Medical network - March 13, 2017 health people club department directory in the notice, request the provinces (autonomous regions and municipalities) according to the requirements of drug price reform was accelerated by the common name for medicare drug payment standards work, the region as a whole can further improve the medical insurance drugs classification management method to pay. This predictable, various places page to pay for health care standards will be arriving.
National health insurance directory related notice specifically, plays a role of adjuvant therapy for class b drugs in main medicines, can be appropriately increase individual pay scale, proportion and other class b drugs to pay gap. This means that accompany a medicare catalog, also will have medical insurance pay standard, auxiliary drug use will be limited.
As medical insurance directory of fujian province introduced first paid directories provinces, the price paid has reference effect to the whole industry.
Auxiliary drug reimbursement ratio as low as 50%
Fujian province will jointly limit sun purchasing drugs into non-competitive directory and competitive directory. To non-competitive directory specific "definition" - including the original drug, through the FDA certification, and in Europe and the United States have a sales of generic drugs, as well as by consistent evaluation and exclusive rights to produce generic drugs (registration); In addition to the varieties in competitive directory. In addition, the fujian also press the "therapeutic drugs" "adjuvant drug" and "nutritional medicine" to distinguish the drug properties.
Table 1 fujian paid directories reimbursement ratio of all kinds of products
(source: general sensitive information)
As shown in table 1, the highest competitive directory reimbursement ratio is 100%, the lowest for 50%. Non-competitive directory reimbursement ratio was 90%, the highest minimum ratio is greater than 0%.
Among them, the non-competitive directory 1201 common name, competitive directory is 1125. Among them, 100% for the gauge has 12936, mainly in western medicine (10015), Chinese medicine has 2921. 90% of reimbursement ratio has reached and imatinib for sand, a total of four rules.
For the first time in fujian non-competitive catalogue varieties of therapeutic drugs can be divided into general treatment medication and other special patient groups. Among them, the "special patient medication" payment proportion is as high as 80%. Special patient medicine refined include: diabetes medication, in view of the peritoneal fluid uremia, calcium channel blockers for high blood pressure and role in the renin - angiotensin system drugs, drug for the regulation of blood lipid, thyroid treatment for hyperthyroidism and JiaJian, selective immunosuppressant for organ transplants, interleukin inhibitors, calcium neurotransmitter inhibitors and other immunosuppressants, antiepileptic drugs for smi, Parkinson's drug resistance, antipsychotics neurons, anxiolytics, and medicine.
Table 2 fujian paid directories each product gauge number of reimbursement ratio
(source: general sensitive information, March 10, according to the fujian province's official website version)
In addition, as shown in table 2, proprietary Chinese medicine only five medicare pay levels: 100%, 80%, 70%, 50% and 0%. Up nearly 80% of drugs gauge reimburses 100%; Can submit an expense account 80% of the product rules, into drug gauge has 318, 221 western medicine only. Remove resistance T cells rabbit immune globulin, tetanus immunoglobulin, rabies immunoglobulin, special patient groups use western medicine therapeutic drug use a total of 147 gm.
Auxiliary medicine should have a "normal" or "universal"? !
Fujian outreach to adjuvant can be divided into general adjuvant and universal adjuvant, but does not provide a definition, only backward reimbursement ratio according to the form of what products are common adjuvant, those who belong to the universal adjuvant.
Reimbursement and 70% belong to the competitive within the catalogue for the common adjuvant. Western medicine of sulfur profumo ning - enteric capsules/enteric-coated metformin hydrochloride/producing injection/small capacity injection, methionine d B1 - producing injection/small capacity injection and metronidazole, vaginal gels, wu benzene beauty department - film-coated tablet/capsule/tablet and ferulic acid sodium - tablet, capsule, capsule, as well as the traditional Chinese medicine compound cantharis radix bupleuri - small capacity injection, HuaChan element - enteric capsules/enteric-coated metformin hydrochloride and qing spirit - small capacity injection belong to one of them.
60% reimbursement and belong to product of a non-competitive directory for exclusive auxiliary drug use. Specifically, promote liver cells auxin - producing injection/small capacity injection, polyene phosphatidyl choline - small capacity injection/capsule, fructose ErLinSuanNa - powder injection, human recombinant acidic fibroblast growth factor - producing belongs to one of them.
Belong to the competitive directory of universal adjuvant (50%) are: ligustrazine - large volume injection/western medicine producing injection/solvent crystallization powder injection/small capacity injection, puerarin - large volume injection/producing injection/small capacity injection, fructose ErLinSuanNa - producing injection/powder injection/menstruum crystal powder injection, adenosine cyclophosphate - producing injection/small capacity injection, pursuant to the adr - small capacity injection. In addition to traditional Chinese medicine danshen - large volume injection/small capacity injection, pulse-activating decoction - large volume injection/small capacity injection, zhen stilbene centralizer - granules/film-coated tablet/capsule, and m - large volume injection/small capacity injection, panax notoginseng saponins - producing injection/small capacity injection, cordyceps sinensis fermentation agents - film-coated tablet/capsule.
Belongs to a non-competitive directory of universal adjuvant (50%) with pyritinol - small capacity injection and nicotinic acid sustained-release capsules.
Traditional Chinese medicine injections, only 13 products into fujian paid directories. On March 7, fujian has been adjusted a proportion of medical insurance directory, after the adjustment TCM injections are divided into three grades, 70%, 50% and 0%, respectively. Only radix bupleuri injection and qing ling injection belong to common adjuvant, for 70%. The remaining nine products for 50%, xiang Dan injection and father of hemp injection for 0%.
Table 3 the reimbursement ratio of fujian paid directories TCM injections
(source: general sensitive information, March 10, according to the fujian province's official website version)
Pay special attention to
Expired branded drug reimbursement ratio, pegged to the price of generic drugs
Non-compete directory have imitation in the treatment of special patients groups with medicinal properties beyond general therapeutic medicine health care payment settled by not exceed 150% of the group of varieties of the highest selling price competition and their own either person sure of 70% of the highest selling price. Suggesting that they pay for health care products the highest percentage is 70%, but in most cases the medicare payment ratio for generics 1.5 times the highest selling price divided by its health care the highest retail price, if more than generic drugs and bidding is low, the medicare payment proportion will therefore be lower.
By March 7 after adjust the proportion of medical insurance directory of fujian, the original medicare catalog in 0% ~ 10% of the products from the original 42 up to 52. All these products are competitive group directory with imitation in the treatment of special patients groups with medicinal general therapeutic drugs, the medical insurance payment settlement price was only 50% higher than the generics highest selling price.
Table 4: fujian medicare payment proportion is not higher than 10% of the products
(source: general sensitive information, March 10, according to the fujian province's official website version)
Summary < < <
Fujian pay directory brings revelation - auxiliary medicine and nutrition drug restrictions on the use will not only with the using range and also in terms of its health insurance payment standard. However, there are 239 non generic competition directory products under 50%, the proportion of health care payment will greatly reduce the motivation of clinical use, reimbursement ratio is expected to be higher with the indications and belong to the competitive alternative products catalog. |
