Health Insurance Bureau: timely procurement of biological products, new crown vaccine is not included in the medical insurance reimbursement.

On October 9, the State Health Insurance Administration, in response to recommendation No. 6450 of the Third Session of the 13th National People's Congress, said: "Our Bureau is studying the policy of centralized procurement of biological products, biosynthic drugs are not a restricted area for centralized procurement, and will carry out centralized strip procurement in due course, taking into account factors such as the similarity of biosynthic drugs, the stability of enterprise capacity and supply chain, and clinical substitution of specific products."
" on "recommendations to speed up the level of medical security for diseases such as psoriasis", the National Health And Health Commission, the State Drug Administration replied that the National Health Insurance Administration attaches great importance to the issue of drug protection for patients with psoriasis.
the adjustment of the medical insurance drug catalogue focuses on the treatment of major diseases such as basic drugs, cancer and rare diseases, chronic diseases, children's medicines, emergency rescue drugs and other categories.
treatment of psoriasis has been included in the list of essential health insurance drugs.
At the same time, when the 2019 health care catalog was adjusted, the limited payment range of the recombinant human type II. type tumor necrosis subpopulation-antibody fusion protein in the original directory increased the adult severe plaque-like psoriasis adaptation, and added drugs such as Adamo monoanti, Invlisi monoantigen to the health insurance drug list through access negotiations.
nearly 20 drugs (Western medicines) in the current catalogue are available for the treatment of psoriasis.
In accordance with the Notice on the Inclusion of 2019 Negotiated Drugs in Category B, if any generic-named drug (generic) of other manufacturing enterprises is listed within the scope of the catalogue, the medical insurance department shall have the right to adjust the payment standards for medical insurance according to the price of generic drugs, and shall also have the right to include the generic-name drug in the scope of centralized procurement.
generics such as Symele (Adamo Monoanti) are included in medicare payments.
Basic medical insurance does not exclude any disease, including immunization-related chronic diseases, and persons who participate in basic medical insurance in accordance with the law and pay according to the provisions, regardless of the disease, the expenses of medical treatment, in accordance with the provisions, may be paid by the basic medical insurance fund.
In the process of perfecting the basic medical insurance system, while doing a good job in ensuring the treatment of inpatients, the state guides all localities to include the outpatient medical expenses of some chronic diseases and special diseases, mainly in outpatient treatment, in accordance with the income and expenditure situation of the basic medical insurance fund.
Basic medical insurance shall be managed locally, and the level of financing and treatment shall be in accordance with the level of local economic development and medical consumption, and the scope and corresponding standards for outpatient chronic diseases, special diseases and corresponding standards paid by the co-ordination funds shall be determined by the co-ordination areas according to the local fund's ability to pay, the level of economic development and the level of medical consumption.
understood that some co-ordination areas have been psoriasis into the outpatient chronic special disease protection.
In its reply to recommendation No. 9354 of the Third Session of the 13th National People's Congress, the State Health Insurance Administration mentioned that Article 30 of the Social Insurance Law of the People's Republic of China clearly stipulates that medical expenses that should be borne by public health shall not be covered by the basic medical insurance fund.
Interim Measures for the Administration of Essential Medical Insurance Drugs, published in July 2020, states that preventive vaccines are not covered by medicare payments.
prevention and control programs, such as vaccines and vaccination costs, should be addressed through funding channels for public health services.
, the current level of financing for basic medical insurance in China, especially for urban and rural residents, is low, with only about 800 yuan per capita for urban and rural residents in 2019.
and the number of people vaccinated was high, and the total cost was high, significantly exceeding the affordability of the health-care fund.
From the current stage of the overall development of the medical insurance system, the needs of mass disease treatment and medical insurance fund financing level and anti-risk ability, the current basic medical insurance system is still based on providing basic disease treatment and protection for the masses, focus on meeting the basic medical needs of the masses, has not been able to expand the scope of payment to vaccines and other non-therapeutic projects.
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