Can imported drugs be reimbursed by medical insurance?

Whether the medical insurance for imported drugs can be reimbursed depends on the actual situation, such as:

1. Commercial medical insurance: The necessary and reasonable medical expenses incurred by the insured due to imported drugs during hospitalization are provided by the hospital, and commercial medical insurance can generally be reimbursed; If the medical expenses of imported drugs are not incurred during hospitalization, but imported drugs purchased by the insured himself from pharmacies, then generally only medical insurance with special drug protection can be reimbursed; And if there is no special drug protection, or it is not within the scope of special drug protection of medical insurance, then naturally it cannot be reimbursed.

2. Basic medical insurance: If imported drugs are included in the scope of basic medical insurance through negotiation, such as Tai Sen, somadoline, rituximab, gleevec, fosinox, etc. Basic medical insurance can be reimbursed; Imported drugs not covered by medical insurance will not be reimbursed.

According to the basic requirements of the payment of basic medical insurance benefits in China, the insured person who goes to the medical insurance institution to reimburse the medical expenses incurred by himself for medical treatment generally meets the following conditions:

(1) The insured must go to the designated medical institution of basic medical insurance or to the designated retail pharmacy determined by the social insurance institution with the medical prescription issued by the doctor in the designated hospital.

(2) The medical expenses incurred by the insured in the process of medical treatment must conform to the basic medical insurance drug list, diagnosis and treatment items, the standard scope of medical service facilities and payment standards, and be paid by the basic medical insurance fund according to regulations.

(III) Among the medical expenses that the insured meets the scope of payment of basic medical insurance, the part that is higher than the Qifubiaozhun of the social medical co-ordination fund and lower than the maximum payment limit shall be paid by the social medical co-ordination fund in a unified proportion.

legal ground

Social insurance law

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