The reimbursement rate of Class A drugs is 100%, and that of Class B drugs is 70%-80%. The National Drug Catalogue of Basic Medical Insurance divides drugs into three categories: the first category A can all enter the scope of medical insurance reimbursement and be reimbursed according to the proportion of medical insurance; The second category B is that individuals need to bear part of the expenses according to a certain proportion, and the rest will enter the scope of medical insurance reimbursement, and be reimbursed according to the medical insurance proportion stipulated by law; Class III and Class C, these drugs are not reimbursed, and all of them are borne by individuals.
What is the reimbursement scope of national medical insurance?
1, drug reimbursement for basic medical insurance
Class A and B drugs included in the basic medical insurance coverage can be reimbursed. Among them, Class A drugs refer to drugs that can basically meet the basic clinical needs.
Class B drugs are included in the scope of basic medical insurance payment after the employees pay a certain percentage of the expenses, and the expenses are generally paid according to the basic medical insurance payment standard.
2, the basic medical insurance treatment project reimbursement
The scope of basic medical insurance payment items must be determined in accordance with the scope of basic medical insurance diagnosis and treatment items stipulated by the state. The diagnosis and treatment items that are part of the expenses paid by the basic medical insurance can be paid by the insured in advance and then paid in accordance with the provisions of the basic medical insurance.
Among them, the basic medical insurance diagnosis and treatment project must meet the following conditions: 1, designated medical institutions provide designated medical services for the insured; 2. The charging standard is stipulated by the price part; 3, clinical diagnosis and treatment projects must be safe, effective and reasonable cost.
3. Reimbursement of basic medical service facilities
The reimbursement scope of medical service facilities of basic medical insurance covers the service facilities that the insured person must live in during the process of diagnosis and treatment, including bed fees for outpatient and emergency observation and bed fees for hospitalization.
For some referral transportation expenses, emergency transportation expenses, infant incubator expenses, food incubator expenses, nursing expenses and escort expenses, the basic medical insurance fund cannot reimburse them.
To sum up, Class A drugs 100% shall be reimbursed according to the reimbursement ratio.
Class b should pay part of its own expenses and reimburse part of it. The specific reimbursement ratio varies according to local policies and specific drugs. It should be noted that the part that enters the basic medical expenses will be reimbursed according to the prescribed proportion and standard after it is higher than the basic medical expenses Qifubiaozhun.
Class A Otc is marked in red, Class B otc is marked in green, and Class A and B drugs are covered by medical insurance.
In the Measures for the Administration of Over-the-counter Drugs, Class A drugs must be sold in pharmacies, and Class B drugs can be sold in ordinary commercial enterprises and other places, but they must be examined and approved by the local drug supervision and administration department at or above the prefecture level, and eligible drugs can be issued with a quasi-sale sign.
The medical insurance catalogue is selected according to the national essential drugs catalogue, and Class A and Class B are determined according to the price ratio of curative effect, that is to say, those with definite curative effect and low cost are included in Class A without payment.
Class b basically has a self-payment ratio, which is determined by each place; In addition, the local labor and social security bureaus have the right to adjust the B-type varieties of medical insurance, and the total amount of transfer-in and transfer-out is controlled within 15% of the number of varieties, while all localities have no right to adjust the A-type varieties of medical insurance.
Legal basis:
People's Republic of China (PRC) social insurance law
Twenty-third employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.