Human Resources and Social Security Departments (Bureaus) of the Provinces, Autonomous Regions, Municipalities Directly under the Central Government, and Xinjiang Production and Construction Corps, and the Fujian Provincial Office of Medical Insurance:
The "National Catalog of Medicines for Basic Medical Insurance,
Since the issuance of the National Medicines Catalogue for Basic Medical Insurance, Workers' Compensation Insurance and Maternity Insurance (2009 Edition), the human resources and social security departments at all levels have been earnestly implementing the requirements of the medicines catalog, constantly standardizing and improving the management of medicines under medical insurance, which has played an important role in safeguarding the basic medicines needs of the insured persons, maintaining the smooth operation of the fund, and promoting the healthy development of the pharmaceutical industry. In order to implement the spirit of the National Health and Wellness Conference, establish a fairer and more sustainable social security system, steadily raise the level of basic medical insurance, promote the technological progress and innovation of medical services and drug production, and gradually establish and improve the mechanism for dynamic adjustment of the scope of medicines used in the basic medical insurance, the Interim Measures on the Administration of the Scope of Medicines Used in the Basic Medical Insurance for Urban Workers (Interim Measures on the Administration of the Scope of Medicines Used in the Basic Medical Insurance for Urban Workers) (Labor and Social Security Bureau) have been adopted. Scope Management Interim Measures (Ministry of Labor and Social Affairs [1999] No. 15) and other laws, regulations and documents, the Ministry has organized experts to conduct drug reviews and formulated the National Drug Catalogue for Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (2017 Edition) (hereinafter referred to as the "Drug Catalogue"). The relevant issues are notified as follows:
I. Strict payment regulations for the Drug Catalog. The Drug Catalog is divided into four parts: vanillin, western medicines, proprietary Chinese medicines, and traditional Chinese medicine tablets. The catalog is the "Drug Catalog" of the layout format, name dosage form specifications, limited payment scope and other content of the explanation and description, western medicine part of the chemical drugs and biological products, proprietary Chinese medicine part of the Chinese medicine and ethnic drugs, Chinese medicine tablets part of the use of exclusionary provisions of the fund does not pay for the cost of the tablets. Expenses incurred by insured persons for the use of western medicines and proprietary Chinese medicines in the catalog as well as Chinese herbal medicinal tablets outside the catalog are paid in accordance with the relevant provisions of basic medical insurance, industrial injury insurance and maternity insurance. If the anti-HIV drugs provided free of charge by the state and the anti-tuberculosis drugs, anti-malarial drugs and anti-schistosomiasis drugs involved in the national public **** health program are used by the insured persons and are within the scope of the payment of public **** health, the basic medical insurance, industrial injury insurance and maternity insurance funds will not pay for them.
Two, standardize the adjustment of the provincial drug catalog. Provinces (autonomous regions and municipalities) social insurance authorities of the Drug Catalog Category A drugs shall not be adjusted, and should be strictly in accordance with the current laws, regulations and documents for the adjustment of Category B drugs. The adjustment of the Drug Catalog should adhere to the expert evaluation mechanism, adhere to fairness, impartiality and openness, and effectively do a good job of preventing and controlling integrity risks, and shall not collect fees from enterprises under any name, shall not take any form of local protectionist behavior, and the administrative authorities shall not intervene in the results of the expert evaluation.
Provinces (autonomous regions and municipalities) should release their local drug catalogs for basic medical insurance, work injury insurance and maternity insurance before July 31, 2017. The number of adjustments (including transferring in, transferring out, and adjusting the limited scope of payment) shall not exceed 15% of the number of national Class B drugs. The adjustment of Class B drugs in each province (autonomous region and city) shall be reported to the Ministry for the record in accordance with the regulations.
The coordinated regions shall implement the new version of the drug catalog within one month after the release of the drug catalogs for basic medical insurance, industrial injury insurance and maternity insurance in their provinces (autonomous regions and municipalities), and update the list of hospital preparations included in the scope of payment of the fund in accordance with the relevant regulations.
Third, improve the use of drug catalog management. The coordinating regions should do a good job of corresponding to the drugs in the catalog according to the use of drugs in medical institutions and retail pharmacies under their jurisdiction, and update and improve the information system drug database in a timely manner. Provinces (autonomous regions and municipalities) should accelerate the application of the industry standard of "Social Insurance Drug Classification and Codes" in conjunction with the work of direct settlement of medical treatment in other places, establish and improve the unified drug database of the whole province (autonomous regions and municipalities), and realize the unified management of western medicines, proprietary Chinese medicines, hospital preparations, and traditional Chinese medicines and drinking tablets within the provincial area.
Localities should incorporate the implementation and use of the Drug Catalog by designated medical institutions into the scope of management and assessment of designated service agreements, in conjunction with the management regulations of the Drug Catalog and the prescription management methods, clinical technical specifications, clinical diagnostic and treatment guidelines, and guiding principles for clinical application of medicines formulated by the departments of health, planning and sanitation, and so on. A sound system of intelligent monitoring of basic medical insurance medical services and a system for monitoring and analyzing the use of medicines for social insurance have been established, focusing on monitoring medicines that are used in large quantities, incur high costs and may be used unreasonably, and the results of such monitoring are announced to the public in an appropriate manner. The role of pharmacists will be brought into play, and medical institutions will be incentivized to take effective measures to promote the rational use of medicines in clinical practice.
Provinces (autonomous regions and municipalities) should accelerate the work of formulating payment standards for medicines under medical insurance by generic name in accordance with the requirements of drug price reform. The coordinated areas can further improve the medical insurance drug classification and payment management methods. For drugs in Class B that mainly play an auxiliary therapeutic role, the proportion of individual out-of-pocket payment can be appropriately increased to widen the gap between the proportion of payment for drugs in Class B and that for other Class B drugs. For drugs outside the catalog necessary for clinical emergency rescue and treatment of special diseases, a reporting system for designated medical institutions can be established, with corresponding audit and management methods clarified and reported to the higher-level human resources and social security departments for the record.
Four, explore the establishment of health insurance drug negotiation access mechanism. The Ministry will be determined by the expert evaluation of the proposed negotiation of drugs in accordance with the relevant rules of negotiation, eligible drugs into the scope of payment of health insurance, the list will be released separately.
Everywhere in the adjustment of the Drug List and the organization and implementation of the process, in the event of any major problems, should be reported in a timely manner. After the issuance of this document, the document "Notice on the Issuance of the National Drug Catalog for Basic Medical Insurance, Workers' Compensation Insurance and Maternity Insurance" (Ministry of Human Resources and Social Security [2009] No. 159) will be repealed at the same time.
Attachment: National Drug Catalog for Basic Medical Insurance, Workers' Compensation Insurance and Maternity Insurance (2017 Edition)
Ministry of Human Resources and Social Security
February 21, 2017
Click to download Attachment 1: General Examples
Click to download Attachment 2: Western Medicines Section
Click to download Attachment 3: Proprietary Chinese Medicines Section <
Click to download Attachment 4: Traditional Chinese Medicine section