What drugs can be reimbursed by medical insurance?

Drugs included in the basic medical insurance payment scope are divided into Class A and Class B, which can be reimbursed by medical insurance.

Class A drugs refer to drugs that are basically unified throughout the country and can ensure the basic needs of clinical treatment. The expenses of such drugs are included in the payment scope of the basic medical insurance fund, and the expenses are paid according to the basic medical insurance payment standard.

The list of Class B drugs shall be adjusted by all provinces, autonomous regions and municipalities directly under the Central Government according to their own conditions. Before such drugs are included in the payment scope of the basic medical insurance fund, the employees shall pay according to a certain proportion and pay according to the basic medical insurance payment standard.

Generally speaking, there are many drugs reimbursed by medical insurance, including penicillin, amoxicillin, piperacillin-tazobactam, piperacillin-sulbactam, amoxicillin-clavulanate potassium, ticarcillin-clavulanate potassium, Ganmao Qingre Oral Liquid, Yinqiao Jiedu Pill, Gleevec (leukemia) and Libitai (lung cancer).

The following drugs do not belong to the basic medical insurance reimbursement scope:

1, which is mainly a tonic drug;

2, some medicinal animals and animal organs, dried (water) fruit;

3. Various wine preparations brewed with Chinese herbal medicines and Chinese herbal pieces;

4. Fruity preparations and oral effervescent agents in various drugs;

5 blood products and protein products (except for special indications and first aid and rescue);

6, the provisions of the administrative department of social insurance basic medical insurance fund does not pay for other drugs.

To sum up: Generally speaking, ordinary medical expenses can be reimbursed, but some imported drugs and complex diseases cannot be reimbursed. When paying fees in the hospital, the amount marked "self-pay one" at the bottom of the document can be reimbursed, but the fees such as "customs duty" and "self-pay two" cannot be reimbursed.

Legal basis:

People's Republic of China (PRC) social insurance law

second

The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.

Article 26

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.