Suspected of violating the law
Recently, the shopkeeper learned from the National Health Insurance Administration that semaglutide, as a drug for the treatment of diabetes, has been included in the medical insurance catalog. However, the drug has not been approved for weight control, and it is suspected of being illegal to open and buy on behalf of others.
Semaglutide is used to lower glucose
Yes, it is reimbursable
According to the National Health Insurance Administration, the 2023 edition of the National Medical Insurance Drug List 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.
Relevant statistics show that from January to February 2024, semaglutide will be reimbursed more than 700,000 times in the national medical insurance, and the drug burden of patients will be greatly reduced.
Semaglutide is used for weight loss
No reimbursement is possible
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, alcohol and other drugs that "improve living conditions".
That is to say, 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. Therefore, the scope of payment for semaglutide injection is limited to two situations related to adult type 2 diabetes, and weight loss is not within the scope of payment, and medical insurance cannot reimburse it.
Not only can it not be reimbursed
If diabetic patients prescribe relevant medications
Suspected of violating the law
If you think you have diabetes or give your medical insurance card to your relatives and friends who have diabetes and ask someone to help you open it on your behalf, will you be reimbursed by medical insurance? Can you sell semaglutide that you can't use? In this regard, the National Health Insurance Bureau stressed: Arbitrage of the medical insurance foundation will be punished, and it 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.
Special caution
Is it possible to buy semaglutide for weight loss with a personal account of medical insurance or through an e-commerce platform? In this regard, the National Health Insurance Administration said that although it is not illegal to do so, it still reminds everyone that "it is a medicine that is three parts poisonous", and the medication should be used according to the doctor's instructions.
Semaglutide injection is a prescription drug, and prescription drugs must be prescribed by a licensed physician or licensed assistant physician before they can be dispensed, purchased, and used. Before use, the doctor usually conducts relevant examinations on the patient to rule out contraindications to the drug. There is a high risk of blind use.
In fact, most of us are not considered "obese" in the clinical sense, so we should not fall into "body anxiety" excessively, and through self-discipline exercise and reasonable diet, we can do a good job in weight management in most cases. Blindly following trends and abusing drugs can cause endless harm. For patients who do need treatment, please follow the doctor's instructions and treat them reasonably.
📃 Source | CCTV News
💻 O&M | Changzhou Internet News Center
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