Legal basis: Notice of the National Health Insurance Bureau on the inclusion of 17 anticancer drugs in the category B of the national basic medical insurance, industrial injury insurance and maternity insurance drug list.
First, the inclusion of anticancer drugs in the scope of medical insurance payment through negotiation is an important measure to implement the requirements of the CPC Central Committee and the State Council. All localities should unify their thinking, raise their awareness and ensure that good things are done well. Especially during the period of institutional reform, it is necessary to strengthen overall coordination and implement it within the prescribed time limit so that the masses can get benefits as soon as possible.
Second, our bureau organized experts to negotiate some anticancer drugs according to procedures, and included azacitidine and other 17 drugs (hereinafter referred to as "negotiated drugs") into the category B scope of the National Drug List of Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (version 20 17) (hereinafter referred to as the Drug List), and determined the medical insurance payment standard (the list is attached) Provinces (autonomous regions and municipalities) medical insurance authorities shall not transfer the negotiated drugs out of the catalogue, nor shall they adjust the limited payment scope. At present, the integration of medical insurance for urban and rural residents has not been realized, and these drugs should be included in the payment scope of the new rural cooperative medical system in time according to regulations.
Three, the schedule "medical insurance payment standard" column payment standard includes all the expenses paid by the basic medical insurance fund and the insured, and the proportion of the basic medical insurance fund and the insured is determined by the overall planning area. The stipulated payment standard is valid until 165438+20201October 30, and will be adjusted according to the relevant provisions of the medical insurance payment standard after expiration. Within the validity period, if generic drugs (generic drugs) are listed, our bureau will adjust the payment standard of the drugs according to the price level of generic drugs, and notify them separately. If the actual price of the drug market is obviously lower than the current payment standard, our bureau will negotiate with the enterprise to re-establish the payment standard and notify it separately. Four, the provinces (autonomous regions and municipalities) centralized drug procurement institutions should be in 20 18+08 before the end of the negotiation of drugs in accordance with the payment standards in the provincial centralized drug procurement platform public hanging network. Medical insurance agencies should update the information system in time to ensure that it is implemented before the end of 0+ 165438. Five, the overall planning area should take effective measures to ensure the supply and rational use of drugs. If the actual cost of medical institutions in 20 18 exceeds the total control index due to policy reasons such as the inclusion of negotiated drugs in the catalogue, reasonable compensation should be given at the end of the year, and the factors of rational use of negotiated drugs should be comprehensively considered when formulating the total control index in 20 19. At the same time, it is necessary to strictly implement the negotiated drug payment scope, strengthen the use management, focus on monitoring and analyzing drugs with high cost and large dosage, and ensure the safety of medical insurance funds. In case of major problems in the implementation, we should give timely feedback to our bureau.