Zhejiang: dynamic adjustment, full coverage of medical insurance payment standard

In accordance with the relevant provisions of the state and our province on centralized drug purchase and the reform of medical insurance drug payment standard, and in combination with the current reality, our bureau has formulated the plan for promoting the function of centralized drug purchase and promoting the full coverage reform of medical insurance drug payment standard (Draft for comments), which is now open to the public for comments At the same time, the drug catalogue that belongs to the scope of centralized drug procurement and has been included in the national directory of drugs for basic medical insurance, work injury insurance and maternity insurance (including those not yet deleted in the original provincial supplementary directory) and the national directory of basic drugs (2018 version) under the generic name that does not have products traded on the drug procurement platform of Zhejiang Province will be publicized together If you have any modification opinions or suggestions, please feed back to our bureau by email, fax, letter and other forms before January 16, 2020 (Thursday) Contact person and Tel: Price Bidding & Procurement Office Zhang Yanxi 0571-81051027 medical service office Han Xiuping 0571-81051027 email: ty xixi@aliyun.com contact address: Zhejiang Medical Security Bureau (NO.213, Baoju Road, Xihu District, Hangzhou 310007), Zhejiang Medical Security Bureau, January 8, 2020, improve the centralized purchasing function of drugs, promote the full coverage reform plan of medical insurance drug payment standard (Draft for comments) according to the relevant provisions of the state and our province on centralized drug procurement and the reform of medical insurance drug payment standards, and in combination with the current reality, this plan is formulated 1、 General idea Under the guidance of Xi Jinping's new socialist ideology with Chinese characteristics, we should adhere to the people centered development thought and optimize the system, improve policies and innovative ways, strengthen the role of strategic buyers of medical insurance, and bring into play the advantages of centralized procurement and payment of medical insurance to coordinate and promote the advantages of China Full coverage of online trading products to improve the price discovery function of the platform; introduction of dynamic competition mechanism to improve the effectiveness of products and reduce the purchase price; expansion of the scope of service objects to encourage designated private medical institutions and designated retail pharmacies to voluntarily enter the platform for purchase and enhance the main function of platform service trading; improvement of medical insurance drug payment standard system to promote medical insurance drug payment The standard covers all aspects, standardizes the payment policy of medical insurance drugs, effectively guarantees the drug rights and interests of the insured personnel, improves the performance of medical insurance funds, ensures the operation safety of medical insurance funds, and promotes the orderly competition and healthy development of the medical market 2、 The implementation scope covers all public medical institutions, private medical institutions designated by medical insurance and retail pharmacies designated by medical insurance 3、 Main tasks (1) dynamic adjustment of online trading products 1 Adjustment range (1) transfer in range 1) Drugs that belong to the scope of centralized purchase of drugs and have been included in the catalogue of drugs for national basic medical insurance, work injury insurance and maternity insurance (including those not deleted in the original provincial supplement catalogue, hereinafter referred to as the "drug catalogue") and drugs without online trading products under the general name of the national basic drug catalogue (2018 version) (hereinafter referred to as the "transfer in scope 1") Medical insurance catalogue drug dosage form: the western medicine dosage form shall be subject to the dosage form combined and classified in the drug catalogue, and the unclassified dosage form shall be subject to the dosage form marked in the drug catalogue; Chinese patent medicine pill includes water pill, honey pill, water honey pill, paste pill, concentrated pill and micro pill, without dropping pill; capsule refers to hard capsule, without soft capsule If other dosage forms are not merged, the one marked in the drug Catalog shall prevail Online trading products include products that win the bid and are linked to the Internet, such as volume purchase, tight supply, low-cost drugs, national negotiation and serious illness medical insurance negotiation, and products that are recorded for purchase 2) Compared with the products with the same product specification that have been traded online, the products with obvious price advantages (hereinafter referred to as transfer in scope 2) Online trading of products with the same product specification does not include drugs with a common name involved in volume purchase, as well as drugs with low price, drugs with tight supply, original cheap drugs, general large infusion and drugs for record purchase 3) Through the consistency evaluation of quality and efficacy, generic drugs can be traded online, and the original research drug or reference preparation corresponding to the generic drugs (hereinafter referred to as transfer in scope 3) (2) Transfer out scope 1) there are products that can be replaced by other drugs (hereinafter referred to as transfer out scope 1) due to industry supervision, production line adjustment and the fact that the enterprise has been unable to supply at the existing price and there is no transaction record for more than 2 years 2) The products with higher price in the drugs traded online (the following short transfer out range 2) (3) If there is no online trading product on the platform for clinical needs or purchase is unable to be made according to the established price for independent filing, it shall be included in the independent filing directory after the application of the public medical institution and the review of the provincial drug and equipment purchasing center, and the public medical institution shall be allowed to make independent filing and purchase, but the purchase amount shall not exceed 1% of the annual drug settlement amount of the medical institution (4) If other countries or our province have relevant regulations, they shall prevail 2 Adjustment method (1) the adjustment work shall be carried out in the way of active application by the enterprise The qualified products in the provincial drug base can be declared by the enterprise, and must be committed to the above scope The provincial pharmacy purchase center combs according to the rules, and those belonging to the combed scope and in line with the price control are included in the online transaction The adjustment of transfer in scope 1 will be carried out after the adjustment of the medical insurance drug catalog, and this round of adjustment will be completed before March 2020; the adjustment of transfer in scope 2 will be carried out once a year in principle (if there are many products under the product specification, the adjustment will be carried out in the way of transfer out scope 2), the first round of adjustment will be carried out in 2020; the adjustment of transfer in scope 3 will be carried out as the case may be Before the release of transfer in results and within the purchase cycle, organize the price sorting according to the situation, and if necessary, carry out price evaluation by experts If the new negotiated price is not accepted, it will not be listed in the trading directory or the trading will be suspended (2) Transfer out method 1) transfer out method of transfer out range 1 After the enterprise actively applies, it will organize experts to carry out the evaluation if necessary after the evaluation and review If it does not affect the clinical medication, it will be transferred out The product will not be accepted for online transaction within two years after transfer out 2) The transfer out method of transfer out range 2 will be determined separately (3) Handling method of independent filing The public medical institutions select the qualified products in the basic drug storehouse of our province by themselves through the provincial drug purchase platform, and propose the purchase demand The qualified distribution enterprises of our province can respond to the demand after meeting the demand The medical institutions negotiate with the distribution enterprises to determine the purchase price according to the principle of fairness, and purchase online according to the actual agreed price, and must meet the requirements of alloy value ratio The products without purchase by medical institutions for more than one year will be suspended from the Internet; the medical institutions that propose purchase demand but do not actually purchase will also be notified 3 Price control (1) transfer in range 1 and transfer in range 3 products If there are 10 or more provinces (excluding Guangdong, Fujian, Chongqing and the military region, the same below) that have centralized purchase online (bid winning) and actual online transaction by province as a unit, online purchase shall be carried out at the lowest price not higher than the national minimum price; if there are less than 10, online purchase shall be carried out at the lowest price not higher than the national minimum price, and after negotiation with at least 10 tertiary hospitals in our province, online purchase shall be carried out at the lowest price not higher than the negotiated minimum price Net purchase The products that have participated in the centralized purchase of drugs in our province in 2014 shall not be higher than the reference price at that time (2) For the products within the transfer in scope 2, the control price shall not be higher than 70% of the lowest price of the products with the same product specification and 49% of the low value of the original research and import products, and shall not be higher than the national lowest price (3) The purchase price of the self filing products shall be determined by the medical institution through consultation with the distribution enterprise in accordance with the principle of fairness The Provincial Pharmaceutical Machinery Procurement Center shall regularly publicize the independent record transactions, and focus on monitoring the products with high unit price, large purchase amount and more medical institutions （2） Enhance the main function of platform service transaction 1 Deepen the development of new modules of the platform, promote the expansion of hardware and software of the platform, develop the drug procurement function modules of designated private medical institutions and designated retail pharmacies of medical insurance, and encourage designated private medical institutions and designated retail pharmacies to voluntarily enter the platform for procurement 2 optimize and perfect the new functions of the platform, according to the idea of "Internet plus bidding and purchasing", optimize and perfect the functions of "basic library system, bidding system, trading system, settlement system and monitoring system", so as to better meet the needs of convenient and fast online transactions 3 Enhance platform synergy and security to fully integrate into "smart healthcare", promote cloud transformation, break business barriers, optimize process reengineering, and provide a basic environment for data sharing and application integration According to the information security strategy of "smart medical insurance", improve the information security of the platform and ensure the security of transaction data （3） Improve the payment standard system of medical insurance drugs 1 The payment scope of medical insurance drugs shall be included in the drugs (excluding self filing products) listed in the medical insurance catalogue of online transaction of provincial medical equipment purchase platform 2 Payment standards for medical insurance drugs: all designated medical institutions (including private medical institutions) in the province shall implement the zero plus policy for drugs and the unified payment standards for medical insurance drugs The designated private medical institutions shall refer to the medical service price reform policy of public medical institutions of the same level to improve the medical insurance payment standard of medical service items All designated retail pharmacies across the province implement a unified medical insurance drug payment standard, which is 15% higher than the determined payment standard of medical institutions (excluding national and provincial negotiated drugs), with a maximum of no more than 200 yuan (based on the minimum package) 3 Adjustment of payment standard: the payment standard of medical insurance drugs shall be adjusted regularly and dynamically Regular adjustment shall be implemented on an annual basis according to the opinions of the general office of the people's Government of Zhejiang Province on reforming and improving the centralized drug purchase mechanism of public hospitals (zzbf [2015] No 57), and dynamic adjustment shall be changed in real time according to the online transaction of the drug purchase platform of the specific province 4、 Strengthen organization and Implementation (1) raise awareness and strengthen leadership This reform involves the adjustment of interests of drug manufacturing enterprises, private medical institutions designated by medical insurance, retail pharmacies designated by medical insurance, etc it has strong policy nature and high sensitivity, and is concerned by all sectors of the society It is necessary to strengthen leadership, clarify the division of responsibilities, closely cooperate with each other, ensure the smooth implementation of the reform, and ensure social harmony and stability （2） Strengthen publicity and guide reasonably We should accurately interpret the reform policies and measures, strengthen positive publicity and guidance, timely solve doubts and doubts, respond to social concerns, accept social supervision, reasonably guide social expectations, and strive to create a good atmosphere for reform （3） We should implement policies by classification, and carry out both dredging and blocking Adhere to the problem orientation, carefully study and judge the possible risks in the reform promotion process, establish emergency response plans, and formulate targeted response measures; closely monitor the implementation of the reform promotion, and promptly respond to and solve the problems in the reform promotion process Appendix: Catalogue of national basic medical insurance, industrial injury insurance and maternity insurance drugs (2019 version) has not been traded online (Western medicine part) PDF catalogue of national basic medical insurance, industrial injury insurance and maternity insurance drugs (2019 version) has not been traded online (Chinese patent medicine part) PDF catalogue of national basic drugs has not been traded online Part of the catalogue of non online transaction varieties (Western medicine part) has not been deleted in the supplementary medical insurance catalogue of Zhejiang province.pdf part of the catalogue of non online transaction varieties (Chinese patent medicine part) has not been deleted in the supplementary medical insurance catalogue of Zhejiang province.pdf 37