Guangdong first landing: a large number of drugs are no longer reimbursed.

Pharmaceutical Network September 28th, a batch of drugs no longer reimbursed, Guangdong took the lead on September 25th, Guangdong Medical Insurance Bureau issued the "Interim Measures for the Administration of Basic Medical Insurance Drug Use in Guangdong Province (Draft for Comments)" (the "Draft for Comments"), open to the public for comments, public consultation deadline is October 14th.
These drugs are included in the Medical Insurance Draft, which is divided into six chapters, namely, the general rules, the formulation and adjustment of the Drug Catalog, the use of the Drug Catalog, the payment of medical insurance medication, the management and supervision of medical insurance medication, by-laws, a total of 31 articles.
as a whole, Guangdong's Draft for Comments, in addition to complying with the provisions of the Interim Measures for the Administration of Basic Medical Insurance Drug Use, the biggest point of view lies in the local landing rules.
it is worth noting that compared with the national version of the health insurance catalog, Guangdong's local health insurance directory has more "hospital preparations" part, and there is a part of the list of places to supplement drugs.
The Draft for Comments proposes that the administrative department of medical security in Guangdong Province, on the basis of the National List of Essential Medical Insurance Drugs, shall, in accordance with the adjustment authority and procedures prescribed by the State, include qualified ethnic medicines, hospital preparations and Chinese medicine tablets in the scope of payment for medical insurance in Guangdong Province, and shall, in accordance with the provisions, file with the administrative department of state medical security for implementation.
departments at all levels shall not make their own catalogues or adjust the scope of payment for medical insurance drugs.
These drugs are not included in the Draft for Comments on Medical Insurance, and the following drugs are not included in medical insurance: (i) drugs that primarily play a tonic role; (ii) medicines containing national precious and endangered wildlife herbs; (3) health-care drugs; (4) preventive vaccines and contraceptives; (v) mainly enhance sexual function, treat hair loss, lose weight, beauty, quit smoking, Drugs that abstive from alcohol and other effects; (6) drugs that cannot be charged separately for reasons such as being included in medical treatment programs; (7) alcohol preparations, tea preparations, all kinds of fruity preparations (except for children's medications in special cases), oral dosages and oral bubbly agents (except in special cases), etc.; and (viii) other drugs that do not meet the requirements of basic medical insurance.
In addition, medicines in the medical insurance catalogue shall be transferred out of medical insurance after expert evaluation and approval by the provincial medical security administrative department: (1) drugs that have been revoked, revoked or cancelled by the drug regulatory authorities; (2) drugs included in the negative list by the relevant departments; (3) comprehensive consideration of clinical value, Adverse reactions, drug economy and other factors, after assessment that the risk is greater than the benefits of drugs; (4) drugs entering the Drug Catalog through fraud and other illegal means; (5) drugs that have been transferred out of the National Basic Medical Insurance Drug Catalog by the State Administration of Medical Security; and (6) other cases that should be directly transferred out as prescribed by the State.
clearly the standard of payment of medical insurance in the payment of medical insurance drugs, the Draft for Comments clearly, in accordance with the relevant provisions of the State will establish the "Drug Catalog" access and medical insurance drug payment standards bridge mechanism.
addition to Chinese medicine tablets and hospital preparations, in principle, the new drugs included in the "Drug Catalog" to determine the payment standards simultaneously.
drugs determine payment criteria based on the outcome of national access negotiations.
non-exclusive drugs, the state organizes the centralized procurement of drugs (hereinafter referred to as centralized procurement) to determine the payment standards in accordance with the relevant provisions of centralized procurement;
for the implementation of government-priced narcotic drugs and psycho-drugs in category I, the payment criteria are determined in accordance with government pricing.
Article 21 of the Draft for Comments stipulates that the insured shall pay in accordance with the payment standards and sharing methods stipulated in the basic medical insurance, and that the insured shall not pay in advance, and that the use of "Class B drugs" shall be paid in accordance with the payment standards stipulated in the basic medical insurance, after a certain proportion has been paid by the insured person, and then in accordance with the sharing method prescribed by the basic medical insurance.
proportion of "Class B drugs" individual out-of-the-money shall be determined by the administrative departments of medical security in the co-ordination areas and reported to the provincial medical security administrative departments for the record.
In the area of the management and supervision of medical insurance drug use, Article 24 of the Draft for Comments stipulates that "targeted pharmaceutical institutions shall improve the organization, improve internal system norms, establish and improve the whole process record and management system for the "in, sale and storage" of medicines, improve the management capacity of medical insurance drugs, and ensure the safety and rationality of medical insurance drug use."
draft for comments, these Measures are intended to come into effect on January 1, 2021.
Attached: Interim Measures for the Administration of Basic Medical Insurance In Guangdong Province (Draft for Comments) Chapter 1 General Article 1 In order to protect the basic drug demand of insured personnel in our province, improve the scientific and fine management level of basic medical insurance drug use, improve the efficiency of the use of basic medical insurance funds, promote the governance system and In accordance with laws and regulations such as the Social Insurance Law of the People's Republic of China and the Opinions of the State Council of the CPC Central Committee on Deepening the Reform of the Medical Security System (Zhongfa (2020) No. 5), and the Interim Measures for the Administration of Basic Medical Insurance Drug Use (Decree No. 1 of the State Administration of Medical Security), these Interim Measures are formulated.
2 These Measures shall be applied to the determination and adjustment of the scope of drug use for basic medical insurance, as well as to the payment, management and supervision of drug use for basic medical insurance within the scope of Guangdong Province. Article
Article 3 According to the provisions of the State, the scope of drug use for basic medical insurance in Guangdong Province shall be managed through the formulation of the List of Essential Medical Insurance Drugs in Guangdong Province (hereinafter referred to as the "Drug Catalog"), and the cost of medicines in accordance with the "Drug Catalog" shall be paid by the Basic Medical Insurance Fund in accordance with the provisions of the State and the province.
the "Drug Catalog" to implement generic name management, "Drug Catalog" drugs of the same generic name of drugs automatically fall within the scope of payment of the basic medical insurance fund.
article 4 The administration of drug use for basic medical insurance adheres to the development thought centered on the people, effectively guarantees the reasonable drug demand of the insured personnel, adheres to the functional orientation of "guarantee the basic" and does its best, and does its best, and the level of drug protection and the basic medical insurance fund It is suitable for the affordability of the insured, adheres to hierarchical management, clarifies the responsibilities and authority of all levels, adheres to expert evaluation, adapts to clinical technological progress, and achieves scientific, normative, fine and dynamic management, adheres to the equal weight of Chinese and Western medicine, and gives full play to the respective advantages of Chinese and Western medicine.
Article 5 The Drug Catalog consists of six parts: all cases, Western medicine, Chinese medicine, state-negotiated medicines, Chinese medicine tablets and hospital preparations during the agreement period.
department of medical security in Guangdong Province shall supplement the list of medicines in accordance with the provisions of the State.
in order to maintain the safety of clinical drug use and improve the efficiency of the use of basic medical insurance funds, the provisions of the National Basic Medical Insurance Drug Catalog shall limit the conditions for payment of medical insurance.
Article 6 The Administrative Department of Medical Security of Guangdong Province shall be responsible for the administration of drug use for basic medical insurance in Guangdong Province, formulate policies and measures for the administration of drug use for basic medical insurance in the province, and be responsible for the supervision and implementation of the Drug Catalog.
The administrative department of medical security in Guangdong Province shall, on the basis of the National List of Essential Medical Insurance Drugs, incorporate eligible ethnic medicines, hospital preparations and Chinese medicine tablets into the scope of medical insurance payment in Guangdong Province in accordance with the adjustment authority and procedures prescribed by the State, and shall implement them after filing with the State Administration of Medical Security in accordance with the provisions.
departments at all levels shall not make their own catalogues or adjust the scope of payment for medical insurance drugs.
The medical security departments of the co-ordination areas shall be responsible for the implementation of the Drug Catalog and related policies, shall, in accordance with the medical insurance agreement, examine, supervise and manage the medical insurance drug use behavior of the designated pharmaceutical institutions, settle and pay the medical insurance expenses in a timely manner in accordance with the provisions, and undertake the relevant statistical monitoring, information reporting and other work.
chapter II, The formulation and adjustment of the Drug Catalog Article 7 The drugs included in the Drug Catalog shall be ethnic medicines approved by the State Drug Administration, which have obtained a drug registration certificate, Chinese medicine tablets formulated in accordance with national standards, therapeutic hospital preparations approved by the provincial drug regulatory departments, and meet the basic conditions of clinical necessity, safety, effectiveness and reasonable price.
Article 8 The following drugs are not included in the Drug Catalog :(I) drugs that play a major tonic role; (2) medicines containing the state's precious and endangered wildlife herbs; (3) health drugs; (4) preventive vaccines and contraceptives; (v) mainly enhance sexual function, treat hair loss, lose weight, beauty, quit smoking, and abstive alcohol drugs of equal effect; (6) drugs that cannot be charged separately for reasons such as being included in the medical treatment program; (7) alcohol preparations, tea preparations, all kinds of fruity preparations (except for children's medications in special cases), oral dosages and oral bubbly agents (except in special cases), etc.; and (viii) other drugs that do not meet the requirements of basic medical insurance. article
If any of the drugs in the Drug Catalog are approved by experts and the provincial medical security administrative department, the drug catalogue :(1) is withdrawn, revoked or cancelled by the drug regulatory department; (2) the drugs listed in the negative list by the relevant departments; (3) comprehensive Taking into account factors such as clinical value, adverse reactions and drug economy, drugs assessed to be more risky than beneficial; (4) drugs entering the Drug Catalog by means of fraud and other illegal means; (5) drugs that have been transferred out of the National Basic Medical Insurance Drug Catalog by the State Administration of Medical Security; and (6) other cases that should be directly transferred out as prescribed by the State.
Article 10 The administrative department of medical security in Guangdong Province shall establish and improve the mechanism for dynamic adjustment, adjust the Drug Catalog in accordance with the unified deployment of the administrative department of medical security of the State, and implement in a timely manner the adjustment work programme formulated by the administrative department of medical security of the State.
Article 11 The interface mechanism between access to the Drug Catalog and the payment standards for medical insurance drugs (hereinafter referred to as payment standards) shall be established in accordance with the relevant provisions of the State.
addition to Chinese medicine tablets and hospital preparations, in principle, the new drugs included in the "Drug Catalog" to determine the payment standards simultaneously.
drugs determine payment criteria based on the outcome of national access negotiations.
non-exclusive drugs, the state organizes the centralized procurement of drugs (hereinafter referred to as centralized procurement) to determine the payment standards in accordance with the relevant provisions of centralized procurement;
for the implementation of government-priced narcotic drugs and psycho-drugs in category I, the payment criteria are determined in accordance with government pricing.
12 Chinese medicine tablets, ethnic medicines and hospital preparations shall be adjusted by means of expert evaluation in accordance with the relevant provisions of the State.
of other medicines shall be carried out in strict accordance with the adjustment programme of the State administration of medical security.
13 The Guangdong Provincial Administration of Medical Security shall be responsible for determining and issuing the Drug Catalog, adjusting the Drug Catalog in a timely manner in accordance with the unified deployment of the State Administration of Medical Security and publishing the results of the adjustment.
The provincial medical insurance department shall determine the payment standard for the drug in accordance with the guidance of the administrative department of state medical security if a generic drug (generic drug) negotiated by the State is listed during the period of the agreement. Article
Article 15 If the ownership of the catalogue of drugs needs to be determined for reasons such as name change or name change, if it belongs to the National Basic Medical Insurance Drug Catalog, the administrative department of medical security of Guangdong Province shall determine the contents of the drug catalogue issued after the identification by the state medical security administrative department;
Article 16 The administrative department of medical security in Guangdong Province shall implement the code of the state medical insurance drug issued by the administrative department of medical security of the State, and shall be responsible for the preparation of the code of Chinese medicine tablets, ethnic medicines and hospital preparations incorporated into the List of Medicines in Guangdong Province in accordance with the provisions of the State.
, Chapter III, Use of the Drug Catalog Article 17 During the agreement period, the State negotiates the purchase of medicines directly on the Internet in accordance with the payment standards.
period of the agreement, the state negotiates drugs with the generic name of the drug in the case of price is not higher than the negotiated payment standard, according to the provisions of the network procurement.
other drugs shall be implemented in accordance with the relevant policies on drug recruitment.
, on the premise of meeting clinical needs, medical insurance designated medical institutions shall give priority to the provision and use of medicines in the Drug Catalog.
to gradually establish the "Drug Catalog" and fixed-point medical institutions drug equipment linkage mechanism, fixed-point medical institutions in accordance with the "Drug Catalog" adjustment results in a timely manner to adjust and optimize the drug catalogue of this medical institution.
Chapter IV Payment of medical insurance medication Article 19 If the costs of using the drugs in the Drug Catalog of the insured person meet the following conditions, they may be paid by the Basic Medical Insurance Fund: (1) for the purpose of diagnosis or treatment of the disease; Statutory adaptation and medical insurance shall be limited to the scope of payment; (3) shall be provided by a designated pharmaceutical institution in accordance with the provisions, except for first aid or rescue; (4) the cost of medicines paid by the co-ordination fund shall be subject to a doctor's prescription or in-patient's order; and (5) shall be examined by a pharmacist or practicing pharmacist in accordance with the prescribed procedures.
Article 20 Western and Chinese medicines in the Drug Catalog of Guangdong Province are divided into "Class A Drugs" and "Class B Drugs".
"Class A drugs" are necessary for clinical treatment, widely used, accurate efficacy, the price of similar drugs or the lower cost of treatment drugs.
"Class B drugs" are available for clinical treatment options, the efficacy of the same kind of drugs than "Class A drugs" price or treatment costs slightly higher drugs.
the agreement period, the state negotiated the inclusion of drugs in the "Class B drugs" management.
the administrative department of medical security in Guangdong Province has determined the classification of Chinese medicine tablets A and B, and the ethnic medicines and hospital preparations included in the "Drug Catalog" in accordance with the provisions of the State into the management of "Class B drugs".
article 21 The insured shall pay according to the payment standard and the sharing method stipulated in the basic medical insurance, and the insured shall not pay in advance, and the use of "class B drugs" shall be paid according to the payment standard stipulated in the basic medical insurance, and shall be paid by the insured person after paying a certain proportion of the basic medical insurance.
proportion of "Class B drugs" individual out-of-the-money shall be determined by the administrative departments of medical security in the co-ordination areas and reported to the provincial medical security administrative departments for the record.
Article 22 The payment standard is the benchmark for the payment of drug expenses by the Basic Medical Insurance Fund when the insured persons of the Basic Medical Insurance use the drugs contained in the Drug Catalog.
basic medical insurance fund shall pay the drug expenses to the designated medical institutions and fixed-point retail pharmacies in accordance with the standard of payment of medicines and the provisions for the payment of medical insurance.
Guangdong Province shall formulate payment standards and adjustment rules in accordance with the provisions of the State.
, Chapter V, Management and Supervision of Medical Insurance Drug Use Article 23 Comprehensive Use Agreement, Administration,