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In order to include more good drugs in medical insurance.
The National Health Security Administration has been established since its establishment.
Continuously promote the adjustment of the national medical insurance drug list.
The new version of the National Medical Insurance Drug Catalogue.
It will be officially implemented from January 1, 2024.
The total number of drugs in the catalogue reached 3,088
What are medical insurance drugs, national drugs, and dual-channel drugs?
Let's find out.
1. What is a medical insurance drug?
The drugs in the list of medical insurance drugs are called "medical insurance drugs", and the medical insurance drugs are mainly divided into two categories, namely Class A drugs and Class B drugs. Class A drugs are clinically necessary, widely used, with good efficacy and low among similar drugs; Class B drugs are drugs that can be used clinically, have good efficacy, and are higher than Class A drugs in the same category.
2. What factors affect the reimbursement ratio of medical insurance?
When the insured person uses "Class A" drugs, he or she can be fully included in the scope of reimbursement. There is a basic out-of-pocket ratio for Class B drugs, and there will be certain differences in the out-of-pocket ratio of the same drug in different provinces and cities. The reimbursement ratio of specific medical insurance drugs is related to the nature of the insured people's insurance (employee medical insurance, resident medical insurance), drug classification (Class A, Class B), the hospital grade of the hospital (** second, first level and below), the form of treatment (inpatient, outpatient), etc., in addition, it is also related to whether the patient is involved in the treatment of slow and special doors, dual channels, etc.
3. What are the medical insurance treatment policies enjoyed by the insured people when they purchase medical insurance drugs directly for medical treatment in other places?
There are two situations of direct settlement for the purchase of medical insurance drugs for medical treatment in other places:
1) The implementation of the province's non-local medical insurance drug payment scope and relevant provisions of the province's unified regulations, but the basic medical insurance ** payment standard, the maximum payment limit, the scope of outpatient chronic diseases, etc., in accordance with the relevant policies stipulated by the place of insurance;
2) Direct settlement for the purchase of medical insurance drugs for cross-provincial and non-local medical treatment, in principle, is the implementation of the scope of payment of medical insurance drugs and relevant regulations stipulated by the place of medical treatment, and the implementation of the basic medical insurance ** payment standard, the maximum payment limit and the scope of outpatient chronic diseases and other relevant policies stipulated by the place of insurance.
4. What is Guotan Medicine?
The National Medical Insurance Negotiation Drug (Guobao Drug) is a drug negotiated and determined by the national centralized organization, and the drug price is greatly reduced, and it is included in the scope of medical insurance reimbursement. The implementation of national medical insurance negotiation drugs involves the vital interests of the majority of insured patients, and is of great significance to better meet clinical needs and improve the efficiency of medical insurance.
5. What are dual-channel and dual-channel drugs?
"Dual channel" refers to the mechanism of meeting the reasonable needs of negotiated drugs, chronic disease drugs (except ** products, psychotropic drugs, and toxic drugs for medical use) through two channels: medical insurance designated medical institutions and medical insurance designated retail pharmacies, and simultaneously incorporated into the medical insurance payment mechanism.
"Dual-channel" managed drugs (hereinafter referred to as "dual-channel" drugs) refer to negotiated drugs and drugs for chronic diseases with high clinical value, urgent needs of patients, and low substitution. Insured patients purchase "dual-channel" drugs at "dual-channel" retail pharmacies through external prescriptions issued by designated medical institutions, and medical insurance** will pay according to regulations.