Kunming Information Port News (Kunming** reporter Liao Jingrong).In the new version of the National Medical Insurance Drug Catalogue, which was officially implemented on January 1 this year, there are 430 varieties of national medical insurance negotiation drugs (hereinafter referred to as "national drugs"), most of which are used for major diseases.
How to make the country talk about medicine to benefit the people in a timely manner? Kunming City actively opens up the "last mile" of the landing of national medicine and promotes the "dual channel" policy. Up to now, there are 222 designated pharmacies in the city that have been included in the "dual channel" management, and the designated medical institutions have played a "combination punch" and run out of acceleration, so that patients can "buy, use, and report" the national medicine.
Multi-party joint efforts Patients can buy "new" drugs
At the beginning of the new year, Mr. Huang, who lives in Kunming, waited for good news.
Mr. Huang, 71 years old, was diagnosed with gastrointestinal stromal tumor for many years, and had tumor metastasis in December last year, coupled with a genetic mutation, he could only take a targeted drug called "avatinib" for **. At that time, "avatinib" was not included in the medical insurance, and Mr. Huang purchased drugs through other channels, and he needed to pay 39,900 yuan per month, and he was so worried that he couldn't sleep. Only a month later, "avatinib" was included in the new version of the national medical insurance drug list after national negotiations, which means that his "life-saving drug" can finally be reimbursed by medical insurance.
On January 23, Mr. Huang came to the Department of Gastric and Small Intestine Surgery of Yunnan Hospital of Peking University Cancer Hospital (Yunnan Provincial Cancer Hospital) to find a long-term expert and plan to prescribe a new Guotan drug. However, after consultation, Mr. Huang found that the hospital did not have this medicine for the time being, and it would take some time if he went through the collection procedure, but his stock of medicine would be exhausted by the end of January.
The medicine was covered by medical insurance but could not be bought, and Mr. Huang was very anxious. The expert reassured him: "Now there is a good solution to the problem - go 'double channel'." What is a "dual channel"? This is one of the practical measures to solve the problem of the landing of national medicine, and to form a joint force of medical treatment, medical insurance, medicine and other forces to help the landing of national medicine. In short, the "dual channel" is to meet the needs of the first guarantee through the two channels of designated medical institutions and designated retail pharmacies. Patients can not only use drugs in the hospital, but also go to designated pharmacies to buy them, and enjoy the same medical insurance treatment as in the hospital. This is also regarded as a new channel to open up the "last mile" of the landing of national medicine.
However, when the doctor prescribed, he found that the system could not save it, indicating that there was no pharmacy in Kunming that was selling the drug. The Department of Gastric and Small Intestine Surgery contacted the Medical Insurance Office of Yunnan Hospital of Peking University Cancer Hospital (Yunnan Provincial Cancer Hospital), and Xu Chunhui, director of the Medical Insurance Office, immediately contacted the "dual-channel" designated pharmacies, and some pharmacies said that they could quickly allocate them. Two days later, the pharmacy said that the medicine had arrived in Kunming, and experts from Peking University Cancer Hospital Yunnan Hospital (Yunnan Provincial Cancer Hospital) issued a "dual-channel" electronic prescription and transmitted it to the "prescription circulation platform" of Yunnan medical insurance, so that patients could go to the "dual-channel" designated pharmacy to pick up the medicine and enjoy the same medical insurance reimbursement treatment as the hospital. On January 25, Mr. Huang successfully got the medicine, he is a Kunming employee medical insurance insured, according to the reimbursement ratio, he only paid 3,100 yuan, and the medical insurance saved him 36,800 yuan.
"Expanding" pharmacies with electronic prescriptions turned up
Xu Chunhui introduced that most of the national drugs are clinically necessary and have definite efficacy, but the most advanced drugs are negotiated by the National Health Insurance Bureau and pharmaceutical companies to achieve the purpose of price reduction and are included in the scope of medical insurance payment. However, as far as hospitals are concerned, it is not possible to prepare all the national medicines, and at this time, the "dual channel" is like a highway, which can allow the national medicines to land as soon as possible and benefit patients.
The "dual-channel" pharmacy is like the hospital's "expansion pharmacy", the patient goes to the medical institution for treatment, the doctor prescribes according to the condition, and the patient through the voluntary principle, if the "dual-channel" electronic prescription is transferred to the designated pharmacy to pick up the drug, the hospital will issue the electronic prescription and transmit it to the "prescription circulation platform" of Yunnan medical insurance. The platform is open and transparent, patients can choose the nearest and available "dual-channel" designated pharmacies, show the patient's medical insurance card or electronic medical insurance certificate to obtain the patient's prescription information, and after passing the review of the licensed pharmacist in the pharmacy, they can be reimbursed in the pharmacy for taking the medicine.
On September 14, 2023, Peking University Cancer Hospital Yunnan Hospital (Yunnan Provincial Cancer Hospital) successfully realized the first offline electronic prescription settlement in the "dual-channel" pharmacy medical insurance; On November 1 of the same year, the "dual channel" function of the hospital's Internet hospital medical insurance was officially launched, becoming the first hospital in the country to realize the "dual channel" prescription circulation of Internet hospital medical insurance drugs. At present, the "dual channel" of the hospital can be carried out online and offline simultaneously, among which the "dual channel" prescription of the online Internet hospital can be successfully transferred to the "dual channel" designated retail pharmacy of medical insurance in Yunnan Province, and patients do not need to go to the hospital to prescribe medicine, and can pick up the medicine at the pharmacy at the doorstep.
Strict access to achieve full coverage of "dual channels".
Sinopharm Kunming Pharmacy is currently equipped with more than 140 specifications of Guotan Medicine, mainly for blood, tumor, respiratory and other diseases, which can basically meet the needs of patients. Since most of these drugs have special requirements for storage conditions, the drug area is divided into room temperature area, cool area and refrigerated area.
My father has had severe eczema for over 5 years and needs to use a box of dupilumab injection every two months**. Previously, we have been regularly seeing and taking medicine in the First Affiliated Hospital of Kunming Medical University, but because of the large number of patients, we can usually only see and take medicine in the morning and only in the afternoon. Since the implementation of the 'dual channel' policy, there is an option to purchase medicines at a 'dual channel' pharmacy near the hospital through electronic prescription circulation, which can be completed in the morning**. Ms. Sun, a citizen, said. On February 28, Ms. Sun came to the pharmacy again, and the dupilumab injection she purchased was a cold-chain drug. The patient's electronic medical insurance certificate is presented, and the patient's electronic prescription is quickly displayed in the pharmacy's system, and the patient's personal information, clinical diagnosis information, drug name specifications and other information are readily available. In less than 3 minutes, Ms. Sun bought the medicine she needed at the pharmacy. The original price of the drug is 5561 per box6 yuan, after using medical insurance payment, the individual only paid 956$6.
According to He Yan, manager of the store management department of Sinopharm Yunnan *** Retail Center, Sinopharm Kunming Pharmacy *** Xichang Road Pharmacy received the first "dual-channel" prescription on November 16, 2023, with an average of about 30 orders per day. The company is a batch and zero integrated management, and the headquarters Guotan drug allocation rate is more than 90%, which can be quickly transferred to the pharmacy according to demand.
The relevant person in charge of the Kunming Medical Security Bureau said that the "dual channel" management mechanism is an important measure for the implementation of Guotan Medicine, and the introduction of the policy has changed the single way of the original medical insurance co-ordination in medical institutions, and incorporated some social designated retail pharmacies, which has improved the accessibility of Guotan Medicine. In addition, in order to ensure the continuity of drug use and the stability of treatment for the insured, in addition to the 430 varieties that can currently enjoy the national drug policy, the 53 varieties that have been transferred from the national drug to the regular catalog after the adjustment of the catalogue will continue to implement the original national drug payment policy. At present, Kunming has achieved full coverage of the "dual channel" of national drugs, and 222 designated pharmacies have been included in the "dual channel" management, and all supplementary agreements have been signed to ensure that there is at least one "dual channel" designated pharmacy in each county (city) district of the city.
From the perspective of medical insurance, it is of great significance for the high-quality development of Kunming's biomedical industry to effectively open up the various medical insurance links of Guotan medicine into hospitals, pharmacies and clinical use. In the future, the Kunming Municipal Medical Security Bureau will continue to take "new" measures, strictly manage access, stimulate competitive vitality, release the dividends of medical insurance policies in place, and ensure that the national medicine will benefit patients as soon as possible.