Legal analysis: category A costs all into the basic medical costs; category B to pay 10%, 90% into the basic medical costs; category C out-of-pocket expenses.
Basic medical insurance national drug catalog will be divided into three categories of drugs, the first category A, can all enter the scope of reimbursement, according to the proportion of medical insurance reimbursement;
The second category B, with this type of drugs need to be part of the cost of a certain proportion of the individual, the remaining part of the scope of reimbursement of the medical insurance, reimbursement according to the proportion of the medical insurance;
The third category C, the part of the drugs are not reimbursed, all of which is borne by the individual.
Legal basis: "National Basic Medical Insurance, Workers' Compensation Insurance and Maternity Insurance Drug Catalog (2020)
The second, to strengthen the management of drug payment
Localities should strictly implement the "2020 Drug Catalog", shall not formulate their own catalogs or increase the number of drugs in the directory by using alternative methods, and shall not adjust the scope of payment of drugs in the directory on their own. The information system should be adjusted in time, the database should be updated and improved, and the drugs that are transferred in this adjustment should be included in the scope of payment of the fund according to the regulations, and the drugs that are transferred out should be transferred out of the scope of payment of the fund in a synchronized manner.
The negotiated medicines (hereinafter referred to as negotiated medicines) within the agreement period will be subject to a unified national health insurance payment standard, and the coordinating regions will determine their out-of-pocket and reimbursement rates according to the fund's affordability, and no secondary bargaining will be allowed within the agreement period.
Three, do a good job of catalog landing
"2020 Drug Catalog" since March 1, 2021, the official implementation. The centralized drug procurement agencies of each province (autonomous region and city) should list the negotiated drugs directly on the provincial centralized drug procurement platform as early as possible. If there are drugs with the same generic name on the market during the agreement period, the directly listed price of the drugs with the same generic name shall not be higher than the negotiated standard of payment for the same specification of health insurance. If the specifications are different from those of the negotiated drugs, the directly listed price shall not be higher than the health insurance payment standard calculated in accordance with the principle of price difference. Provincial health insurance departments can be in the same generic name of the drugs on the network, in accordance with the provisions of the generic name of all drugs under the development of a unified health insurance payment standards.
Medicare departments around the world should work together with the relevant departments to guide designated medical institutions to rationally equip and use the drugs in the catalog, and may make reasonable adjustments to their annual totals in conjunction with the actual use of medicines by medical institutions. Strengthen the management of the agreement of the designated medical institutions, the medical institutions will be reasonably equipped to use the drugs in the "2020 Drug Catalog" into the content of the agreement.
Innovating working methods and approaches to promote the landing of the 2020 Drug Catalog by improving outpatient protection policies, opening access to health insurance designated pharmacies, and reasonably adjusting total control. All localities should establish and improve the monitoring system for the landing of negotiated drugs, and provide regular feedback to the State Medical Insurance Bureau on the use and payment of the negotiated drugs in the 2020 Drug Catalog as required.
Provincial health insurance departments should speed up the digestion of the original self-added varieties, clean up varieties that do not meet the requirements of the Interim Measures for the Management of Basic Medical Insurance Medicines as required, and promote the basic unification of the scope of medicines.