1, class A drugs: drugs that are necessary for clinical treatment, widely used, with good curative effect and lower price among similar drugs. When the insured uses such drugs, they can all be included in the scope of reimbursement and reimbursed according to the prescribed proportion;
2. Class B drugs: drugs that are available for clinical use and have good curative effect, and the price of similar drugs is higher than that of Class A drugs. When the insured uses Class B drugs, he must first deduct a certain amount of personal out-of-pocket expenses according to the proportion (stipulated by each locality), and then include the remaining expenses in the scope of reimbursement, and reimburse them according to the prescribed proportion. According to China's current medical insurance reimbursement policy, western medicine and Chinese patent medicine are divided into Class A and Class B, and the main difference between them is that the reimbursement ratio is different. 100% Class A drugs are reimbursed according to the reimbursement ratio, and Class B drugs are partially reimbursed according to the medical insurance policy.
Details are as follows:
1. According to the current medical insurance policy, outpatient or inpatient 100% reimbursement;
2. For Class B drugs within the scope of medical insurance, 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 proportion of medical insurance. The specific reimbursement ratio varies according to local policies and specific drugs.
The compensation ratio is as follows:
1. Due to the different levels of medical insurance financing in different parts of China, in order to ensure the basic medical drugs for the insured, the basic medical insurance drug list is divided into Class A and Class B management;
2. The purpose is to define the graded use of drugs in order to achieve the best cost-effective effect. It aims at grading drug use and improving resource efficiency.
A and B medical insurance reimbursement calculation is as follows:
1. The expenses of drugs, diagnosis and treatment incurred by the insured after arriving at the hospital, including drugs of Class A and Class B;
2. After deducting the out-of-pocket expenses for Class B drugs, plus the total expenses of Class A drugs, plus the medical expenses and other expenses that meet the requirements of medical insurance;
3, for more than the deductible expenses, according to the patient's own insurance, hospital level, according to the provisions of the proportion of reimbursement.
To sum up, all Class A drugs are reimbursed in proportion. Class B drugs pay part of their own expenses and are reimbursed. The specific reimbursement ratio varies according to local policies and specific drugs.
Legal basis:
Article 24 of the Interim Measures for the Administration of Medication in Basic Medical Insurance
Western medicine and Chinese patent medicine in the national drug list are divided into "Class A drugs" and "Class B drugs". "Class A drugs" refer to drugs that are necessary for clinical treatment, widely used, with definite curative effect, and the price or treatment cost is lower than that of similar drugs. "Class B drugs" refers to drugs of the same kind that can be used for clinical treatment with definite curative effect, and the price or treatment cost is slightly higher than that of "Class A drugs". During the agreement period, the negotiated drugs will be included in the management of "Class B drugs".
The national medicines and preparations of medical institutions that are included in the Drug Catalogue by the provincial medical security department according to the provisions of the state are included in the management of Class B drugs.
The "A-B classification" of Chinese herbal pieces is determined by the provincial medical security administrative department.