of reimbursement is equal to the instructions, which can greatly facilitate hospital prescriptions and patients’ use, and avoid social misunderstanding and controversy.
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After the reform of employee medical insurance, the attribution of personal account balance remains unchanged
According to CCTV recently, some places have promoted the reform of the mutual aid security mechanism for outpatient medical insurance for employees, which has aroused the attention of some people. Some people have doubts regarding the reduction in the transfer of employee medical insurance personal accounts following the reform, and have concerns regarding the convenience of seeing a doctor following the reform. In response to the general concerns of the society in this reform, the person in charge of the relevant department of the National Medical Security Administration answered questions from reporters.
What are the benefits of this reform for the insured?
According to the person in charge of the relevant department of the National Medical Security Administration, this reform will benefit the insured in the following three aspects.
“Increase” has enabled most areas to realize the transformation of general outpatient reimbursement from scratch. In layman’s terms, it means that areas where employee medical insurance participants were not reimbursed for ordinary outpatient clinics can be reimbursed following the reform; areas where ordinary outpatient clinics can be reimbursed before, the reimbursement amount has been further increased. First, in addition to the reimbursement of drug expenses, expenses such as inspections, inspections, and treatments that meet the regulations can also be reimbursed. Second, some outpatient expenses for diseases with long treatment periods, great damage to health, and heavy burden of expenses will be included in the reimbursement of ordinary outpatient clinics, and enjoy a higher reimbursement ratio and amount. Third, the drug guarantee services provided by qualified designated retail pharmacies are also included in the scope of outpatient reimbursement.
“Excellent”, to alleviate the problem of “difficulty in hospitalization” to a certain extent by optimizing the allocation of medical resources. Before the reform, unreasonable medical behaviors such as “hospitalization without indications”, “hospitalization in bed” and “hospitalization for minor illnesses” occurred frequently due to insufficient protection in general outpatient clinics. After the reform, insured persons can enjoy reimbursement in general outpatient clinics, which can reduce the previously high hospitalization rate to a certain extent, reduce the pressure on bed turnover in large hospitals, promote the rational allocation of medical resources, and leave high-quality medical resources to those who really need them patient.
“Expand” means to expand the scope of use of personal accounts from the insured person himself to family members. Before the reform, personal accounts might only be used by insured employees themselves, and family members might not use relatives’ personal accounts when they were sick. This reform has expanded the use of personal accounts in three aspects: first, it can pay for the medical expenses borne by the spouse, parents and children when they seek medical treatment in designated medical institutions; second, it can pay for spouses, parents and children in designated medical institutions. Retail pharmacies purchase drugs, medical equipment, and medical consumables that are borne by individuals; third, some areas can pay for spouses, parents, and children who participate in the basic medical insurance for urban and rural residents.
The proportion and direction of personal payment of in-service employees remain unchanged
According to the person in charge of the relevant department of the National Medical Security Administration, there are mainly 3 “unchanged” and 2 “adjustments” regarding the adjustment of the personal account transfer method.
3 “unchanged”. First, the attribution of personal account balances remains unchanged. The principal and interest of personal accounts, whether they are historical balances before the reform or newly transferred balances following the reform, are still owned by the individual and can still be carried forward for use and inherited. Second, the proportion and flow of personal contributions of in-service employees remain unchanged. The individual medical insurance premiums paid by employees are still fully transferred to their personal accounts. Third, the policy that retirees do not pay contributions remains unchanged. Retirees still do not need to pay fees, and the personal account funds are still transferred from the medical insurance pooling fund.
The two “adjustments” refer to adjusting the transfer methods of personal accounts of active employees and retired employees according to different methods. First, for current employees, before the reform, the source of funds for personal accounts consisted of part of the unit’s payment and personal payment; following the reform, the individual’s payment is still all transferred to the personal account, and the part of the original unit’s payment that was transferred to the personal account is transferred to the Co-ordinating funds. Second, for retirees, before the reform, the funds transferred to personal accounts in most places every month were “the actual amount of personal pensions × transfer standards”; The average level of the basic pension in the year of the reform × the inclusion standard”, in which, the inclusion standard following the reform is lower than that before the reform.
The core of this reform is to “replace” the overall reimbursement of general outpatient clinics with the method of adjusting the transfer of personal accounts. The reform involves the adjustment of interests, and the funds transferred to the personal accounts of many insured persons will be reduced to varying degrees.
Source: Xiaoxiang Morning News
