Medical network - on February 24, on February 23, people club department issued "about issued by the national basic medical insurance, inductrial injury insurance and maternity insurance drug catalogue (2017 edition) notice (hereinafter referred to as" notice "), officially announced in 2017 edition of the national basic medical insurance, business insurance and maternity insurance drug catalogue.
Tongji medical college huazhong university of science and technology and drug policy and management research center researcher Tony thinks, the new catalogue of the health care into a number of new drugs approved after 2007, overall easing directory, in line with previous expectations, access to relax, the provinces can reimbursement ratio by adjusting to guarantee fund running smoothly.
1, contains drugs is rising by about 15.4%
The new directory, western medicine and traditional part contains 2535 drugs, compared with the 2009 version of the directory increased by 339, rising by about 15.4%. Part of western medicine, 1297, proprietary Chinese medicine section 1238 (including ethnic medicine, 88). Chinese medicine yinpian part did not make an adjustment, still continue to use the provisions of the 2009 drugs directory. The fund of inductrial injury insurance granted only paid five varieties; Birth insurance fund granted only pay four varieties.
Western medicine 402 class a drugs, Chinese patent medicine class a drugs, 192, the rest of class b drugs. Fund of insurance of primary medical treatment to pay the cost of drugs to distinguish between party a and b, inductrial injury insurance and maternity insurance to pay the cost of drugs, regardless of party a and b.
2, synchronization, determine the 45 to negotiate drug
People club department will also explore establishing access to health care medicine negotiation mechanism, eligible drug into the medical insurance to pay limits, the list shall be issued separately. At present, according to people club department website, through expert review synchronous identified 45 to negotiate drug, are of higher clinical value but relatively expensive, exclusive patent drugs. Next, after will confirm whether enterprises have intention, publish to the society plans to negotiate drug list and group negotiation according to related procedure.
Reporter discovery, previously included in the new apt national drug price negotiations for the treatment of non-small cell lung cancer for ek, the treatment, also entered the directory, for class b drugs. Beida pharmaceutical bulletin said, into the medical insurance directory will be conducive to product sales.
3, raise the auxiliary medication since the pay scale
"Notice" requirements the provinces (autonomous regions and municipalities) to accelerate the according to the requirements of drug price reform in accordance with the common name for medicare drug payment standards work, and as a whole the area can further improve the medical insurance drugs classification management method to pay. For class b drugs mainly its auxiliary therapeutic effect of drugs, can be appropriately increase individual pay scale, proportion with other class b drugs pay gap.
To accelerate the medicare drug payment standards in according to the common name, Tony said: "the reality is, the concept of desalination directory, in the tender under the condition of charged fees, access to hospital and payment standards that enterprises focus. We will accelerate in the common name of medicare drug payment standard work, are likely to face the reality is that the provinces are lower in the quality level of the lowest price as the standard for health care payment limit, enterprises should be rational to sit down and think seriously about how to deal with the next."
In his view, as after a phased results consistency evaluation, national health insurance directory in the direction of the future will be fully correct negative directory. The adjustment of this work will be affected by consistency evaluation work, medical services price adjustment and medicine separate payment, health care reform, positioning, and many other factors, individual account and would be a long process. At present, the enterprises should focus on is the most important and the policies of micro forming mechanism of payment standard provinces for the directory.
4, need directory of drugs for the record
"Notice" clearly, the clinical emergency rescue and special treatment needed outside the directory of drugs, can establish a reporting system for the medical establishment that decide a dot, clear the corresponding measures for the management of audit, and be submitted to the human resources of the social security department for the record.
5 released on July 31, the local directory, b the drug does not exceed 15%
"Notice", stressed that the competent department of the provinces, autonomous regions and municipalities directly under the social insurance for class a drugs shall not be adjusted in the catalogue of drugs, should be strictly carried out in accordance with the current laws and regulations and documents b drug adjustment. The provinces (autonomous regions and municipalities) should be released on July 31, 2017 local insurance of primary medical treatment, inductrial injury insurance and maternity insurance drug catalogue. Adjust the number of (including call in and out, adjust the limit to pay limits) shall not exceed 15% of the national class b drugs number. The class b drugs for adjustment. It should be in accordance with the provisions, newspaper club department for the record.
"Notice" requirements, each as a whole the area in the province, autonomous regions and municipalities directly under the basic medical insurance, inductrial injury insurance and maternity insurance drug catalogue to perform within a month after the release of the new drug directory, and in accordance with the relevant regulations, update into the fund to pay limits medical preparation list.
6, large dosage of key monitoring and rational use of drugs
"Notice" requirements, each as a whole the area according to the medical institutions within their respective jurisdictions, and retail pharmacy drug usage, do a good job directory corresponding drugs, drug database update perfect information system. The provinces (autonomous regions and municipalities) to combine different direct settlement work, speed up the application of "social insurance drug classification and code" industry standards, establish and improve the province (area, city) unified drug database, realize provincial scale, proprietary Chinese medicine, western medicine hospital preparations, Chinese medicine yinpian, unified management.
Integrated with the catalog of drug management rules and measures for the management of family planning and other departments of public health prescription, clinical practice, clinical guidelines and clinical drug application guidelines, etc., will be implemented the medical establishment that decide a dot use the catalog of drugs into the designated service agreement scope management and examination. Establish and improve the medical service intelligent monitoring system of insurance of primary medical treatment and social insurance drug use analysis and monitoring system, the key monitoring dosage, expense and there may be more not rational use of medicines, monitoring results to the public in the proper manner. |
