The latest medical insurance documents issued by Zhejiang Province affect all hospitals, pharmaceutical enterprises and pharmacies

On January 8, Zhejiang Medical Insurance Bureau issued the notice on public opinions and suggestions (hereinafter referred to as the "draft") The content of the draft involves the adjustment of online trading products, the improvement of medical insurance drug payment standard system, etc the following are the summary and analysis points of cypress blue that deserve your attention The scope of this dynamic adjustment of online trading products in Zhejiang Province includes transfer in and transfer out ( The scope of transfer in includes the undeleted varieties in the original provincial supplement catalogue, which is also in line with the requirements of the state health insurance bureau for the gradual cleaning up of local supplement varieties within three years Although these varieties are still included in the full coverage of medical insurance payment at present, if they are cleaned up according to the proportion of 40%, 40% and 20% of the varieties circulated in the past three years, this part of varieties will also face the problem of transferring out the medical insurance catalog and the full coverage of medical insurance payment In addition, transfer in products with the same product price that have been traded online have obvious advantages, which will encourage products with lower price to enter Zhejiang market, further change the competition pattern of the market, and promote the decline of drug price The transfer out scope includes the products with higher price in online trading of drugs, which is complementary to the products with obvious advantages in the previous transfer in price, which will avoid the situation of virtual high drug price The drug price traded on the platform will be more reasonable once in and out In addition, for the products mentioned in the opinion draft that have clinical needs but no online trading products on the platform or cannot be purchased at the set price, you can choose to exit the platform transaction and choose to record the purchase Record purchase is to directly discuss the price with the medical institution According to the requirements of the opinion draft, as long as the purchase amount does not exceed 1% of the annual drug settlement amount of the medical institution, it is OK Therefore, if the price system of enterprise products is well maintained, it is a good way for many exclusive varieties, medicines in short supply, first-aid medicines, etc According to the opinion draft, Zhejiang Province dynamically adjusted the online trading products of the procurement platform of medical devices, realized the full coverage of online trading products under the generic name of medical insurance drugs, improved the price discovery function of the platform, introduced the dynamic competition mechanism, improved the effectiveness of products, and reduced the purchase price According to the opinion draft, different products have different price requirements on the platform According to the requirements of the opinion draft, Zhejiang is still relatively strict in terms of price regulation, which is basically to keep pace with the lowest price in China In addition, it is worth noting that according to the draft of opinions, all designated medical institutions (including private medical institutions) in Zhejiang Province uniformly implement the zero plus drug policy and the unified payment standard for medical insurance drugs The designated private medical institutions shall refer to the medical service price reform policy of public medical institutions of the same level to improve the medical insurance payment standard of medical service items That is to say, the varieties that are fully covered by the medical insurance payment on the platform can be purchased on the online transaction of the platform, and enjoy the corresponding medical insurance payment standards, including in the designated pharmacies of medical insurance and private hospitals All designated retail pharmacies across the province implement a unified medical insurance drug payment standard, which is 15% higher than the determined payment standard of medical institutions (excluding national and provincial negotiated drugs), with a maximum of no more than 200 yuan (based on the minimum package) Some analysts told saibelan that although the designated pharmacies of medical insurance can enjoy medical insurance payment by participating in centralized purchase, it also means that the retail price of medical insurance drugs in pharmacies cannot be increased at will For example, if the centralized purchase price of a medical insurance drug is 20 yuan, the retail price shall not exceed 23 yuan If the limit is exceeded, the medical insurance will not be settled and can only be settled at its own expense This regulation has advantages and disadvantages for designated pharmacies of medical insurance As we all know, medical insurance payment is particularly important for designated pharmacies Once there is no medical insurance payment function, pharmacies will face a large loss of customers However, for the purpose of medical insurance, pharmacies have to pay a price As early as October 24, Zhejiang Medical Insurance Bureau issued the Interim Measures for the administration of designated pharmacies of basic medical insurance of Zhejiang Province (Draft for comments) It refers to: At present, drugstores sell Medicare drugs at a 15% mark up Under the requirement of not less than 50% of drug varieties traded online, drugstores will have a large part of their profits limited to 15% For some varieties with more than 15% of the original profits, if the drugstore takes the platform to participate in the medical insurance settlement, it is equivalent to actively giving up the profits beyond 15% In addition, daily necessities, cosmetics, health care products, etc are not allowed to enter designated drugstores Under this requirement, the profits of drugstores will be greatly reduced In the future, under the full coverage of medical insurance drug payment standards, pharmaceutical enterprises, pharmacies and hospitals will all face great opportunities and challenges Attachment: the list of varieties not traded online has not been deleted in the supplementary medical insurance catalogue of Zhejiang Province