Is the "miracle drug for weight loss" into the medical insurance?

Source: National Health Insurance Administration

No matter how "godly" diet pills are, they can't enter medical insurance!

As soon as spring arrives, the great cause of weight loss has been put on the agenda by many friends. A drug called "semaglutide" is sought after by many beauty lovers. Many enthusiastic netizens shared the usage on social platforms, promoting the "miracle effect" of "lying down to become slimmer", and some even said that it made the world's richest man Musk "judge two horses".

So as a drug that has been marketed in China, has semaglutide entered the medical insurance? If so, wouldn't swiping the medical insurance card still save a fortune for the great cause of weight loss? Now, let's have a good chat.

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. 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.

(Data from: https://www.drugs.com/price-guide/ozempic)

Seeing this, some friends are not "happy", since they have been included in medical insurance, does it mean that weight loss can also be reimbursed by medical insurance? Calm, let's continue to talk.

Yes, you read that right! No matter how "godly" diet pills are, they can't be covered by 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" (interested partners can download and learn from the official website of the National Health Insurance Bureau~), 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, smoking cessation, alcohol cessation and other drugs that "improve living conditions". Not only the mainland, but also some other countries have similar regulations, and the reason why they do this is to keep and use everyone's "life-saving money" well. The employee medical insurance fund is mainly paid by the employer and the individual employee, and the resident medical insurance fund is two-thirds from the financial subsidy, which is hard-won and must be used on the "blade" of treating diseases and saving people. You can understand that if the main function of a drug is to lose weight, the medical insurance will definitely not report it; if it can treat both the disease and lose weight, the medical insurance may reimburse the indication for treating the disease, but the medical insurance for the indication of weight loss must not report it. 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.

Talking about this, some "smart people" may think, if I just say that I have diabetes or give my medical insurance card to my relatives and friends with diabetes, and ask someone to help me open it, will I be reimbursed by medical insurance, or even if I can't use it to sell, wouldn't I still be able to make a profit?

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. At present, the WeChat official account of the National Medical Insurance Bureau and the national medical insurance service platform have opened the inquiry window of the national medical insurance negotiation drug allocation agency, as long as you enter the name of the drug, you can easily find the city's medical insurance designated medical institutions and designated retail pharmacies. However, everyone should understand that these conveniences are not provided for the convenience of pouring and selling medicines. Every insured person is the guardian of the medical insurance fund, and must not damage the "life-saving money" because of the "small interests" in front of them;

So, some people have said that I use my medical insurance personal account to buy or buy through an e-commerce platform to lose weight, which is always okay, right? Although it is not illegal to do so, I still remind everyone:

"It is a medicine with three points of poison", and the medication is in accordance with 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. Stimulated by the "hot and piping hot", many people have set the flag of becoming thinner this year, but in fact, most of us are not considered "obese" in the clinical sense, and we advise everyone not to fall into "body anxiety" excessively, and through self-discipline exercise and reasonable diet, you can do a good job in weight management in most cases. "The girl injected 1mg semaglutide herself and sent to the hospital for rescue" The news may have been seen by everyone, and blindly following the trend and drug abuse are infinitely harmful. For "fat friends" who really need to use treatment methods, please also be sure to follow the doctor's instructions and treat them reasonably.

Editor-in-charge: Li Dan

Proofreading: Liao Shengchao

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