Where to find medical insurance drug information

Where to find medical insurance drug information

[ad_1]

“Where can I buy drugs in the medical insurance drug catalog?” “What adjustments are made to reimbursement?” For more than half a year, the WeChat public account of the National Medical Insurance Administration has launched catalog query and drug dispensing agency query functions. Some insured people have questions about which new drugs will be included in the 2023 version of the national medical insurance. We still don’t know much about the drug catalog and specific reimbursement details. In response to issues of general concern to the society, the relevant person in charge of the National Medical Insurance Administration recently provided detailed answers.

The total number of drugs in the catalog reaches 3088

Q: What is the National Medical Insurance Drug List?

Answer: In order to ensure the basic medical needs of insured persons and standardize the medication management of basic medical insurance, the state has formulated a medical insurance drug catalog. The medical insurance fund will pay the relevant medical expenses incurred by insured persons in designated medical institutions that comply with the medical insurance drug catalog in accordance with regulations.

The National Medical Insurance Administration has established and improved a dynamic adjustment mechanism for the medical insurance drug catalog. In principle, the medical insurance drug catalog is adjusted once a year, and drugs that meet basic conditions such as clinical necessity, safety, effectiveness, and reasonable price are included in the medical insurance drug catalog.

After 6 rounds of adjustments, a total of 744 new drugs have been added to the medical insurance drug catalog, of which 446 have been added through negotiation, covering all 31 treatment areas in the catalog. Among the drugs negotiated for admission, 100 are for oncology and 93 are for chronic diseases such as hypertension, diabetes, and mental illness. Most of the drugs included in the catalog through negotiation are drugs that have been newly launched in recent years and have high clinical value. A large number of drugs with new mechanisms and new targets have been included in the catalog. Before 2017, there was not a single tumor-targeted drug in the medical insurance catalog. There are already 74 tumor-targeted drugs in the 2023 version of the catalog. Many of these treatment areas have achieved diversified selection of targeted drugs from different generations. At the same time, a total of 395 drugs with uncertain efficacy, easy abuse, clinical elimination, or about to be withdrawn from the market have been recalled over the past six years. At present, the total number of drugs in the national medical insurance drug catalog has reached 3,088, including 1,698 Western medicines, 1,390 Chinese patent medicines, and 892 Chinese medicines.

National medical insurance negotiation drug information is available through multiple channels

Q: Where can I find detailed information about medical insurance drugs? If a patient is first diagnosed in a tertiary hospital and is prescribed a drug negotiated for national medical insurance that needs to be taken long-term, and after a course of treatment, he wants to go to a community hospital to get it, but he does not know whether the community hospital has it. Where can he find this information?

Answer: Drug information in the medical insurance drug catalog can be queried through the National Medical Insurance Service Platform, the official website of the National Medical Insurance Administration, the National Medical Insurance Service Platform APP, and the WeChat official account of the National Medical Insurance Administration. For example, if you use the WeChat official account of the National Medical Insurance Administration to query, first enter the official account, click “Microservices”, find “National Medical Insurance Drug Catalog Query”, and enter the query page. Enter the specific drug name and click search to learn detailed information such as whether the drug is in the catalog, the drug category it belongs to, and the specific reimbursement category. You can also select “Drug Classification” or “Medical Insurance Reimbursement Category” to filter according to your own needs.

As for which medical institutions are equipped with national medical insurance negotiation drugs, you can go to the “National Medical Insurance Negotiation Drug Distribution Agency Query During the Agreement Period” in the “Micro Service” of the WeChat public account of the National Medical Insurance Administration, and the “National Medical Insurance Negotiation Drugs” on the official website of the National Medical Insurance Administration. The information can be obtained from the “Inquiry of Distribution Agencies” or in the “Inquiry for the List of Distribution Agencies for National Medical Insurance Negotiations” in the National Medical Insurance Service Platform APP.

Nourishing, health care, preventive and other categories cannot be reimbursed

Question: What do the words “pay one out of pocket” and “pay two out of pocket” on the payment receipt for medical treatment and medicine mean?

Answer: On the documents, some medicines only have “self-pay one”, and some medicines have both “self-pay one” and “self-pay two”. The difference lies in the different categories of drug efficacy: within the scope of medical insurance reimbursement, only “self-pay” Those with “pay one” and “pay two” are Class B drugs.

In the medical insurance drug catalog, Western medicines and Chinese patent medicines are divided into two categories: A and B. “Category A drugs” refer to drugs that are necessary for clinical treatment, are widely used, have proven efficacy, and have lower prices or treatment costs among similar drugs. When an insured person uses such drugs, the full amount can be included in the reimbursement scope, and then reimbursed according to the prescribed proportion. “Category B drugs” refer to drugs that are available for clinical treatment, have definite curative effects, and are slightly higher in price or treatment cost than “Category A drugs” among similar drugs. When insured persons use such drugs, they need to pay a certain proportion out of their own pocket, and the remaining part will be included in the scope of reimbursement, and then reimbursed according to the prescribed proportion.

Among the 3,088 drugs in the 2023 version of the National Medical Insurance Drug Catalogue, 395 are Category A western medicines, 246 are Category A Chinese patent medicines, and the rest are Category B drugs. During the agreement period, negotiated drugs will be paid according to Category B.

Nourishing, health-care, preventive and other categories of drugs are not included in the national medical insurance drug catalog and need to be paid for at your own expense.

[ad_2]

Source link