What are some of the drugs that are included in the Medicare supplement?

Brokers often mention a few concepts to their clients when introducing medical insurance, including Class A, B and C drugs, drugs outside of social security and purchased drugs. Today to focus on explaining the concept of these a few.

Category A drugs: drugs that are essential for clinical treatment, widely used, effective, and less expensive than similar drugs. 100% reimbursement within the social security catalog. Social security catalog in a certain percentage of reimbursement.

Category C drugs: drugs that are not necessary for clinical treatment and are expensive. Outside of the social security catalog, basically not reimbursed, but reimbursed by Medicare.

Out-of-hospital medications: Medications purchased outside of the hospital with a doctor's prescription, not reimbursed by Social Security or Medicare.

01

Drugs outside of social security

According to the above, the drugs used in social security, i.e., Class A drugs and Class B drugs.

The drugs used outside the social security can be simply understood as Class C drugs, according to the State Drug Administration data show that at present there are 150051 types of domestic drugs, 3903 types of imported drugs, a total of 153954 types.

That is to say, social security can be reimbursed for drugs in Category A and B accounted for more than 98% of the social security outside 100% of the out-of-pocket expenses of Category C drugs, only from the cost of this item to see the scope of social security reimbursement is very limited.

Therefore, those who still feel from the heart that social security is enough to pay attention to: the number of participants in the country has been hundreds of millions of people, but the circle of friends in the water droplets easy to chip example is still less? Don't they have social security? Yes, but the country's social security only to achieve "broad coverage" and "low protection", so can be reimbursed outside of the social security of the drug commercial insurance is the real protection against large medical expenses.

02

Out-of-pocket medications

So is it true that all medications on the social security list are eligible for reimbursement? The result is also negative. There are two main cases.

First, the payment scope of some drugs is limited.

The medical insurance catalog downloaded by the National Health Insurance Bureau shows that in addition to the classification of drugs, there is also a "Remarks" column, and some of the drugs need to comply with the provisions of the social security system can be reimbursed.

For example, human albumin in Class B is a very widely used drug in the clinic, which can be used for various reasons such as shock, nephrotic edema and cirrhosis of the liver, cardiopulmonary bypass, adjuvant treatment of burns, adjuvant treatment of hemodialysis, and to enhance the immunity and resistance of the patient. However, the social security regulations, "limited to rescue, serious or cirrhosis, cancer patients with ascites, and albumin less than 30g / L," the use of human blood protein can be reimbursed, and the rest of the cases need to be out of pocket.

There are also expensive antitumor drugs, the note requirements are even more. For example, in the case of lenvatinib for liver cancer, the note explicitly limits the treatment of patients to "unresectable hepatocellular carcinoma patients who have not received systemic therapy"; those who have received systemic therapy can only be reimbursed at their own expense.

Lenvatinib costs over $600,000 a year.

Second, because of the "drug ratio", "medical insurance control", "medical insurance procurement" and other reasons, the hospital can not prescribe drugs

The above mentioned that the country's hundreds of millions of people to participate in the insurance, and China's aging problem is obvious. The problem of aging is becoming more and more obvious, the cost of health insurance is rising year by year, you can imagine how much pressure on the national health insurance. Medical insurance fee control is bound to be the need for long-term adherence to the policy. Each hospital issued by the medical insurance funds are limited, more than the limit must be paid out of pocket, in this case the hospital can only try not to prescribe or even do not purchase expensive drugs. It is becoming more and more common for patients to be prescribed out-of-hospital medications.

Recently, the health insurance collection is also one of the hotspots of concern, the original tens of thousands of drugs into the collection catalog can be reduced to a few hundred dollars, which is how to do it? Because the "national group purchasing" commitment to purchase a large number of guaranteed annual purchase number of stable, free of enterprise marketing and promotion costs. This also means that doctors must give priority to the drugs in the collective purchasing catalog when prescribing drugs, or else they will not be able to accomplish the goal of large annual consumption and continued purchasing the following year. Moreover, most of the medicines in the collection list are generics, because the original research and development cost of more than billions of dollars can not achieve such an exaggerated price reduction. But the extent to which patients are comfortable with generics varies from person to person.

As you can see from the above, health care policy has a significant impact on both Social Security reimbursement and Social Security-linked Medicare.

Assuming a customer buys a Medicare policy, what is he likely to face when he gets sick? Let's take Zhang as an example.

Zhang purchased Million Dollar Healthcare with Social Security and asked for the best medicines, but the doctor was only able to prescribe Category A medicines because of the limitations of Social Security, and the doctor prioritized the use of medicines within the Medical Insurance Catalog.

The second year, Zhang renewed his insurance with no social security status, and asked for the best drugs, but the doctor could only prescribe Class A drugs, because the ratio of drugs, the health insurance collective purchasing, the hospital indicators and other issues make the doctor had to consider the drugs in the health insurance catalog.

The third year of Zhang's illness, he ate the hospital's generic medicines, the effect is general, can only self-financed use of the original drug. The hospital didn't even buy them, because it needed to control costs, and finally had to write a prescription for them to buy them at an outside pharmacy. For Zhang, purchasing drugs from outside pharmacies was time-consuming, laborious and costly. Although he bought a million-dollar health insurance policy, he could not be reimbursed.

How do you solve the problem of purchasing drugs? In fact, some of the mid-range and high-end medical insurance policies can reimburse you for the purchase of medicines, and some of them have additional services such as overseas purchase of medicines and direct delivery to the pharmacy.

03

Different medical insurance can be reimbursed for the range of drugs

We divided the market medical insurance into millions of medical and high-end medical, in fact, in accordance with today's article explains the three kinds of medical insurance should be this distinction:

Multi-million medical = basic medical, medical insurance is the most important part of the medical insurance.

We hope that through this article, you will have a clearer understanding of the medicines that are not covered by the social security system and the medicines that are purchased outside the system, as well as your own medical insurance coverage, and we also hope that you can pay more attention to your own healthcare needs: in case of a serious illness, where do you want your insurance to stop?

• Previous article:Where can I get the baby social security card?
• Next article:What is the telephone number of Linyi Human Resources and Social Security Bureau? The latest news