Beijing medical insurance increased again
74 medicines
Recently, the Municipal Medical Security Bureau and the Municipal Human Resources and Social Security Bureau jointly issued the "Notice on Adjusting the Reimbursement Scope of The City's Basic Medical Insurance, Work Injury Insurance and Maternity Insurance" (Beijing Medical Insurance Fa [2021] No. 34), according to the adjustment of the national 2021 version of the drug catalog, the city's medical insurance drug catalog has been adjusted in and out, the reimbursement scope and reimbursement category of some drugs have been adjusted, and the reimbursement policy for special diseases in outpatient clinics in the city has been improved.
Implementation date: January 1, 2022
Applicable population: Urban workers, urban and rural residents and other insured persons in Beijing.
An additional 74 new drugs were included in the reimbursement
01
This year, the state negotiated to include 74 innovative drugs such as Northinacine sodium injection into the scope of national medical insurance reimbursement, which greatly reduced the price of drugs, with an average reduction of 61.71%.
02
The newly included drugs accurately complement the drug needs of tumors, chronic diseases, anti-infection, rare diseases, women and children, etc., and patients benefit from a wide range.
03
The city's adjustment is to implement the national 2021 version of the medical insurance drug catalog, and all 74 drugs added by the state will be included in the city's medical insurance drug catalog.
Northinalsan sodium injection
Treatment of spinal myelopathy amyotrophy
Before the negotiations,
The average annual cost for children is about 2 million yuan
After negotiations,
The average annual drug cost for pediatric patients is about 100,000 yuan
After Medicare reimbursement,
The personal burden was reduced to about 34,000 yuan.
The document was issued to delete the drugs deleted from the national medical insurance drug list from the city's medical insurance drug list, and the drugs deleted were mainly drugs with low use and strong substitution in recent years.
Improve relevant drug reimbursement policies
Further reduce the burden of medical expenses on patients with serious diseases
At the same time, 67 kinds of negotiated drugs are included in the scope of medical insurance reimbursement, and closely combined with the situation in the city, the reimbursement policy for some drugs with higher annual costs has also been adjusted and improved.
For example, the new drug "aminopyridine extended-release tablets" is included in the reimbursement scope of outpatient special disease drugs of "multiple sclerosis"; 21 other new drugs such as "Pamipali capsules" are included in the reimbursement scope of outpatient special disease drugs such as malignant tumors and severe mental illness in the city. After the above drugs are included in the outpatient special disease reimbursement, the drug costs incurred in the outpatient clinic can be implemented according to the standards of the hospitalization reimbursement policy, and the burden of drug costs for patients with serious diseases will be further greatly reduced.
Pamipali capsules
"Pamipali capsules" for the treatment of malignant tumors such as ovarian cancer and fallopian tube cancer
The average annual drug cost of patients is about 250,000 yuan
The average annual drug cost of patients is about 120,000 yuan
After outpatient special illness policy reimbursement,
Retired employees have an average annual personal burden on the drug
Reduced to about 18,000 yuan.
Since 2001, the city has established an "outpatient special disease" system for patients with serious diseases that require long-term outpatient treatment and high costs, and the relevant medical expenses incurred in outpatient treatment are reimbursed according to the proportion of hospitalization reimbursement and reimbursement standards, and only one threshold is charged within 360 days. At present, there are 17 kinds of outpatient special diseases in the city.
Special diseases in outpatient clinics in Beijing
17 outpatient special diseases
Outpatient treatment of malignant tumors
Kidney dialysis
Anti-rejection therapy after kidney transplantation
haemophilia
Aplastic anemia
Anti-rejection therapy after liver transplantation
Anti-rejection therapy after liver-kidney combined transplantation
Anti-rejection therapy after heart transplantation
Anti-rejection therapy after lung transplantation
Multiple sclerosis
Intraocular injection treatment of fundus lesions
Major psychosis
Niemanpic disease type C
Biologic treatment of moderate to severe allergic asthma
Antifibrosis therapy for pulmonary interstitial disease
Targeted therapy for pulmonary hypertension
Multidrug-resistant TB
In view of the successful negotiation of drugs by the state, for long-term outpatient treatment, high cost, suitable for the treatment of a variety of diseases, in order to further reduce the burden of medical expenses of the masses, convenient for the masses of outpatient treatment and medication, the city refers to the reimbursement level of special disease drugs in the medical insurance clinics of urban workers and urban and rural residents, and continues to pilot 14 kinds of drugs such as "agasase α concentrated solution for injection" according to a fixed proportion of the burden, and implements a single line of payment, the basic medical insurance fund for urban workers is paid by 80%, and the basic medical insurance fund for urban and rural residents is paid by 70% pay.
In addition, the reimbursement scope of 5 kinds of drugs such as metoprolol oral regular-release dosage forms, the reimbursement scope of 513 drugs such as omeprazole injection, and the reimbursement categories of 1263 drugs such as clotrimazole oral regular-release dosage forms are also uniformly adjusted and standardized according to national requirements.
Clarify supporting measures
Ensure the implementation of the new policy
In order to make the newly included drugs in the scope of reimbursement available, available and used well, the Municipal Medical Security Bureau and the Municipal Human Resources and Social Security Bureau clearly require in the document that the procurement department will directly hang the negotiated drugs on the centralized procurement platform before the end of December for the procurement of relevant medical institutions. Each designated medical institution shall, according to the medical insurance drug catalog transfer in and out of the drug situation, timely convene a special pharmaceutical management meeting, adjust and optimize the medical institution's drug catalog, so that it "should be fully matched"; for the negotiated drugs that cannot be temporarily included in the medical institution but have clinical needs, they can be included in the scope of temporary procurement, establish a green channel, simplify procedures, shorten the cycle, and timely purchase; for drugs that cannot be equipped temporarily, it is necessary to establish and improve the prescription circulation mechanism and improve the accessibility of drugs. Medical institutions should improve the internal management system, strengthen the supervision of clinical drug use behavior, standardize medical service behavior; rational use of negotiated drugs, not included in the proportion of drugs in medical institutions, the average cost of times, etc. affect the scope of assessment indicators that affect their landing, and medical institutions must not affect the allocation and use of new drugs, especially drugs that are successfully negotiated and renewed, on the grounds of total medical insurance control and the number of drug lists in medical institutions, so as to ensure that patients can use and use them well.
The "Circular" requires that medical institutions and medical insurance agencies should strengthen management, strengthen the monitoring and statistical analysis of the cost of new drugs, especially those that have been successfully negotiated, strengthen the management of the use of medical insurance funds, ensure the rational use of drugs, prevent unreasonable expenditures, and further improve the efficiency of fund guarantees.
Beijing Municipal Medical Security Bureau
Source || Medicare Beijing