The Medical Insurance Bureau continues to promote the national negotiation drug landing effect

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In order to further implement the national deployment requirements for establishing and improving the "dual-channel" management mechanism for negotiated drugs, ensure the effective implementation of national medical insurance negotiated drugs in our province, and better meet the medication needs of the majority of insured patients, the Provincial Medical Security Bureau has recently formulated and issued medical insurance The management policy for the use of special drugs is clarified from four aspects: the scope of special drugs, policy regulations, management services, and work requirements.



Clarify the scope of special drugs. During the agreement period, the national medical insurance negotiation drugs and the tumor-targeted drugs in the medical insurance drug catalog of our province are special drugs for medical insurance. Special drugs meet the reasonable needs of drug supply and insured patients through two channels: designated medical institutions and designated retail pharmacies, and are simultaneously included in medical insurance payment, forming a "dual channel" management mechanism.



Improve the medical insurance payment policy. Insured persons in hospital, outpatient or retail drug purchase use special drugs, the implementation of the current hospital payment policy. Among them, outpatient and retail pharmacies use no starting line. In the aspect of medical insurance reporting and payment, the use of special drugs by employees in the whole province shall be directly included in the medical insurance and paid according to the current Class B drug policy. If urban and rural residents use special drugs, the individual shall pay a certain proportion in advance and then be included in the medical insurance and paid according to the Class B drug policy. The cost of drugs shall be accounted for separately and shall not be included in the total medical insurance payment index of medical institutions.



Strengthen the management of medical insurance services. Special drugs implement the "three-fixed" management of designated medical institutions, designated responsible physicians, and designated retail pharmacies. In principle, no less than one designated medical institution for special drugs of the second level and above and one designated special drug within the scope of each county (city, district) A designated retail pharmacy will be dynamically adjusted in accordance with moderate competition, entry and exit, and will be uniformly announced to the public. In the identification and management of designated medical institutions for special drugs, the system of localization and mutual recognition of the whole province shall be implemented, the management of medical insurance agreements shall be strictly enforced, the rules for the examination and approval of medical insurance drugs shall be improved and refined, intelligent monitoring shall be introduced, and the act of fraudulently obtaining medical insurance funds in the use of special drugs shall be severely cracked down on.



Put forward work requirements. Improve the political position, fully understand the importance of special drug use management. Strengthen organization and leadership, refine measures, improve the level of supply security of special drugs, better protect the rights and interests of insured patients, and ensure the implementation of policies. Through strengthening publicity, let the masses fully understand, understand and master the policy, and truly feel the dividend of medical insurance reform. All levels actively carry out monitoring of the implementation of policies and measures, and timely report new situations and new problems in the process of policy implementation, so as to ensure the smooth progress of special drug policies and effective implementation.



[Source: Qinghai Daily]]