Another province released the "dual channel" catalog!

On November 23, the Jiangxi Provincial Medical Insurance Bureau issued the "Interim Measures for the Administration of Dual Channel Negotiation Drugs in Jiangxi Province" (hereinafter referred to as the "Measures") and announced the first batch of "dual channel" drugs
.
After sorting out, it was found that 53 drugs including vedelizumab, duplizumab, and osimertinib were included, of which 19 were injections

According to the plan of the National Medical Insurance Administration, before the end of October this year, all provinces must determine the list of drugs that are included in the "dual-channel" management of the province and announce it to the public
.
According to public information, there are not many regions that directly release the list, and the number and types of "dual-channel" drugs are also different

Seven situations where the medical insurance fund will not pay; do not require or induce patients to purchase medicines at designated pharmacies

The "Measures" require that the negotiated drugs shall be managed under the generic name of the medical insurance category B and dual channels
.
Negotiated drugs included in dual-channel management shall implement the dual-channel drug payment policy; negotiated drugs not included in dual-channel management shall implement the medical insurance category B drug payment policy

Regarding the medical insurance payment standard, dual-channel drugs set the highest medical insurance payment standard, that is, the drug price (linked to the Jiangxi medical insurance payment standard) minus the fixed cost borne by the individual
.
If the difference between the actual drug price minus the fixed personal burden is lower than the maximum payment standard of medical insurance, the medical insurance pooling fund will be paid according to the difference of the actual drug price; if the difference between the actual drug price minus the fixed personal burden of the cost is higher than the maximum payment standard of medical insurance , The medical insurance pooling fund is paid according to the highest payment standard of medical insurance

It is worth noting that Jiangxi has strict requirements on the use of insured personnel
.
If the insured person has the following conditions, his dual-channel drug protection treatment shall be terminated: (1) The treatment course and dosage requirements in the dual-channel drug list are exceeded; (2) The responsible physician evaluates the insured person’s condition changes, etc.

At the same time, the medical insurance pooling fund will not pay for the dual-channel drug expenses incurred by the insured person in the dual-channel medical institution if one of the following conditions is met: (1) Incurred before the date when the dual-channel drug is included in the payment scope of the medical insurance fund; ( (2) Used by insured patients who have not been assessed by the responsible physician; (3) Occurs when a non-responsible physician writes a prescription; (4) Exceeds the maximum medical insurance payment standard; (5) Occurs beyond the medical insurance limited payment scope; ( 6) Involvement in violations of regulations, such as excessive diagnosis and treatment, inconsistency of personal identification, and false diagnosis and treatment; (7) Involvement in the use of dual-channel drugs provided by drug manufacturers or charitable organizations for free
.

The "Measures" stipulate that dual-channel medical institutions need to have corresponding diagnosis and treatment technologies, have corresponding genetic and pathological testing capabilities, and be designated medical institutions of secondary or higher entities that purchase corresponding dual-channel drugs in a timely manner according to functional positioning and clinical needs
.
Responsible physicians must, in principle, have the qualifications for professional and technical positions with disease-related majors or higher (including sub-senior high) (can be relaxed to attending physicians according to local conditions), and write prescriptions in strict accordance with the legal indications of dual-channel drugs and the limited scope of payment.

Regarding the circulation of prescriptions, the Jiangxi Provincial Medical Insurance Bureau relies on the unified national medical insurance information system and uniformly deploys the province's medical insurance electronic prescription circulation platform in accordance with national standards
.
The dual-channel drug prescription circulation is the prescription by the responsible physician of the dual-channel medical institution, and the prescription is transferred to the dual-channel pharmacy through the medical insurance electronic prescription circulation platform

"Dual channel" landing has a long way to go

According to incomplete statistics, as of now, more than ten provinces (autonomous regions) including Hunan, Fujian, Guangdong, Jiangsu, Zhejiang, Anhui, Henan, Hebei, Xinjiang, Qinghai, Hubei, Jiangxi, Shanxi, and Inner Mongolia have successively released the "dual channel" "Policy
.

However, not many “dual-channel” drug catalogs have been released, but recently, provinces are accelerating the release of relevant catalogs
.
On November 23, Hubei Xianning also released the "dual-channel" management catalog (2021 version) of drugs for the national medical insurance negotiation, with a total of 111 drugs

Sorting out: Jiangsu Province released the first annual "dual-channel" drug list in July this year, with a total of 100 drugs, involving 83 drugs and innovative drugs with major diseases, long service cycles, and high treatment costs; September, Anhui The Provincial Medical Insurance Bureau announced the "Anhui Province National Negotiation Drug "Dual Channel" Management Catalogue (2021 Edition)", which contains 188 different specifications of national negotiation drugs; in early October, the Hunan Provincial Medical Security Bureau determined the year of 2021 through an expert selection process.
The first batch of "dual-channel" management drugs in Hunan Province, a total of 49 drugs, including 40 western medicines and 9 Chinese patent medicines; in mid-October, the Guangdong Provincial Medical Insurance Bureau issued the "Dual-channel" management drug scope in Guangdong Province (2021) 》, a total of 221 drugs were included, a considerable number; on November 1, the Fujian Medical Insurance "dual-channel" electronic prescription circulation platform was officially launched, and the first batch of "dual-channel" management drug catalogs was released, with a total of 32 drugs
.

Some experts believe that at present, in some areas with high levels of outpatient treatment protection, the treatment guarantee basically covers all nationally negotiated drugs, so there is no special policy named "dual channel" to open up the two channels inside and outside the hospital, while the "dual channel" In most areas where the policies have been implemented well, the general outpatient guarantees and special policies cannot fully cover the products of the national talks, and the dual-channel "filling up" role is needed
.
Since 2018, three rounds of drug negotiations led by the National Medical Insurance Administration have been carried out.
A total of 221 negotiated drugs are within the period of the medical insurance agreement.
The fourth round of negotiations has also ended a few days ago
.
With the continuous increase in the number of negotiated drugs, the industry has paid much attention to the implementation of the "dual channel" implementation
.