Four ministries and commissions, including the State Medical Security Bureau, jointly issued the guidance on improving the drug use guarantee mechanism in the outpatient service of urban and rural residents with hypertension and diabetes

In order to further strengthen the prevention and treatment of major chronic diseases and reduce the burden of outpatient medication for urban and rural residents with hypertension and diabetes mellitus (hereinafter referred to as "two diseases"), recently, the state health insurance bureau, the Ministry of finance, the health and Health Commission and the Drug Administration jointly issued the guidance on improving the outpatient medication guarantee mechanism for urban and rural residents with hypertension and diabetes mellitus (hereinafter referred to as "the opinion") The opinions starts from the outpatient medication of "two diseases" to improve the guarantee Relying on the grass-roots medical and health institutions, the comprehensive use of medical insurance treatment, recruitment, payment and improve management services, etc., to achieve the overall controllable cost of outpatient medication of "two diseases" for urban and rural residents, reasonable diagnosis and treatment, safe and affordable foundation, and affordable burden reduction for the masses The opinion defines four safeguard measures: first, it defines the target of safeguard as the "two diseases" patients who participate in the residents' medical insurance and need to take medicine for treatment Second, it is clear that the scope of drug use is the drugs that can reduce blood pressure and blood sugar within the scope of the national basic medical insurance drug catalog Priority should be given to class a drugs in the catalog, basic drugs, varieties that have passed the consistency evaluation, and drugs selected through centralized procurement Third, it is clear that the proportion of payments within the scope of the overall fund policy is more than 50% Fourth, we will continue to implement the existing policies for the "two diseases" patients who have been included in the coverage of outpatient chronic diseases to ensure that the level of people's treatment will not be reduced The opinions put forward three supporting reform measures: first, improve the payment policy We will accelerate centralized bidding and procurement, reasonably determine drug payment standards and dynamically adjust them, and encourage reform of payment methods by disease and by head Second, ensure the supply and use of drugs We will improve the long-term prescription system for outpatient drugs for "two diseases" and explore the third-party drug delivery mechanism Third, standardize management services We will improve the management of agreements, implement the responsibilities of basic medical and health institutions and general practitioners, strengthen health education and health management, and move forward the prevention and treatment of "two diseases" The opinions put forward three specific requirements for the implementation of local organizations: first, compaction responsibility We should print and distribute supporting documents at the provincial level as soon as possible, so that the masses can enjoy treatment within the year The second is to strengthen coordination Define the responsibilities of medical security, finance, health and pharmaceutical supervision departments Third, strengthen supervision We should crack down on fraud and insurance, and use funds well In order to further reduce the burden of medical expenses for urban and rural residents with hypertension and diabetes (hereinafter referred to as "two diseases"), the following are the guiding opinions on the improvement of outpatient medication security for patients with "two diseases": 1、 Guiding ideology Guided by Xi Jinping's socialist ideology with Chinese characteristics in the new era, we carried out the spirit of the nineteen and nineteen sessions of the party's Central Committee and the Third Plenary Session of the Party Central Committee in China In accordance with the general requirements of "ensuring basic, sustainable, improving people's livelihood and pushing forward reform", we took the outpatient drug protection of two patients with basic medical insurance in urban and rural areas as the breakthrough point, and insisted on the principle of "doing our best and doing what we can" To explore and improve the outpatient medication security mechanism for chronic diseases, enhance the outpatient security capacity of basic medical insurance, reduce the cost burden of outpatient medication, and constantly improve the people's sense of access, happiness and security 2、 Lock the scope and define the content of the guarantee (1) define the object of the guarantee "Two diseases" patients who take part in basic medical insurance for urban and rural residents (hereinafter referred to as "resident medical insurance") and take medicine treatment （2） Define the scope of medication For the drugs for lowering blood pressure or blood sugar in outpatient service of patients with "two diseases", the drugs listed in the latest version of the national basic medical insurance drug Catalog shall be selected first, the national basic drugs shall be selected first, the varieties that pass the consistency evaluation shall be selected first, and the drugs selected through centralized bidding procurement shall be selected first （3） Define the level of security Based on the designated primary medical institutions at or below the second level, the cost of blood pressure and blood glucose lowering drugs for the insured patients with "two diseases" shall be paid by the overall planning fund, and the proportion of payment within the policy scope shall be more than 50% Each province (District, city) should set reasonable payment policy on the basis of finding out the actual situation of the number, quantity and amount of drugs used in outpatient service of "two diseases" （4） Do a good job in policy convergence We should do a good job in linking up with the existing outpatient insurance policies to ensure that the level of treatment of the masses does not decrease We should continue to implement the current policies for the treatment of patients with other drugs except for lowering blood pressure and blood sugar, or who have been included in the "two diseases" in the scope of outpatient chronic disease or special disease insurance Avoid repeated reimbursement and treatment We should do a good job in linking up with hospitalization security, further standardize the admission standards, and promote rational diagnosis and treatment and scientific treatment 3、 Supporting reform to ensure patients benefit (1) improve payment standards and reasonably determine payment policies According to the common name, the payment standard of medical insurance should be determined reasonably and adjusted dynamically We will actively promote the centralized procurement of drugs with quantity, and combine quantity with price, bidding and procurement For drugs included in the scope of procurement with quantity, the payment standard for drugs with the same generic name will be determined according to the bid winning price of centralized procurement According to the distribution of medical treatment and medication for insured patients with "two diseases", it is encouraged to pay by head and disease （2） Ensure the supply and use of drugs All relevant departments shall ensure the quality and supply of drugs, and medical institutions shall give priority to the use of centrally purchased selected drugs, and shall not influence the supply guarantee and rational use of selected drugs on the grounds of cost control, drug proportion, requirements for drug varieties, specifications and quantities of medical institutions, approval of drug Affairs Committee, etc Where conditions permit, the third-party distribution mechanism can be explored We should improve the long-term prescription system of "two diseases" outpatients to ensure patients' drug demand, but avoid repeated prescriptions （3） Standardize management services We will improve the medical insurance designated service agreement, and bring the "two diseases" outpatient medication guarantee service into the agreement management Adhere to the principle of prevention first and combination of prevention and treatment, implement the responsibilities of grass-roots medical institutions and general practitioners, strengthen health education and health management of patients with "two diseases", and improve the public awareness of disease prevention and control 4、 Strengthen leadership, do a good job in organizing and implementing (I) compaction responsibility, and ensure the implementation of treatment All provinces (districts and cities) should attach great importance to the outpatient drug use guarantee work of "two diseases" and strengthen overall coordination Within one month after the issuance of this document, they should go out of Taiwan Province to implement the plan, guide and urge the overall planning areas to start implementation in November 2019, so as to ensure that the masses can enjoy the treatment within the year （2） Refine the division of labor and strengthen coordination The administrative department of medical security should actively cooperate with the relevant departments to do a good job in the outpatient medication security of patients with "two diseases", strengthen guidance, and closely track the progress of the work The financial department shall actively participate in the work related to the drug use guarantee of "two diseases" and guarantee the required working funds according to the regulations The health department should do a good job in the health management of patients with "two diseases", strengthen the supervision of medical service behavior, further improve the medication guidelines and norms of "two diseases", standardize the diagnosis and treatment behavior, and ensure the rational use of drugs purchased in a centralized way Drug supervision and administration departments are responsible for the evaluation and evaluation of drug use consistency of "two diseases" and the supervision and management of production, circulation, distribution and other links （3） Strengthen supervision and make good use of funds We need to improve mechanisms such as supervision and reporting, intelligent monitoring and credit management, crack down on fraud and insurance fraud, strengthen supervision on illegal behaviors such as false hospitalization and hanging bed hospitalization, and guide the hospitalization rate back to a reasonable level All departments should fulfill their responsibilities, cooperate closely, cooperate with each other, study and solve new situations and problems in time, summarize and promote experience and practices, and constantly improve the construction of outpatient medication guarantee mechanism for "two diseases" National Medical Security Bureau Ministry of Finance National Health and Health Commission State Food and Drug Administration September 16, 2019