The latest national medical insurance catalog

National Health Insurance Bureau Ministry of Human Resources and Social Security

Notice on the Issuance of

National Medicines Catalog for Basic Medical Insurance, Worker's Compensation Insurance

and Maternity Insurance

(2022)

Medical Insurance Development [2023] No. 5

Provinces, autonomous regions, municipalities directly under the Central Government and Xinjiang Production and Construction Corps Health Insurance Bureau, Human Resources and Social Security Department (Bureau):

In order to implement the decision-making and deployment of the CPC Central Committee and the State Council, and to further improve the level of medication protection for the insured, in accordance with the "Interim Measures for the Administration of Basic Medical Insurance Medicines" and the "2022 Work Program for Adjustment of the Drug Catalogs of the National Basic Medical Insurance, Workers' Compensation Insurance, and Maternity Insurance," the State Medical Insurance Bureau and the Ministry of Human Resources and Social Security have adjusted and formulated the "Drug Catalogs of the National Basic Medical Insurance, Workers' Compensation Insurance, and Maternity Insurance (2022)". The National Medicines Catalog for Basic Medical Insurance, Workers' Compensation Insurance and Maternity Insurance (2022) (hereinafter referred to as the 2022 Medicines Catalog) has been adjusted and formulated by the State Medical Insurance Bureau and the Ministry of Human Resources and Social Security, and is hereby issued for your compliance. The relevant matters are notified as follows:

I. Timely Adjustment of the Scope of Payment

The 2022 Drug Catalog contains 2,967 types of western medicines and proprietary Chinese medicines***, of which 1,586 types are western medicines and 1,381 types are proprietary Chinese medicines. In addition, there are also 892 types of Chinese herbal medicines that can be paid for by the fund. All localities should strictly implement the 2022 Drug Catalog, and should not adjust the contents of drug varieties, remarks and A and B classifications in the catalog on their own. To update the information system and database in a timely manner, the new drugs in the adjustment will be included in the scope of payment of the fund in accordance with the provisions of the transfer of drugs to be synchronized out of the scope of payment of the fund, and in a timely manner in the intelligent supervision subsystem to maintain and strengthen the supervision of the fund.

Second, standardize the payment standards

The negotiated drugs (hereinafter referred to as negotiated drugs) and competitive drugs within the agreement period to implement the national unified health insurance payment standards, the coordinating region according to the fund's affordability to determine the proportion of out-of-pocket expenses and reimbursement rate. For competitively priced drugs, if the actual market price exceeds the payment standard, the excess will be borne by the insured; if the actual market price is lower than the payment standard, the actual price will be shared between the medical insurance fund and the insured. Encourage local health insurance departments to explore, prioritize the price of competitive drugs under the generic name is not higher than the payment standard varieties into the designated medical institutions and "dual-channel" pharmacy equipped with the scope of support for the clinical priority to use, to reduce the burden on patients.

During the validity period of the agreement, if the negotiated drugs or bidding drugs exist in the "2022 Drug Catalog" does not contain the specifications to be included in the scope of payment of health insurance, should be applied by the enterprise to the State Medical Insurance Bureau, the State Medical Insurance Bureau will determine the payment standard according to the terms of the agreement, and then implemented in the country. If there are drugs with the same generic name as the negotiated drugs listed in the market during the agreement period, their listed prices shall not be higher than the negotiated payment standards for the same specifications. The provincial health insurance department can adjust the payment standard of the drug according to the market competition and the price of the drug with the same generic name. Agreement period of negotiated drugs or competitive drugs are included in the national organization of drug centralized purchasing or government pricing, the provincial health insurance department can adjust the drug health insurance payment standards in accordance with the relevant provisions.

"2022 Drug Catalog" in the health insurance payment standard has "*" mark, the local health insurance and human resources social security departments shall not be in the public documents, news publicity and other public ways to announce its health insurance payment standard.

Third, solidly promote the catalog of drugs landing

"2022 Drug Catalog" since March 1, 2023, the official implementation (negotiated drugs in the Azulfidine tablets and lung detoxification particles of the new health insurance payment standards since April 1, 2023 implementation). The National Health Insurance Bureau, the Ministry of Human Resources and Social Security on the issuance of

notice (medical insurance hair [2021] No. 50) from March 1, 2023 at the same time repealed.

Provinces, autonomous regions and municipalities directly under the Centralized Purchasing Agency for Drugs (CPAD) should list the negotiated drugs directly on the provincial centralized purchasing platform by the end of February 2023, and the price of the negotiated drugs should not be higher than the price of the negotiated drugs. The price of the negotiated drugs is not higher than the payment standard. Participate in the catalog access bidding enterprises, in the payment standard validity period, its bidding drugs listed price is not higher than participating in the bidding offer (specific enterprises, drugs and offer to be announced).

Provincial health insurance departments should be in accordance with the "on the establishment of a perfect national health insurance negotiation drugs" dual-channel "management mechanism of the guiding opinions" (medical insurance hair [2021] 28) and "on the adaptation of the national health insurance negotiation of the normalization of the negotiation of drugs continue to do a good job of the work of the landing notice" (medical insurance letter [2021] 182) requirements, improve the "dual-channel" management mechanism, the "dual-channel" management mechanism. Improve the standardization and refinement of the management of the "dual-channel" work. Timely update the scope of drugs included in the "dual-channel" and separate payment in the province, and synchronize the implementation with the new version of the catalog. Encourage localities to actively explore effective modes of enhancing the level of drug supply guarantee for rare diseases through the "dual-channel" channel. Standardize the access procedures of "dual-channel" pharmacies, and further enhance the coverage rate of "dual-channel" pharmacies in rural areas, remote areas and economically underdeveloped areas. by December 31, 2023, provinces should rely on the national unified health insurance information platform for electronic prescription center to establish and improve the coverage rate of "dual-channel" pharmacies across the province. By December 31, 2023, all provinces should rely on the national unified medical insurance information platform electronic prescription center to establish and improve the province's unified, efficient operation, standardized prescription flow mechanism, and realize the electronic flow of "dual-channel" prescriptions within the provincial area. Continue to improve the negotiated drug landing monitoring mechanism, as required to the National Health Protection Bureau regularly feedback to the "2022 Drug Catalog" in the use of negotiated drugs and payment and other aspects of the situation.

The local health insurance departments should work together with the relevant departments to guide the designated medical institutions to rationally equip and use the drugs in the catalog, which can be combined with the actual use of drugs by the medical institutions to make reasonable adjustments to their annual total. It is necessary to strengthen the agreement management of designated medical institutions for medical insurance, medical institutions under the agreement on work injury insurance and institutions under the agreement on work injury rehabilitation. To the medical institutions will be reasonably equipped to use the "2022 Drugs Catalog" within the drug into the agreement, and actively promote the implementation of the new version of the catalog.

Fourth, standardize the management of national medicines, medical institution preparations, traditional Chinese medicine

Provincial medical insurance departments should be in accordance with the requirements of the Interim Measures for the Management of Basic Medical Insurance Drugs, improve procedures, refine the standards, scientific calculations, in line with the conditions of clinical necessity, reasonable price, and precise efficacy of national medicines, medical institution preparations, traditional Chinese medicine, etc., included in the scope of the fund payment. If there are conditions in the region, the medical insurance payment standards can be synchronized. At the same time, the establishment of a dynamic adjustment mechanism, in a timely manner will not meet the conditions of the drug out of the scope of payment.

I. Regulations

II. Western medicines

III. Proprietary Chinese medicines

IV. Negotiated medicines during the agreement period (including competitively priced medicines)

V. Traditional Chinese medicines

NHIS

Ministry of Human Resources and Social Security

January 13, 2023