Medical insurance drugs "difficult to enter the hospital"?

Medical Network News, May 12th, this is the precise "targeted treatment" adopted by the state for the "difficulty in entering the hospital" of medical insurance negotiation drugs-through the "dual channel" of designated medical institutions and designated retail pharmacies, to meet the negotiation of drug supply guarantee and clinical use Reasonable needs in other aspects, and simultaneously included in the medical insurance payment
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Which drugs will be included in the "dual channel"? How to make payment in "dual channel"? How "dual channels" supervise medical insurance funds.
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Recently, the National Medical Insurance Administration and the National Health Commission jointly issued the "Guiding Opinions on Establishing and Improving the "Dual Channel" Management Mechanism for Drugs in National Medical Insurance Negotiations", which includes classified management, selection of pharmacies, and improvement of payment policies.
In other aspects, the management requirements of the "dual channel" were clarified, and Liangjian entered the hospital for the "last mile"
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Which drugs will be included in the "dual channel"?The opinion puts forward that it is necessary to categorize the negotiated drugs, and focus on the "dual-channel" management of drugs with high clinical value, urgent demand, and high cost
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According to the National Medical Insurance Administration, the scope of drugs included in the "dual-channel" management is determined in principle by the provincial medical insurance administrative department in accordance with procedures
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It is necessary to comprehensively consider factors such as the level of economic development in the region, the affordability of medical insurance funds, and the drug needs of patients, and implement classified management of negotiated drugs.
For products with high clinical value, urgent needs of patients, and low substitution, they should be included in the "dual channel" in a timely manner.
"The scope of drug management
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A few days ago, the National Medical Insurance Bureau screened 19 drugs with urgent clinical needs and not strong substitutability among the newly negotiated drugs in 2020, and announced the information of designated medical institutions and designated retail pharmacies.
The public can visit the "National Medical Insurance Service Platform ( APP)” to query
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"For the first time, the opinions are from the national level to include designated retail pharmacies in the scope of drug supply guarantee for medical insurance negotiations, and implement a unified payment policy with medical institutions
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" said Huang Huabo, director of the Medical Service Management Department of the National Medical Insurance Administration, which marks the negotiation of drug supply guarantees.
A step towards diversification will have an important impact on solving the "difficulty in entering the hospital" of negotiated drugs and promoting the reform of the drug management system in medical institutions
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  　　 How to make payment in "dual channel"?   　　For drugs included in the “dual-channel” management, a unified payment policy will be implemented in designated medical institutions and designated retail pharmacies to ensure reasonable treatment for patients
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In other words, patients who purchase negotiated drugs included in the "dual channel" at designated retail pharmacies can enjoy the same payment policy as at designated medical institutions
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"The real-time payment and settlement of medical insurance in designated retail pharmacies will effectively alleviate the burden of medical expenses for patients
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" said Chen Hao, a senior economist at Tongji Medical College of Huazhong University of Science and Technology.
"And get the corresponding medical insurance payment, which will undoubtedly expand the benefits of the reform of the medical insurance system to benefit the people’s livelihood, and will also protect the corresponding rights and interests of the negotiating enterprises
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According to the National Medical Insurance Administration, it is possible to explore the establishment of a separate drug protection mechanism for negotiated drugs with a longer use period and higher treatment costs
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In addition, it will explore and promote the inclusion of "dual-channel" negotiated drugs into the scope of direct settlement for medical treatment in different places
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  How does the "dual channel" supervise the medical insurance fund?   　　 The "dual channel" transfers part of the functions of the original drug hospital management to outside the hospital, posing new challenges to fund security risk management and control .
In this regard, with the prescription circulation center as the core, it will connect medical insurance agencies, designated medical institutions, and designated retail pharmacies, and implement the requirements of "designated institutions, designated doctors, and traceability" to realize the whole-process supervision of patients' medication behavior .
The National Medical Insurance Bureau stated that it will improve the detailed medical insurance drug review rules, introduce intelligent monitoring, and severely crack down on fraudulent funds for medical insurance in the "dual channel" field .
We will also strengthen the routine analysis and monitoring of "dual-channel" medication costs and fund expenditures, and adjust and improve regulatory policies and measures in a timely manner to ensure fund safety .
At the same time, designated retail pharmacies should take more stringent measures to verify the identity of patients to ensure that "prescribed patients" and "actual medication patients" are consistent, plug the loopholes of "fraud insurance" and ensure fund security　　 .
  　　Finishing the second half of the   　　 " hospital admission" "At present, the frequency of access to the medical insurance catalog has been greatly accelerated, and the drug access mode of medical institutions has not changed significantly
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" Huang Huabo said that before the reform, most of the drugs were listed as "advanced hospitals and late- entry medical insurance" After the reform, it has become "advanced medical insurance, later entering the hospital", which puts forward higher requirements for the rapid admission of medical institutions and the widespread use of clinicians in the short term
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He introduced that designated retail pharmacies have the characteristics of flexible service and wide distribution.
They will be included in the supply guarantee of negotiated medicines, complementing designated medical institutions, and will increase drug supply channels and patient medication options
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During the first half of the medical insurance negotiations, he landed in the hospital in the second half
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Guo Wudong, an associate researcher at the National Medical Insurance Research Institute of Capital Medical University, believes that patients can obtain negotiated drugs smoothly and conveniently, and they can fully release the reform dividends obtained in the previous negotiations
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Guo Yanhong, Inspector of the Medical Administration of the National Health Commission, said that the National Health Commission will cooperate with the medical insurance department to implement the "dual channel" related policies, combined with the circulation of prescriptions, so that patients can get the medicines they need in designated retail pharmacies .
Insuring the health rights of patients
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