In accordance with the decision-making and deployment of the CPC Central Committee and the State Council, the National Health Insurance Bureau, in conjunction with the Ministry of Human Resources and Social Security and other departments, organized and carried out the adjustment of the national basic medical insurance, work injury insurance and maternity insurance drug catalog in 2022, which has now been successfully completed. This adjustment, *** there are 111 drugs added into the catalog, 3 drugs were transferred out of the catalog. From the negotiation and bidding situation, 147 drugs outside the catalog to participate in the negotiation and bidding (including the original catalog of drugs to renew the negotiation), 121 drugs negotiation or bidding success, the overall success rate of 82.3%. The average price reduction of the newly admitted drugs in the negotiation and bidding was 60.1%. After the current round of adjustment, the total number of drugs in the national health insurance drug catalog reached 2967, of which 1586 kinds of Western medicines, 1381 kinds of proprietary Chinese medicines; traditional Chinese medicine tablets have not been adjusted, is still 892 kinds. In this adjustment, the National Health Insurance Bureau in strengthening the research and demonstration, extensive consultation on the basis of the introduction of competitive bidding mechanism, improve the renewal rules, optimize the evaluation process, the directory adjustment of the scientific, standardized, refined level to a new level. In the adjustment, the National Health Insurance Bureau firmly grasp the "basic" functional positioning, the fund affordability as the "bottom line" must be adhered to, do their best, within their means, efforts to meet the majority of participants in the basic needs of medicines; focusing on the prevention and control of the national new crown epidemic situation In order to meet the basic medication needs of the insured, we have been focusing on the prevention and control of the new crown epidemic in China, and have included the eligible medications for the new crown into the scope of the catalog to help prevent and control the epidemic; we have also introduced varieties with higher clinical value and cost-effective price, and have successfully upgraded and modernized the drug protection. At the same time, this adjustment to ensure the safety of the fund on the basis of continuing to appropriately relax the scope of payment of some of the varieties in the catalog, drug accessibility and fairness of medication has been further enhanced. Since the establishment of the National Health Insurance Bureau, it has carried out the adjustment of the drug catalog for five consecutive years, adding a total of 618 drugs into the scope of the catalog, and at the same time, transferring a number of drugs with inaccurate efficacy, easy to abuse in the clinic, or eliminated drugs out of the catalog, leading to profound changes in the use of drugs. The Blue Book on the Progress and Effectiveness of China's Medicare Drug Management Reform released by the China Pharmaceutical Society shows that since 2018, the proportion of medicare drugs in the use of medicines in healthcare organizations has increased year by year, the dominant position has been further consolidated, and the reasonableness of clinical use of medicines has been actively improved. At the same time, the speed of innovative drugs into the medical insurance is obviously accelerated, the price level of commonly used drugs is significantly reduced, the level of drug protection for major diseases and special populations is greatly improved, significantly reducing the burden of drug use on the masses. Next, the National Health Insurance Bureau, the Ministry of Human Resources and Social Security will conscientiously implement the spirit of the twentieth CPC National Congress, excel, courage and determination, pay close attention to the implementation of the new version of the directory, and strive to enhance the level of protection for the majority of the people's medicines, and to do a good job of the new Coronavirus therapeutic drug price guidance and medical cost protection, to take action to help the prevention and control of the epidemic and the construction of a healthy China. National Health Insurance Bureau Ministry of Human Resources and Social Security on the issuance of "national basic medical insurance, industrial injury insurance and maternity insurance drug catalog (2022)" notice Medical insurance hair [2023] No. 5 Provinces, autonomous regions, municipalities directly under the central government and the Xinjiang Production and Construction Corps Medical Insurance Bureau, Human Resources and Social Security Department (Bureau): To implement the CPC Central Committee, The State Council's decision-making and deployment, and further improve the level of drug protection for the insured, in accordance with the "Interim Measures for the Administration of Basic Medical Insurance Drugs" and the "2022 Work Program for Adjustment of the National Drug Catalogs for Basic Medical Insurance, Workers' Compensation Insurance and Maternity Insurance", the State Medical Insurance Bureau and the Ministry of Human Resources and Social Security have organized the adjustment and formulation of the "2022 Drug Catalogs for Basic Medical Insurance, Workers' Compensation Insurance and Maternity Insurance ("2022")". 2022) (hereinafter referred to as the 2022 Drug Catalog), which 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 (pCms), of which 1,586 are western medicines and 1,381 are pCms. In addition, there are also 892 types of Chinese herbal medicinal tablets that can be paid for by the fund. All localities shall strictly implement the 2022 Drug Catalog and shall 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 added in this adjustment will be included in the scope of payment of the fund in accordance with the provisions of the transfer out of the drugs to be synchronized out of the scope of payment of the fund, and timely maintenance in the intelligent supervision subsystem, to strengthen the supervision of the fund. Second, standardize the payment standard The negotiated drugs (hereinafter referred to as negotiated drugs) and bidding drugs during the agreement period to implement the national unified health insurance payment standard, the coordinating region according to the fund affordability to determine its out-of-pocket expenses and reimbursement ratio. 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 the local health insurance department to explore, prioritize the price of competing 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, reduce the burden on patients.
The agreement is valid, if the negotiated drugs or bidding drugs exist in the "2022 Drug Catalog" does not contain the specifications need to be included in the scope of payment of health insurance, should be applied by the enterprise to the State Health Insurance Bureau, the State Health Insurance Bureau will determine the payment standard according to the terms of the agreement, after the national implementation. If there are drugs with the same generic name as the negotiated drugs on the market during the agreement period, their listed prices shall not be higher than the negotiated payment standards for the same specifications. Provincial health insurance departments may adjust the health insurance payment standard of the drug according to the market competition situation and the price of the drug with the same generic name. During the agreement period, the negotiated drugs or competitively priced drugs are included in the national organization of drug centralized band purchasing or government pricing, the provincial health insurance department can adjust the drug health insurance payment standard 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 propaganda and other public ways to announce its health insurance payment standard.
Third, solidly promote the catalog 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 the notice (medical insurance hair [2021] No. 50) since March 1, 2023 at the same time repealed. Provinces, autonomous regions and municipalities directly under the Centralized Purchasing Agency for Drugs (CPAD) are required to list the negotiated drugs directly on the provincial centralized purchasing platform for drugs by the end of February 2023. The listed 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 the participation 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] No. 28) and "on the adaptation of the normalization of the national health insurance negotiation continue to do a good job of negotiating the work of the landing of the drugs" (medical insurance letter [2021] No. 182) requirements, to improve 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 of "dual-channel" pharmacies in rural areas, remote areas and economically underdeveloped areas. by December 31, 2023, each province shall rely on the national unified health insurance information platform electronic prescription center to establish and improve the province's unified and comprehensive electronic prescription system, as well as to establish and implement the "dual-channel" system. By December 31, 2023, all provinces should rely on the national unified health insurance information platform electronic prescription center to establish and improve the province's unified, highly efficient and 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 regularly feedback to the National Health Security Bureau "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 medical institutions to make reasonable adjustments to their annual total. To strengthen the health insurance designated medical institutions, industrial injury insurance agreement medical institutions and industrial injury rehabilitation agreement institutions agreement management. To the medical institutions reasonably equipped to use the "2022 Drug Catalog" within the drug into the agreement content, and actively promote the new version of the catalog landing implementation. Fourth, standardize the management of national medicines, medical institution preparations, traditional Chinese medicine Provincial medical insurance departments should, in accordance with the requirements of the "Interim Measures for the Management of Basic Medical Insurance Drugs", improve the procedures, refine the standards, scientific calculations, to meet the conditions of clinical necessity, reasonable price, and exact efficacy of the national medicines, medical institution preparations, traditional Chinese medicine, and other drugs, to be included in the scope of the fund to pay. Where conditions exist, the medical insurance payment standards can be determined simultaneously. 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. Annex: National Drug List for Basic Medical Insurance, Workers' Compensation Insurance and Maternity Insurance (2022) I. General Regulations II. Western Medicines III. Proprietary Chinese Medicines IV. Negotiated Medicines during the Agreement Period (including Competitively Priced Medicines) V. Traditional Chinese Medicines and Herbal Medicines NHIB Ministry of Human Resources and Social Security 2023 January 13, 2023