2. Diagnostic Item Catalog
3. Medical Service Facility Catalog
These three catalogs are the most basic guidelines for the implementation of China's medical insurance policy and reimbursement. The basic medical insurance drug catalog is the policy basis and standard for medical, industrial and commercial, and maternity insurance to pay for drug costs; it is a selection of therapeutically necessary, inexpensive, and therapeutically effective drugs on the basis of the national basic drugs.
The medicines included in the scope of payment of basic medical insurance are divided into two categories: category A and category B. The first category is the list of medicines that are not covered by basic medical insurance.
Category A drugs are those that are basically uniform across the country and can ensure the basic needs of clinical treatment. The costs of these drugs are covered by the Basic Medical Insurance Fund and are paid in accordance with the Basic Medical Insurance Benefit Criteria.
The list of Class B drugs is also set by the state, but provinces and municipalities can adjust the list on their own, but the adjustment cannot exceed 15% of the national limit. These drugs are covered by the basic medical insurance fund after the employee pays a certain percentage of the cost, and are paid in accordance with the basic medical insurance payment standard. Generally speaking, the out-of-pocket expenses for Class B drugs range from 10% to 30%. Chongqing's latest policy for 2019 is to include 90% of Class B drugs in the scope of the coordinated payment, in other words, employees only need to pay 10% out-of-pocket. Drugs that are not included in the catalog of Class A and Class B drugs are "off-catalog". And the ones that are not on the list are all out-of-pocket (commonly known as "Category C").
Legal basis:
National Health Insurance Bureau Ministry of Human Resources and Social Security on the issuance of the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drugs Catalog (2021)" Notice, Article 1, the timely adjustment of the scope of payment
The Drugs Catalog of 2021 contains Western medicines and proprietary Chinese medicines** 2860 types, of which Western medicines and proprietary Chinese medicines have been included. **2,860 types, of which 1,486 are western medicines and 1,374 are proprietary Chinese medicines. 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 2021 Drug Catalog and shall not adjust the limited scope of payment and A and B classification of drugs in the catalog on their own. It is necessary to adjust the information system in a timely manner, update and improve the database, and include the drugs that have been transferred in this adjustment in the scope of payment of the fund in accordance with the regulations, and the drugs that have been transferred out of the fund should be transferred out of the scope of payment of the fund in a synchronized manner.