Can targeted drugs be reimbursed by medical insurance, and can targeted drugs be reimbursed by medic

The reimbursement scope of medical insurance refers to the scope of reimbursement of drug catalogs, diagnosis and treatment items and medical service facilities in order to ensure the basic medical needs of the insured and standardize the management of drugs, diagnosis and treatment and other aspects of basic medical insurance. The medical expenses incurred by the insured in the designated hospital in accordance with the three major catalogs shall be paid by the medical insurance** in accordance with the regulations.

Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by the risk of disease. Through the employer and individual payment, the establishment of medical insurance**, after the insured person is sick and incurs medical expenses, the medical insurance institution will give him a certain amount of economic compensation. The establishment and implementation of the basic medical insurance system gathers the economic strength of the unit and the members of the society, coupled with the best funding, which can enable the sick members of the society to obtain the necessary material help from the society, reduce the burden of medical expenses, and prevent the sick members of the society from becoming poor due to illness.

Health insurance, like other types of insurance, is a contract that collects premiums in advance from people at risk of illness to establish health insurance**. When the insured falls ill and goes to a medical institution for medical treatment and incurs medical expenses, the medical insurance institution will give certain financial compensation. Therefore, medical insurance also has two major functions of insurance, risk transfer and compensation transfer.

That is, the economic loss caused by the risk of disease in the individual is apportioned to all members who are threatened by the same risk, and the economic loss caused by the disease is compensated by the centralized medical insurance**.

Legal basis

Social Insurance Law of the People's Republic of China

Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled by the social insurance agency and the medical institution and the drug business unit.

The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits. Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

OK.

The National Healthcare Security Administration has included 17 anti-cancer drugs in the scope of Class B of the National Basic Medical Insurance, Work-related Injury Insurance and Maternity Insurance Drug Catalogue, including: azacitidine, cetuximab, afatinib, etc.

Legal basis: Social Insurance Law of the People's Republic of China

Article 2 The State shall establish a social insurance system of basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, maternity insurance, and so on, to ensure citizens' right to receive material assistance from the State and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth.

Article 26 The standards for the treatment of basic medical insurance for workers, new rural cooperative medical care, and basic medical insurance for urban residents shall be implemented in accordance with state regulations. Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

Legal Analysis: Yes.

The new version of the drug list includes 36 new negotiated drugs, of which 15 are targeted drugs for malignant tumors. Covering lung cancer, liver cancer, breast cancer, kidney cancer and other malignant tumor diseases, the targeted drug has a good effect and high quality, and was not reimbursed before.

Through national negotiations, the overall drug** has been reduced by an average of 40% and up to 70%. Take a drug for breast cancer as an example, it turns out that the drug cost of patients is more than 20,000 yuan per month, and it costs about 250,000 yuan a year. Through national negotiations, the drug** has been reduced to more than 7,000 yuan per month, and the personal burden after reimbursement is less.

Legal basis: Social Insurance Law of the People's Republic of China

Article 23 Employees shall participate in the basic medical insurance for employees, and the employer and the employees shall jointly pay the basic medical insurance premiums in accordance with the provisions of the State.

Individually-owned businesses without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexibly employed persons may participate in the basic medical insurance for employees, and the individual shall pay the basic medical insurance premiums in accordance with the provisions of the state.

Article 24: The State is to establish and improve a new type of rural cooperative medical system.

The management measures for the new type of rural cooperative medical care shall be stipulated by ***.

Targeted ** is a genetic drug, which is self-financed and very expensive, and cannot be reimbursed by medical insurance. In 2018, Beijing announced the reimbursement ratio and standard of medical insurance for urban employees, the reimbursement ratio for outpatient services is 70%-90%, and the reimbursement ratio for hospitalization is 85%-. From a national perspective, the reimbursement standard of medical insurance for urban workers in Beijing is relatively high, especially for the retired elderly, which is higher than 90%.

Legal basisArticle 64 of the Full Text of the Social Insurance Law of the People's Republic of China provides that social insurance includes basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance. In addition to the basic medical insurance** and maternity insurance** combined accounts and accounting, other social insurance** according to the type of social insurance separately established and accounted for. Social insurance** implements a unified national accounting system.

The special funds for social insurance are used exclusively and shall not be embezzled or misappropriated by any organization or individual. The basic endowment insurance will gradually implement the national overall planning, and other social insurance will gradually implement the provincial overall planning, and the specific time and steps shall be stipulated by the national level.

The above is only the current information combined with my understanding of the law, please refer to it carefully!

If you still have questions about this issue, it is recommended that you organize the relevant information and communicate with a professional in detail.

Legal analysis: Targeted drugs are reimbursable, and the National Healthcare Security Administration has included 17 anti-cancer drugs in the national basic medical insurance, work-related injury insurance and maternity insurance drug catalogue category B, including: azacitidine, cetuximab, afatinib, etc.

Legal basis: Social Insurance Law of the People's Republic of China

Article 2 The State shall establish a social insurance system of basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, maternity insurance, and so on, to ensure citizens' right to receive material assistance from the State and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth.

Article 26 The standards for the treatment of basic medical insurance for workers, new rural cooperative medical care, and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

Legal analysis: Reimbursement, targeted drugs can be reimbursed, and the National Medical Security Administration has included 17 kinds of anti-cancer drugs in the scope of Class B of the national basic medical insurance, work-related injury insurance and maternity insurance drug catalog.

Legal basis: Notice of the National Medical Security Administration on Including 17 Anti-cancer Drugs in the Category B Scope of the National Basic Medical Insurance, Work-related Injury Insurance and Maternity Insurance Drug Catalogue

First, through negotiation to include anti-cancer drugs in the scope of medical insurance payment is an important measure to implement the requirements of the first and the best, and all localities should unify their thinking, raise awareness, and ensure that good things are done well. In particular, during the period of institutional reform, it is necessary to strengthen overall planning and coordination, implement the work within the prescribed time limit, and let the masses get benefits as soon as possible.

2. Our bureau organized experts to negotiate with some anti-cancer drugs according to the procedures, and included 17 drugs such as azacitidine (hereinafter referred to as "negotiated drugs") into the scope of Category B of the National Basic Medical Insurance, Work-related Injury Insurance and Maternity Insurance Drug Catalogue (2017 Edition) (hereinafter referred to as the Drug Catalogue), and determined the medical insurance payment standards (the list is attached). The competent departments of medical insurance of all provinces (autonomous regions and municipalities) shall not transfer the negotiated drugs out of the catalog, nor shall they adjust the scope of limited payment. At present, the overall planning areas that have not realized the integration of medical insurance for urban and rural residents should also include these drugs in the scope of payment for new rural cooperative medical care in a timely manner according to regulations.

3. The payment standards specified in the "Medical Insurance Payment Standards" column in the attached table include all the expenses jointly paid by the basic medical insurance** and the insured personnel, and the proportion of the basic medical insurance** and the insured personnel shall be determined by each overall region. The prescribed payment standard is valid until November 30, 2020, and will be adjusted in accordance with the relevant provisions of the medical insurance payment standard after the expiration of the validity period. During the validity period, if there is a generic name drug (generic drug) on the market, our bureau will adjust the payment standard of the drug according to the level of generic drug ** and notify you separately.

If the actual ** of the drug market is significantly lower than the current payment standard, our bureau will negotiate with the enterprise to reformulate the payment standard and notify you separately. Fourth, the provincial (autonomous region, municipal) centralized drug procurement institutions should be negotiated drugs according to the payment standards on the provincial centralized drug procurement platform before the end of October 2018. The medical insurance agency should update the information system in a timely manner to ensure that it will be implemented before the end of November.

5. All co-ordinating areas should take effective measures to ensure the optimal and rational use of negotiated drugs. If the actual expenses incurred by medical institutions in 2018 exceed the total amount control index due to policy reasons such as the inclusion of negotiated drugs in the catalog, reasonable compensation shall be given at the end of the year, and the rational use of negotiated drugs shall be comprehensively considered when formulating the total amount control index in 2019. At the same time, it is necessary to strictly implement the scope of payment of negotiated drugs, strengthen the management of use, and focus on monitoring and analysis of drugs with high cost and large dosage to ensure the safety of medical insurance.

If there are major problems in the implementation, we should give feedback to our bureau in a timely manner.

Summary. Some drugs are covered by medical insurance, but not all targeted drugs can be reimbursed.

Some drugs are covered by medical insurance, but not all targeted drugs can be reimbursed.

For example, first-line targeted drugs for lung cancer, including Iressa and Sarot, can be applied for a certain amount of reimbursement as special drugs. Herceptin, a commonly used targeted drug for breast cancer, is also included in the scope of medical insurance reimbursement in most provinces. There are also many oral targeted drugs for gastric residue wide cancer, such as apatizonionib, which has now been included in the scope of medical insurance reimbursement.

However, the types of targeted drugs included in the reimbursement are also different in different provinces and regions. ** If you want to go to the medical insurance department of your local hospital for a detailed consultation, you can also consult a doctor. Each region has a list of drugs, and you can check whether the targeted drugs you use are covered by medical insurance.

Expansion: The proportion of targeted drug reimbursement by region varies greatly, so there is no national uniformity in the Ming and Qing dynasties, for example, 80% in Beijing, 50% in Shandong, and 30% in Shenyang.

Summary. Hello dear, I'm honored to answer your <>

Targeted drugs can be reimbursed by medical insurance Targeted drugs have entered the medical insurance, and targeted drugs can be reimbursed within the scope of medical insurance, but the reimbursement of targeted medical insurance cannot be 100%, and the reimbursement ratio is different in each place, and the reimbursement in different places and local is also different. The new version of the drug list includes 36 new negotiated drugs, of which 15 are targeted drugs for malignant tumors.

Can targeted drugs be reimbursed by medical insurance?

Hello dear, I'm honored to answer your <>

Targeted drugs can be reimbursed by medical insurance Targeted drugs have entered the medical insurance, and targeted drugs can be reimbursed within the scope of medical insurance, but targeted medical insurance reimbursement cannot be achieved by 100%, and the reimbursement ratio in each place is different, and the reimbursement in different places and local areas is also different. The new version of the drug list includes 36 new negotiated drugs, of which 15 are targeted drugs for malignant tumors.

Legal analysis: 1. Different groups of people. The medical insurance for urban employees is mainly for in-service employees who have a work unit or are engaged in individual economy and those who have retired from the spine and those who have retired from the spine.

The medical insurance for urban residents is mainly for unemployed elderly residents with urban household registration, subsistence allowance recipients, severely disabled people, students and children, and other urban non-employees2. The payment standard is different from **. The medical insurance for urban employees shall be jointly paid by the employer and the individual employee, and shall not enjoy the first subsidy. The payment standard of medical insurance for urban residents is generally lower than that of employee medical insurance, and appropriate subsidies are given on the basis of individual contributions3. The standard of treatment is different.

The level of financing is low, and the standard of medical treatment is slightly lower than that of employees4. The payment requirements are different. The minimum payment period for urban employee medical insurance is established, and if the payment period is reached (25 years for men and 20 years for women), they can enjoy the basic medical insurance treatment after retirement.

Legal basis: Article 26 and Article 26 of the Law of the People's Republic of China on Social Insurance: The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical filial piety insurance for urban residents shall be implemented in accordance with national regulations.