Are Class B drugs covered by medical insurance reimbursement?

Class B drugs can be partially reimbursed by medical insurance, and drugs are divided into three categories in the national drug list of basic medical insurance:

1, the first category A, can all enter the scope of medical insurance reimbursement, according to the proportion of medical insurance reimbursement;

2. Class B, the use of such drugs requires individuals to bear part of the expenses according to a certain proportion, and the rest will enter the scope of medical insurance reimbursement and be reimbursed according to the proportion of medical insurance;

3, the third category C, this part of the medicine is not reimbursed, all borne by the individual.

Medicare Class B drugs refer to Class B drugs, and the basic medical insurance fund has the ability to pay part of the expenses. The expenses arising from the use of such drugs shall be paid by the insured according to a certain proportion, and then included in the scope of payment of the basic medical insurance fund, and the expenses shall be paid according to the provisions of the basic medical insurance.

According to the fund's affordability, each region may first set a certain proportion of individuals to pay for Class B drugs, and then pay according to the provisions of basic medical insurance. In other words, Class B drugs may not be reimbursed by 100%.

It is worth noting that the drug lists of industrial injury insurance and maternity insurance are not divided into two categories, and they are all reimbursable. The basic medical insurance, industrial injury insurance and maternity insurance fund will not be paid for the anti-cancer drugs provided by the state free of charge and the anti-tuberculosis, anti-malaria and anti-schistosomiasis drugs involved in the national basic public health projects, which are used by the insured and meet the scope of public health payment; Do not meet the scope of public medical payment, basic medical insurance, work injury insurance and maternity insurance funds in accordance with the provisions of payment.

What are the conditions for medical insurance reimbursement?

1. In order to obtain medical insurance reimbursement for medical behavior in designated institutions, first of all, the insured person needs to see a doctor or buy medicine in designated medical institutions and pharmacies stipulated by the basic medical insurance in order to obtain reimbursement, otherwise it cannot be reimbursed;

2. If it belongs to the social security catalogue, it is necessary to have medical treatment items or purchased drugs in the social security catalogue to be reimbursed, otherwise it cannot be reimbursed;

3. To reach the deductible standard, medical insurance reimbursement is required. First, the medical expenses incurred by the insured reach the deductible line stipulated by social security, and the part exceeding the deductible line can only be reimbursed within the limit, and the unified proportion is paid by the basic medical pooling fund.

legal ground

Notice of the Ministry of Labor and Social Security, the State Development Planning Commission and the State Economic and Trade Commission on Issuing the Interim Measures for the Administration of the Scope of Medication of Basic Medical Insurance for Urban Employees.

Eighth basic medical insurance insured to use the "Drug List" drugs, the expenses incurred by the payment according to the following principles.

The expenses incurred in using Class A drugs shall be paid in accordance with the provisions of the basic medical insurance. The expenses incurred in the use of "Category B drugs" shall be paid by the insured according to a certain proportion, and then according to the provisions of the basic medical insurance. The specific proportion of individual pays shall be stipulated by the overall planning area and reported to the administrative departments of labor security of provinces, autonomous regions and municipalities directly under the Central Government for the record.

The expenses incurred in the use of Chinese herbal pieces shall be paid in accordance with the provisions of the basic medical insurance, except for drugs that are not paid by the basic medical insurance fund.