On November 28, 2019, Lynparza (olaparib) was included in the National Health Insurance Class B Reimbursement Catalog, which is limited to use in first-line platinum-containing chemotherapy for first-treated adult patients with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer who carry germline or somatic BRCA mutations (gBRCAm or sBRCAm). after achieving complete remission or partial remission.
The conditions for reimbursement of Olaparib medical insurance are as follows:
1. Participants must go to the designated medical institutions of the basic medical insurance for medical treatment and purchase of medicines, or go to the designated retail pharmacies determined by the social insurance institutions for purchasing medicines out of the designated retail pharmacies with the medicine prescription issued by the doctor of the designated hospitals;
2. Medical expenses incurred by the insured persons in the process of medical treatment and purchase of medicines must be in accordance with the basic medical insurance The medical expenses incurred by the insured person in the course of visiting a doctor must conform to the scope and payment standards of the basic medical insurance drug list, diagnostic and therapeutic items, and standards of medical service facilities, in order to be paid by the basic medical insurance fund in accordance with the regulations;
3. Among the medical expenses of the insured person that conform to the scope of payment of the basic medical insurance, the portion of the expenses that are above the starting standard of the social medical insurance fund and below the maximum payment limit are paid by the social medical insurance fund at a uniform ratio. Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by disease risks. Through the employer and individual contributions, the establishment of a medical insurance fund, the insured person sick visit medical expenses incurred by the medical insurance organization to give them a certain amount of financial compensation.
The health insurance reimbursement conditions for olaparib vary from country to country and region to region, here is an overview of some common health insurance reimbursement conditions:
1. Diagnostic conditions: Olaparib is usually indicated for patients with ovarian and breast cancers that have been diagnosed with mutations in the BRCA1 and BRCA2 genes. Patients require genetic testing to confirm the presence of the mutation.
2. Therapeutic Stage Condition: Olaparib is generally indicated for patients with locally advanced or metastatic ovarian and breast cancer whose disease has progressed after first-line therapy. It is also indicated for patients with progressive disease after experimental treatment.
3. AGE CONDITIONS: The conditions for the use of olaparib usually require that the patient be 18 years of age or older. For use in minors, special proof of license may be required.
4. Medical Facility Conditions: Olaparib is usually required to be prescribed by a physician and administered at a designated medical facility. These medical facilities must have the appropriate specialized equipment and conditions to ensure patient safety and proper use of the medication.
5. Medical reimbursement conditions: Medical insurance reimbursement for Olaparib usually requires patients to provide relevant medical records, diagnostic certificates, genetic test results and other materials. And they need to pass the audit and verification of medical insurance in order to get the reimbursement of related expenses.
6. Out-of-pocket conditions: Although Olaparib can be partially reimbursed by health insurance, some costs still need to be borne by the patient. The out-of-pocket percentage will vary depending on the specific health insurance policy and region.
I hope the above can help you, if there are still questions please consult a professional lawyer.
Legal basis:
Article 8 of the Regulations for the Implementation of the Social Insurance Law
Medical expenses incurred by insured persons in the agreed medical institutions, which are in line with the standards of the basic medical insurance drug catalog, diagnostic and therapeutic items, and medical service facilities, shall be paid out of the basic medical insurance fund in accordance with national regulations.
Participants in need of emergency treatment, rescue, can be in a non-agreement medical institutions; rescue must be used for the drugs can be appropriately relaxed. The specific management of emergency and rescue medical services for the insured persons shall be formulated by the co-ordinating region according to the actual situation in the locality.