Drugs included in the Basic Medical Insurance Drug List should be clinically necessary, safe and effective, reasonably priced, convenient to use, and produced to ensure supply, and have one of the following conditions:
Drugs included in the Chinese People's Republic of China Pharmacy (current edition).
Drugs that meet the standards issued by the State Food and Drug Administration.
Drugs officially imported with the approval of the State Food and Drug Administration.
The Basic Medical Insurance Drug List is divided into Class A and Class B drugs. In the reimbursement of Class B drugs, the individual has to pay 10% of the total amount before reimbursement is made for Class A drugs.
Category A drugs are those that are clinically necessary, widely used, have good therapeutic effects, and are less expensive than other drugs in the same category.
Category B drugs are those that can be used for clinical treatment, have good therapeutic effects, and are slightly more expensive than their counterparts in the Category A list.
Basic Medical Insurance Drug Catalog
Introduction:
The National Basic Medical Insurance Drug Catalog includes 913 varieties of Western medicines, 575 varieties of proprietary Chinese medicines, and 47 varieties of ethnic medicines. The part of traditional Chinese medicine tablets includes 28 kinds and 1 category of drugs that are self-financed for single or compound use and 101 kinds of drugs that are self-financed in the case of single-prescription use (the exclusion method is applied to this category of drugs, and all those included in the catalog are self-financed). Western medicines and proprietary Chinese medicines are divided into two categories, A and B. There are 327 western medicines and 135 proprietary Chinese medicines in Category A, and 586 western medicines and 440 proprietary Chinese medicines in Category B. For medicines that are subject to basic medical insurance, individual employees are required to bear part of the cost of medicines in accordance with the local basic medical insurance regulations in each co-ordination area. The price of Class B medicines is generally higher than that of Class A medicines, and the proportion of out-of-pocket expenses paid by individuals is higher than that of Class A. The standard of out-of-pocket expenses is set by each co-ordination area. The out-of-pocket standard is set by each co-ordinating region. Category A drugs are uniformly implemented nationwide and may not be adjusted in any region, while Category B drugs have a 15% right of adjustment in each region. The National Catalog of Medicines for Basic Medical Insurance has been officially promulgated, and employees participating in basic medical insurance can be reimbursed for the use of Category A and B medicines on the Catalog and Chinese medicinal herbs outside the Catalog according to the proportions stipulated by each region. Western medicines and proprietary Chinese medicines on the list are divided into two categories, A and B. Category A medicines are uniformly enforced throughout the country and are not subject to change in any part of the country, while Category B medicines are subject to 15% adjustment in each province, autonomous region and city. The price of Class B drugs is generally higher than that of Class A drugs, and the proportion of individual payment is also higher than that of Class A drugs, with the specific payment standard set by each coordinating region.
Features:
The newly promulgated National Basic Medical Insurance Drug Catalogue has the following features compared with the past medical drug catalog of the public-funded and labor-insured medical treatment: 1) two basic "overlaps", i.e., more than 80% of the drugs in the existing medical drug catalog of the public-funded and labor-insured medical treatment in each province, autonomous region and city overlap with the National Basic Medical Insurance Drug Catalogue. Medical Insurance Drug List" overlap; "National Basic Medical Insurance Drug List" in more than 90% of the drugs and "National Essential Drugs" overlap. ② Two "increases", i.e., when comparing the National Basic Medical Insurance Drug Catalog with the current scope of drug reimbursement for national public medical care, there is an increase of 15.9% and 8.1% in western medicines and proprietary Chinese medicines, respectively, and the proportion of joint-venture and imported medicines in western medicines has slightly increased. The National Basic Medical Insurance Drug List replaces some old drugs and dosage forms with effective new drugs and dosage forms that have been on the market for the past few years.
Principles:
This time, the National Basic Medical Insurance Drug List was formulated in accordance with five principles: to ensure the safety and effectiveness of medicines used by workers; to ensure the basic medical needs of workers; to encourage and support the progress of medicine science and technology; to insist on a smooth transition between the old and the new methods of using medicines; and to adhere to the principles of science, fairness and authoritativeness.
Management:
China's Regulations for the Implementation of the Drug Administration Law stipulate that drugs included in the Medical Insurance Catalog shall be subject to government pricing or government-guided pricing. Starting from August 1, 2005, the pricing of over-the-counter drugs in the Medicare Catalog was decentralized to localities, with each province setting its own prices. Previously, the pricing of Class A drugs in the Medicare Catalog was unified by the state, while Class B drugs were set by the state at a guideline price, and local pricing could fluctuate within a range of 5%. This year, the National Development and Reform Commission (NDRC) announced a new "National Development and Reform Commission Pricing Drug Catalog", the number of varieties expanded from about 1,500 to about 2,400? This includes the 2,100 reimbursed drugs identified in the Medicare Catalog. Some enterprises, while celebrating the fact that their medicines have been able to enter the Medicare Catalog, have also begun to struggle with the shrinking profit margins brought about by the hard targets for drug prices. The expansion of terminal sales is accompanied by the limitations imposed by the maximum retail price and the amount of hospital health insurance. That's why some people pointed out that the enterprise's drugs into the "medical insurance catalog" does not have to show off the place, the final profit is the most powerful characterization. At the same time, there are industry insiders believe that the mandatory price cuts can not fundamentally solve the problem of high drug prices, this problem is caused by the shortcomings of the system, it should be resolved by moving the system of surgery. But because of the special nature of the commodity drugs, completely by the market to dictate the price, the possibility is still not great. Therefore, the complex feelings of enterprises to enter the "medical insurance catalog" is self-evident. However, in any case, China's health insurance system will gradually improve the market potential of pharmaceutical companies also know that the "health insurance catalog" is not a "safe", but its existence and role can never be underestimated.
Development:
China's "medical insurance catalog" is based on foreign experience, along with the development of the health insurance system and the establishment of the five years so far.
Origin of WHO
In 2000, the National Basic Medical Insurance Drug Catalog (referred to as the "Medical Insurance Catalog") was born, marking the official start of the reform of China's medical insurance system supporting measures.
In September 2004, the Ministry of Labor and Social Security published the National Basic Medical Insurance and Work Injury Insurance Drug Catalog (2004), which is different from the 2000 version in that the new catalog includes more drugs than the 2000 version. The difference between the 2000 and 2004 versions is that the new catalog added the item "Worker's Compensation Insurance". In this first adjustment of the "medical insurance catalog" since 2000, 714 kinds of drugs were selected for the latest version of the "medical insurance catalog", of which 408 kinds of traditional Chinese medicines increased by 98%, and 306 kinds of western medicines were newly added, an increase of 42%.
Professor Hu Shanlian of Fudan University's School of Public **** Health told reporters: "In 1979, WHO proposed the development of the National Essential Drugs Catalog, which aims to protect people's basic right to health, mainly for developing countries.WHO developed a guiding directory on the basis of which individual countries can make adjustments.In the 1980s, China introduced the In the 1980s, China introduced a drug catalog for publicly-funded labor insurance, which was formulated on this basis. It facilitated the standardization of medication management and met the basic needs of each region. Since then, there has been the Interim Measures for the Administration of the Scope of Medicines for Urban Workers' Medical Insurance in 1999, which laid the foundation for the National Basic Medical Insurance Drug Catalog introduced in 2000. At present, the number of drugs in China's Medical Insurance Catalog has greatly exceeded that of the National Basic Drug Catalog, with nearly 2,000 items, much higher than the level of drug catalogs in other developing countries, so a lot of foreign companies want to get their products into China's Medical Insurance Catalog.
Government pricing has far-reaching effects
Zhuang Yi-qiang, president of Allergan Management Consultants Ltd. and deputy director of the Lingnan Institute of Pharmaceutical and Health Economics and Management at Sun Yat-sen University, believes that the existence of and adjustments to the Medicare Catalog have triggered public relations actions and opportunities for many pharmaceutical companies, increasing the cost of drug distribution, which is ultimately passed on to patients. For pharmaceutical companies, despite knowing that their products will face the pressure of national price limits after entering the Medicare Catalog, one of the top priorities is still to find ways to make their products enter the Medicare Catalog, because sales of products entering the Medicare Catalog are guaranteed. Even if the centralized bidding procurement of drugs, whether the product can enter the bidding scope of one of the basis is to see whether to enter the "medical insurance directory", this linkage undoubtedly prompted the enterprise to increase the medical insurance varieties of gold. One of the most obvious examples here is that every session of the National Drug Trade Fair, investment in popular varieties of seven or eight out of ten are health insurance varieties.
Curbing the surge in medical costs?
On the role of the Medicare Catalog in controlling medical costs, Zhuang Yiqiang believes that we cannot blindly draw conclusions. The original intention of the "medical insurance catalog" is mainly to control the excessive growth of medical costs, but from the actual situation after the promulgation of the "medical insurance catalog", the annual growth rate of medical costs (about 13%) is higher than the growth rate of the gross domestic product (about 9%), can not be easily based on this to the "medical insurance catalog" to draw conclusions. The rapid growth of medical costs is a complex issue with many threads involved, and the Medicare Catalog, which is an integral part of the reform measures, has been in place for only five years and is in need of development and improvement.
Comprehensively implementing basic medical insurance for urban residents?
Mr. Yu Mingde, executive director of the China Association of Pharmaceutical Enterprises Management (CAPEM), has a different view. He believes that the "Medical Insurance Catalog" has indeed played a considerable role in the construction of the medical insurance system, guaranteeing the accessibility of medicines for the people. Medical insurance designated hospitals and designated pharmacies are required to stock a full range of medicines for medical insurance purposes, thus guaranteeing the supply of varieties of medicines. From the perspective of doctors, the Medical Insurance Catalog also has a guiding effect on doctors, guiding them to give priority to prescribing drugs in the catalog and controlling the cost of medicines more effectively. In the past, the catalog contained fewer varieties, but in 2004 the number of varieties in the catalog increased, providing patients with more choices.
China's public hospitals have been exercising total control over the growth of medical costs since around 2000, in which the Medicare Catalog has played a big role, but there have been many problems. A person in charge of a famous tertiary hospital in Shanghai told reporters that for public tertiary hospitals like theirs, the control of medical costs has always puzzled them. Because the patient to the big hospitals is rushing to the hospital's brand, identified in the big hospitals to treat the disease, more drugs, good drugs, so more patients, prescriptions, resulting in hospitals to control the total cost is more than enough and not enough. It is understood that this situation is not an isolated phenomenon in the three major hospitals.
Beginning in 2004, the "Medical Insurance Catalog" will be revised and improved once every two years in the future. What is the direction of the future development of the Medical Insurance Catalog? Now the "medical insurance catalog" varieties of choice by the price of drugs, pricing factors have a greater impact, in fact, some of the relatively high price of new special drugs and high quality and high price of drugs can also be appropriate to enter the "medical insurance directory", for such new special drugs and high-priced drugs to implement the standard management of payment, the purpose is to make the "medical insurance directory" moderate expansion, so that patients have more autonomy to choose.