Semaglutide is on fire again? It is reported that the drug is known as the "miracle drug for weight loss" because of its certain weight loss function, and at the beginning of this year, this drug once again entered the public eye.
On April 16, China City Daily searched for "semaglutide" on multiple social platforms and found that most of the content was also related to weight loss, not diabetes.
On April 16, the National Health Insurance Administration issued a response to issues such as whether "semaglutide" is included in medical insurance.
There is no doubt that semaglutide injection is really covered by medical insurance
The 2023 edition of the National Medical Insurance Drug Catalogue contains 3,088 drugs, covering more than 90% of the drug share of public hospitals across the country, including 7 hypoglycemic drugs that belong to glucagon-like peptide-1 (GLP-1) receptor agonists.
Screenshot from the "National Basic Medical Insurance, Work-related Injury Insurance and Maternity Insurance Drug Catalogue (2023)".
In December 2017, the drug was approved by the US FDA for "blood sugar control in adult patients with type 2 diabetes", and in 2020, the FDA further approved "for adult patients with type 2 diabetes with cardiovascular disease to reduce the risk of related diseases". Thanks to the adjustment mechanism of the national medical insurance drug list, the above two indications of semaglutide injection were included in the national medical insurance list through negotiation in April 2021 after they were approved in the mainland in April 2021, and the price was less than one-tenth of that of the United States.
Relevant statistics show that from January to February 2024 alone, semaglutide will be reimbursed more than 700,000 times in the national medical insurance, and the dual factors of negotiation and medical insurance reimbursement have greatly reduced the drug burden of patients.
No matter how "godly" diet pills are, they can't enter medical insurance
In order to promote the construction of a healthy China, ensure the basic drug needs of the insured, and improve the scientific and refined management level of basic medical insurance drugs, in 2020, the National Health Insurance Administration issued the "Interim Measures for the Administration of Drugs in Basic Medical Insurance", which clearly stipulates that there are 8 types of drugs that cannot be reimbursed by medical insurance, mainly for enhancing sexual function, treating hair loss, weight loss, beauty, quitting smoking, quitting alcohol and other drugs that "improve living conditions".
To put it simply, if the main function of a drug is to lose weight, the medical insurance will definitely not report it, and if it can treat both the disease and lose weight, the medical insurance may reimburse the indication used to treat the disease, but the medical insurance must not report the indication of weight loss.
For example, liraglutide injection, which is the same as semaglutide, has been approved by the mainland drug regulatory department for weight loss, but the 2023 version of the National Medical Insurance Drug List stipulates that it can only be reimbursed when it is used to treat type 2 diabetes in adults.
Similarly, payment for semaglutide injection is limited to two situations related to type 2 diabetes in adults. Weight loss is not covered by the payment and cannot be reimbursed by medical insurance.
If I ask someone to open it on my behalf, can I be reimbursed by medical insurance?
If you have diabetes or give your medical insurance card to your relatives and friends who have diabetes, and ask someone to open it on your behalf, can you be reimbursed by medical insurance, or even if you can't use it and sell it, wouldn't you still be able to make a profit?
According to the National Health Insurance Administration, arbitrage of medical insurance foundations is punished and may even be illegal.
According to the Regulations on the Supervision and Administration of the Use of Medical Security Funds (Decree No. 735 of the State Council) and the Guiding Opinions of the Supreme People's Court, the Supreme People's Procuratorate and the Ministry of Public Security on Several Issues Concerning the Handling of Criminal Cases of Medical Insurance Fraud Even if it does not reach the level of a crime, if the perpetrator hands over his medical insurance card to others for fraudulent use or uses his own medical insurance to prescribe drugs and then resell them, in addition to a fine of 2-5 times, he may also be suspended from medical insurance network settlement for 3-12 months.
The National Health Insurance Administration reminds that "it is a medicine that is three parts poisonous", and the medication should be used according to the doctor's instructions. The Administrative Measures for the Classification of Prescription Drugs and Non-prescription Drugs (for Trial Implementation) stipulate that prescription drugs can only be dispensed, purchased and used with a prescription from a licensed physician or a licensed assistant physician.
Semaglutide injection is a prescription drug, and doctors will generally conduct relevant examinations on patients before use to rule out drug contraindications. In particular, this drug for weight control has not yet been approved by the mainland drug regulatory department, and it is still an off-label drug for the treatment of obesity in China, and there is a greater risk of blind use.
■Source: WeChat public account of the National Health Insurance Administration
■编辑：欧帆、越玥、张阿嫱