What is the scope of social security drugs?

All Class A examinations or medication should be reported completely; 80% reimbursement for class B examination or medication, and 20% self-payment; Class C examination or self-funded medication.

Notice of Ministry of Human Resources and Social Security on Printing and Distributing the National Drug List of Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (Version 20 17) to all provinces, autonomous regions, municipalities directly under the Central Government, the Human Resources and Social Security Department (Bureau) of Xinjiang Production and Construction Corps and the Medical Insurance Office of Fujian Province;

Since the publication of the National Drug List of Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (2009 Edition), human resources and social security departments at all levels have earnestly implemented the requirements of the drug list and constantly standardized and improved the management of medical insurance drugs, which has played an important role in ensuring the basic drug demand of insured persons, maintaining the stable operation of funds and promoting the healthy development of the pharmaceutical industry.

In order to implement the spirit of the National Health and Wellness Conference, establish a fairer and more sustainable social security system, steadily improve the level of basic medical security, promote the progress and innovation of medical services and pharmaceutical production technology, and gradually establish and improve the dynamic adjustment mechanism of basic medical insurance coverage.

Extended data:

According to the provisions of the Social Insurance Law of People's Republic of China (PRC), Regulations on Work-related Injury Insurance, Interim Measures for the Administration of Drug Use Scope of Basic Medical Insurance for Urban Employees (No.1999 of the Ministry of Labor and Social Security) and other laws, regulations and documents, our department organized experts to conduct drug evaluation and formulated the National Drug List of Basic Medical Insurance, Work-related Injury Insurance and Maternity Insurance (the National Drug List). The relevant issues are hereby notified as follows:

First, strict drug list payment regulations.

1, the Drug Catalogue is divided into four parts: common cases, western medicines, Chinese patent medicines and Chinese herbal pieces. Each example is an explanation and explanation of the format, name and dosage form of the drug list, and the limited payment scope. Western medicine includes chemicals and biological products, Chinese patent medicines include Chinese patent medicines and ethnic medicines, and Chinese herbal medicines are not paid by the fund according to the exclusion law.

2. The expenses incurred by the insured in using western medicine, Chinese patent medicine and Chinese herbal pieces outside the catalogue shall be paid according to the relevant provisions of basic medical insurance, industrial injury insurance and maternity insurance. Anti-HIV drugs provided free of charge by the state and anti-tuberculosis drugs, anti-malaria drugs and anti-schistosomiasis drugs involved in national public health projects will not be paid by the basic medical insurance, industrial injury insurance and maternity insurance funds within the scope of public health payment after being used by the insured.

Two, standardize the adjustment of the provincial drug list.

1. The social insurance authorities of all provinces (autonomous regions and municipalities) shall not make adjustments to Class A drugs in the drug list, and the adjustments to Class B drugs shall be strictly implemented in accordance with existing laws, regulations and documents. Drug list adjustment should adhere to the expert evaluation mechanism, adhere to fairness, impartiality and openness, do a good job in the prevention and control of integrity risks, and should not charge enterprises in any name or adopt any form of local protectionism. The administrative department shall not interfere with the expert evaluation results.

2, the provinces (autonomous regions and municipalities) should be released on July 3, 20061+07 local basic medical insurance, industrial injury insurance and maternity insurance drug list. The adjusted quantity (including transfer-in, transfer-out and adjustment of limited payment scope) shall not exceed 15% of the national quantity of Class B drugs. All provinces (autonomous regions and municipalities) shall report the adjustment of Class B drugs to the Ministry for the record as required.

3, the overall planning area should be in the province (autonomous regions and municipalities) basic medical insurance, industrial injury insurance and maternity insurance drug list released 1 month after the implementation of the new drug list, and in accordance with the relevant provisions of the update into the scope of the fund to pay the hospital preparation list.

Third, improve the management of drug list use.

1. All co-ordination areas should do a good job of drug correspondence in the catalogue according to the drug use situation of medical institutions and retail pharmacies within their respective jurisdictions, and update and improve the drug database of the information system in a timely manner. All provinces (autonomous regions and municipalities) should combine the direct settlement of medical treatment in different places, speed up the application of social insurance drug classification and code industry standards, establish and improve the unified drug database of the whole province (autonomous regions and municipalities), and realize the unified management of western medicine, Chinese patent medicine, hospital preparations and Chinese herbal pieces within the province.

2, all localities should be combined with the health and family planning departments to develop the "Drug Catalogue" management regulations and prescription management methods, clinical technical operation norms, clinical diagnosis and treatment guidelines and guiding principles of clinical application of drugs, and the implementation and use of the "Drug Catalogue" in designated medical institutions will be included in the scope of management and assessment of designated service agreements.

3, establish and improve the basic medical insurance medical service intelligent monitoring system and social insurance drug monitoring and analysis system, focusing on monitoring large doses, high costs and possible irrational drug use, and announce the monitoring results to the public in an appropriate way. Give full play to the role of pharmacists and encourage medical institutions to take effective measures to promote clinical rational drug use.

4, all provinces (autonomous regions and municipalities) should be in accordance with the requirements of drug price reform, accelerate the development of medical insurance drug generic name payment standard. All co-ordination areas can further improve the management measures for classified payment of medical insurance drugs. For drugs that mainly play an auxiliary therapeutic role in Class B drugs, the proportion of individual self-payment can be appropriately increased to widen the gap with other Class B drugs. For drugs that are necessary for clinical first aid and treatment of special diseases, the declaration system of designated medical institutions can be established, and the corresponding audit management measures can be clarified, and reported to the higher human resources and social security department for the record.

Four, explore the establishment of medical insurance drug negotiation access mechanism.

1, our department will negotiate the drugs to be negotiated determined by experts according to relevant rules, and the qualified drugs will be included in the scope of medical insurance payment, and the list will be released separately.

2, around the "Drug List" adjustment and organization and implementation process, in case of major problems, should be reported in a timely manner. After the issuance of this document, the Notice on Printing and Distributing the National Drug Catalogue of Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (Ministry of Human Resources and Social Security Fa [2009]159) shall be abolished at the same time.

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