The regulations stipulate that Class A drugs and treatment programs do not require you to pay a certain percentage of the cost, but most of the regional health insurance companies have set up a starting line, a ceiling and a percentage of benefits. So a full reimbursement does not mean you don't have to pay.
The three main catalogs of the health insurance (drug catalog, diagnostic and treatment items and medical service facilities), including the drug catalog of western medicine and pCms are distinguished as "Class A drugs and Class B drugs". The diagnostic and treatment programs are also differentiated into "Class A and Class B catalogs" (which may be called differently in different cities), and Class A drugs and diagnostic and treatment programs do not need to bear a certain percentage of their own.
Medicare Class A refers to the Class A drugs that are required for clinical treatment under national regulations. Widely used in the same class of drugs, therapeutic efficacy, low price, the costs incurred in the use of these drugs should be included in the scope of the basic medical insurance fund contributions, and in accordance with the provisions of the basic medical insurance scheme to pay, 100% of the Class A drugs reimbursed at the reimbursement rate.
Legal basis
The Interim Measures for the Administration of Medicines for Basic Medical Insurance, Article 24 of the National Medicines Catalog, western and proprietary Chinese medicines are divided into "Class A medicines" and "Class B medicines". "Article 24 "Class A medicines are those that are necessary for clinical treatment, widely used, have precise therapeutic effects, and are less expensive or costly to treat than other medicines in the same category. "Category B drugs" are drugs that can be used as an option for clinical treatment, have proven therapeutic efficacy, and are slightly more expensive or costly than Category A drugs in the same category. The drugs negotiated during the agreement period are included in the management of "Class B drugs".
Ethnic medicines and medical institution preparations that are included in the Drug List by the provincial medical security departments in accordance with national regulations are included in the management of "Class B drugs".
The "Classification A and B" of Chinese herbal medicines is determined by the provincial medical security administrative departments.
Article 25 The use of "Class A drugs" by insured persons shall be paid according to the payment standards and sharing methods stipulated by the basic medical insurance; the use of "Class B drugs" shall be paid according to the payment standards stipulated by the basic medical insurance, and a certain percentage of the payment shall be paid by the insured persons out of their own pockets, and then a certain percentage of the payment shall be paid by the insured persons according to the sharing methods stipulated by the basic medical insurance. The use of "Class B drugs" is paid according to the payment standards stipulated by the basic medical insurance, after which the insured person pays a certain percentage out of his own pocket, and then pays according to the sharing method stipulated by the basic medical insurance.
The proportion of out-of-pocket payment for "Class B drugs" is determined by the provincial or regional medical insurance administrative departments.