A large number of drug and medical insurance payment restrictions have been lifted (with list attached)

01 30 drugs cancel the limited payment scope of medical insurance

Recently, the Fujian Provincial Medical Insurance Bureau issued the "Notice on Adjusting the Restricted Payment Scope of Some Drugs", which clearly stated that from January 1, 2022, 30 drugs, including Xuesaitong for injection (freeze-dried), will be restored to the limited payment scope of medical insurance.

In an interview with reporters about the adjustment of the 2021 catalogue, the National Medical Insurance Administration stated that from the perspective of maintaining the fairness of patients' medication, improving the relationship between doctors and patients, and facilitating reasonable clinical treatment, it is necessary to gradually restore the scope of payment for drugs in the catalogue to the approval of the drug regulatory department.

For the 94 drugs successfully negotiated during this year's adjustment, the payment scope is consistent with the instructions

During the pilot process, according to the voluntary application of enterprises, the scope of drug payment included in the pilot scope will be simultaneously restored to the drug insert sheet

Some chemical drugs and proprietary Chinese medicines, such as 30 kinds of drugs such as Glycidazole Sodium for Injection, Erecoxib Tablets, Arbidol Hydrochloride Tablets, Danhong Injection, etc.

02 Pilot work on medical insurance payment standards in many provinces

According to incomplete statistics from Cyberland, Jiangxi, Inner Mongolia, Guizhou, Xinjiang and other provinces have also successively carried out pilot work on medical insurance payment standards

Jiangxi (29)

On January 6, 2022, the Jiangxi Provincial Medical Insurance Bureau issued a notice on printing and distributing the "First Batch of Medical Insurance Drug Payment Standard Pilot List in Jiangxi Province", which clearly included 29 varieties including Jianwei Xiaoshi tablets

It is worth noting that the pilot varieties of medical insurance payment standards in Jiangxi Province are differentiated by manufacturers, and some varieties are also different because manufacturers do not have to pay standards

Inner Mongolia (30 )

On December 31, 2021, the Inner Mongolia Medical Insurance Bureau issued a notice to carry out the pilot work of medical insurance drug payment standards, stipulating that insured patients use drugs with a price not higher than the payment standard, and patients and medical insurance funds are based on the actual sales price and share according to policy regulations.

Patients use medicines with a price higher than the payment standard, the part exceeding the payment standard shall be borne by the patient, and the part within the payment standard shall be shared by the patient and the medical insurance fund according to the policy

Guizhou (24)

On December 30, 2021, the Guizhou Provincial Medical Insurance Bureau issued the "Notice on Printing and Distributing the Medical Insurance Payment Standards for Pilot Drugs".

Xinjiang (21)

On December 29, 2021, the Xinjiang Provincial Medical Insurance Bureau issued a notice on printing and distributing the "Implementation Plan for the Pilot Work of the Medical Insurance Drug Payment Standard in Xinjiang Uygur Autonomous Region and Xinjiang Production and Construction Corps", which included 21 drugs including gastrodin injection into Xinjiang Medical Insurance The list of drugs in the pilot scope of payment standards and payment standards

It is worth noting that although various provinces are carrying out the pilot work of medical insurance payment standards, the pilot varieties and medical insurance payment standards of each province are not completely consistent

03 There are still payment restrictions for a large number of drugs

The 2021 version of the medical insurance catalog has been implemented.

Among them, there are 395 types of western medicines, 246 types of Chinese patent medicines, and the rest are type B medicines.

Cyberblue’s review found that among the 275 negotiated drugs (including 213 western medicines and 62 Chinese patent medicines), 233 had payment restrictions (201 western medicines and 32 traditional Chinese medicines)

Payment restrictions mainly include patients, limited indications, limited second-line drugs, limited onset time, limited use period (such as before and after surgery),
etc.

In addition, there are 747 medical insurance drugs that need to pay attention to payment restrictions, that is, reimbursement must meet certain qualifications
.
(Click to read for details ☞From now on! The new version of the medical insurance catalog will be implemented, and 747 drugs will be restricted from payment (with a list))

The limited payment scope of medical insurance is the standard for whether the medical insurance fund will pay.
Insured patients can only be paid by the basic medical insurance fund if they meet the medical insurance limited payment conditions for drugs, diagnosis and treatment items, and special medical materials
.

It is not known which more medicines will cancel the limited payment scope of medical insurance in the future, but the National Medical Insurance Bureau said that in the next step, the Medical Insurance Bureau will reduce the increment according to the progress of the pilot, on the premise of ensuring the safety of funds and the fairness of patients' medication.
, the principle of digesting the stock, and gradually restore the payment scope of more drugs in the catalog to the drug inserts
.

Fujian

Jiangxi

Inner Mongolia

Guizhou

Xinjiang