Which drugs are expected to be included in the medical insurance this year, and what are the drugs t

Up to now, more than 60 drugs for rare diseases have been approved for marketing in China, of which more than 40 have entered the national medical insurance catalog, involving 25 diseases.

The work plan clarifies that rare disease ** drugs approved for marketing by the State Food and Drug Administration before June 30, 2022 can apply for this year's medical insurance negotiations, and the indications of the declared drugs must include the rare diseases included in the "First Batch of Rare Disease Catalog".

In the process of dynamic adjustment of the medical insurance catalog, the "soul bargaining" of drug negotiation has attracted much attention. The medical insurance department negotiates with the pharmaceutical company on the drug payment standard, and directly decides whether the drug can be included in the medical insurance and with what ** according to the results. In 2021, there were 67 exclusive drugs that were negotiated into the medical insurance list, with an average price reduction.

According to the Interim Measures for the Administration of Drug Use in Basic Medical Insurance, in principle, the validity period of the negotiated drug agreement is 2 years. After the expiration of the agreement, the actual expenditure of medical insurance** during the agreement period will be analyzed and compared with the budget submitted by the enterprise before the negotiation, and the price will be reduced according to the degree of difference, and the agreement will be renewed.

Drugs for rare diseases and children's drugs are expected to be covered by medical insurance.

According to the work plan, 6 types of drugs not included in the catalogue can apply to participate in the adjustment of the 2022 medical insurance catalogue, including new generic drugs, drugs with major changes in indications or functional indications approved by the State Food and Drug Administration from January 1, 2017 to June 30, 2022; New crown pneumonia-related ** drugs, etc.

Compared with last year, the 2022 medical insurance catalogue has been adjusted to add children's drugs and generic drugs. Among them, the scope of children's drugs should be in the list of three batches of children's drugs for encouraged R&D and declaration issued by the National Health Commission and other departments, and generic drugs should be in the list of two batches of encouraged generic drugs.

In August, the National Health Insurance Administration announced a new version of the National Medical Insurance Drug Catalog, requiring all provinces and cities to strictly implement the National Medical Insurance Drug Catalog, and not to formulate their own catalog or use workarounds to increase the drugs in the catalog, and make it clear that all provinces and cities should gradually adjust the previously increased Class B drugs within 3 years, and finally be consistent with the National Medical Insurance Drug Catalog.

2.The new version of the National Medical Insurance Drug Catalogue not only adds new drugs, but also deletes drugs with low clinical value, obvious abuse, and better alternatives that have been revoked by the national drug regulatory department, as well as drugs that are under the key monitoring of the national health department.

In accordance with the requirements of the state, Beijing has also deleted the drugs deleted by the state from the municipal medical insurance drug list.

As a result, some drugs are no longer covered by medical insurance.

Many of the drugs included in the medical insurance are commonly used drugs and can basically meet the needs of patients.

The drugs included in the medical insurance adopt the access system, that is to say, each drug is listed, and the amount is too large to be listed here. What is certain is that health care, health care, nourishment, etc. are not included.

Drugs that are covered by medical insurance include, such as cold medicines. Basic medical medications will be available.

What are the drugs covered by medical insurance, and there are many drugs that are included in medical insurance, and generally some basic drugs are included in that medical insurance.

There are 190,000 kinds of drugs in the country, and only 2,000 kinds are reported by social security.

The types and quantities of drugs that can be reimbursed by China's social security.

1. Reimbursement of drugs for basic medical insurance.

The drugs included in the scope of basic medical insurance are divided into two types: Class A and Class B. Class A drugs refer to drugs that are basically unified across the country and can ensure the basic needs of clinical practice. The cost of such drugs is included in the scope of basic medical insurance** and is paid according to the standard of basic medical insurance.

The list of Class B drugs is adjusted by the provinces, autonomous regions and municipalities directly under the Central Government according to their own conditions, and such drugs are first paid by employees for a certain percentage of the cost, and then included in the scope of basic medical insurance, and paid according to the standard of basic medical insurance.

Answer: Drugs covered by medical insurance are those that are included in the "Basic Medical Insurance Drug Catalog". That is, drugs that can be reimbursed by medical insurance. When the state determines the drug varieties of the "Basic Medical Insurance Drug Catalog", it is to consider the basic needs of clinical practice, and also consider the economic differences between regions, and pay equal attention to Chinese and Western medicines.

The drugs included in the "Basic Medical Insurance Drug Catalogue" are clinically necessary, safe and effective, reasonable, easy to use, and can be guaranteed by the market, and meet one of the following conditions: 1. Drugs included in the Chinese Pharmacopoeia (current edition), 2. Drugs that meet the standards issued by the State Food and Drug Administration, and 3. Drugs approved by the State Food and Drug Administration for formal import.

Drugs that cannot be included in the scope of drugs in the "Basic Medical Insurance Drug Catalogue": 1. Drugs that mainly play a nutritional and tonic role, 2. Some animals and animal organs, dried fruits that can be used for medicine, 3. All kinds of wine preparations prepared with Chinese herbal medicines, 4. Fruity preparations and oral effervescent agents in various drugs, 5. Blood products, protein products (except for special indications and first aid and rescue), 6. Other drugs that are not paid by medical insurance according to the Ministry of Labor and Social Security.

That's too much, the new version of the medical insurance catalog includes a total of 2,709 drugs, compared with the 2017 version, 218 drugs are transferred in, 154 drugs are transferred out, a net increase of 64. 70 new drugs were included in the National Reimbursement Drug List, with an average decline.

If you want to know the specific drugs, you can go to the National Medical Security Administration to check, in fact, you can ask the doctor to prescribe drugs within the scope of medical insurance as much as possible when you seek medical treatment. The follow-up medical insurance reimbursement can allow the company's personnel to help, but because our company does not have a personnel specialist, we are the personnel platform that pays social security to assist us in applying for medical treatment.

As follows: all Category A expenses are included in basic medical expenses; Category B has to pay 10% out of pocket, and 90% goes into basic medical expenses; Category C is self-paying.

Basic medical insurance.

The National Drug Catalogue divides drugs into three categories, the first category A, which can all be included in the scope of medical insurance reimbursement.

According to the proportion of medical insurance.

Reimbursement; In the second category of class B, the use of such drugs requires individuals to bear part of the cost according to a certain proportion, and the remaining part is included in the scope of medical insurance reimbursement and reimbursed according to the proportion of medical insurance;

The third category of category C, this part of the medicine is not reimbursed, all borne by the individual.

Drugs for rare diseases and children's drugs are expected to be covered by medical insurance.

According to the work plan, 6 types of drugs not included in the catalogue can apply to participate in the adjustment of the 2022 medical insurance catalogue, including new generic drugs, drugs with major changes in indications or functional indications approved by the State Food and Drug Administration from January 1, 2017 to June 30, 2022; New crown pneumonia-related ** drugs, etc.

Compared with last year, the 2022 medical insurance catalogue has been adjusted to add children's drugs and generic drugs. Among them, the scope of children's drugs should be in the list of three batches of children's drugs for encouraged R&D and declaration issued by the National Health Commission and other departments, and generic drugs should be in the list of two batches of encouraged generic drugs.

<>**Drugs for special diseases in children, which are expected to be covered by medical insurance. With the continuous progress and development of social science and technology, children's overall immunity will decline, and they are more likely to get sick, and even individual children suffer from some special diseases. To ensure the physical health of children, many drugs for special diseases of children are expected to enter the medical insurance, and the maximum reimbursement of these consumption after entering the medical insurance is about 80%.

There are also rare drugs that are also expected to be covered by health insurance。In addition to the various diseases that people are familiar with in daily life, there are a very small number of groups suffering from very rare symptoms, which are not only difficult, but also very expensive, and it is difficult for ordinary families to afford them, so in this year's pharmaceutical negotiation process, these rare special drugs will hopefully enter the medical insurance to save more minority families, for example, the cost of a special drug for a rare disease is as high as 1.2 million yuan, after entering the medical insurance, The amount borne by each family may only be about 200,000 yuan to 300,000 yuan, although this money is still a lot for a family, but compared with the original actual ** relevant departments have really worked hard.

Some Western medicines are used for various cancers, and there is also hope that they will enter the medical insurance. With the acceleration of people's pace of life and the increase of life pressure, many people will have a variety of diseases in their bodies when they are old, and even have the risk of cancer.

The adjustment of the national medical insurance catalogue is about to start, and a total of 119 drugs have been added to the catalogue through this high adjustment, and 29 of the original catalogue have been transferred out, because of the impact of the epidemic, this year's ribavirin file injection and arbidol granules will successfully enter the medical insurance, and 17 kinds of anti-cancer drugs have been added, such as rivatinib.

It is used for some of the rarer drugs. There are also some medicines for ** special diseases. There are also drugs that are urgently needed in clinical practice.

There are also some medicines used for children's diseases. There are also some drugs that can be used for ** underlying diseases. There is hope that they can enter the medical insurance, and this kind of news is also Ji Yin makes people feel that the special fight hall is not excited, and it can also bring great convenience to everyone.

More rare disease drugs, children's drugs are very likely to enter the scope of medical insurance, and this year, China's medical insurance catalog has been adjusted, new children's drugs and generic drugs, so where is the future national chain, in terms of medical insurance benefits, there will be more people in the audience, so that more people can afford to see a doctor, and will no longer go to the doctor because of lack of money.

A silver draft is some relatively rare disease drugs, and children's drugs can hope to enter the medical insurance, and some generic drugs are also in the catalog, and there are some new generic names, drugs, indications, functional indications, etc.

There are certain regulations on the use of drugs in medical insurance, and only the drugs included in the "List of Drugs in Basic Medical Insurance" belong to medical insurance drugs, so what conditions must be met by medical insurance? Please see the text for details. The national basic medical insurance drug, hence the name medical insurance drug.

The scope of drugs used in basic medical insurance is managed through the formulation of the "Basic Medical Insurance Drug Catalog" (hereinafter referred to as the "Drug Catalog"). The principle of determining the "Drug Catalogue" is: based on the national basic medical insurance drug catalogue, adhere to the clinically necessary, safe and effective, reasonable, easy to use, market guarantee, medical insurance can afford the drugs.

At the same time, it is necessary to consider not only the basic needs of clinical practice, but also the economic differences and medication habits between regions, and pay equal attention to traditional Chinese medicine. Drugs included in the "Records of Pure Discussion on Drugs" must specify one of the following conditions: (1) drugs included in the Pharmacopoeia of the People's Republic of China (current edition);

2) Drugs that meet the standards promulgated by the State Drug Administration;

3) Commodities officially imported with approval from the State Drug Administration. The following drugs cannot be included in the scope of basic medical insurance:

1) Drugs that mainly play a nutritional tonic role;

2) Some animals and animal organs, dried (water) fruits that can be used for medicine;

3) All kinds of liquor preparations brewed with Chinese herbal medicines and decoction pieces of Chinese medicine;

4) Fruit-flavored preparations and oral effervescent agents in various types of drugs;

5) Blood products and protein products (except for special indications, first aid and rescue); Rotten touch.

6) Other drugs that are not paid by the basic medical insurance according to the labor and social security administrative departments at or above the provincial level. The Drug Catalogue is divided into "Category A Catalogue" and "Category B Catalogue". The "Class A Catalogue" is selected on the basis of the "National Essential Drugs" and issued by the state as the most clinically necessary, widely used, with good efficacy, and the lowest among similar drugs.

"Category B Catalogue" is selected on the basis of the "National Essential Drugs", and formulated and promulgated by the state, provinces, administrative regions and municipalities directly under the Central Government can be based on the local economic level, medical needs and drug habits, in the sum of the increase and decrease of varieties does not exceed the total number of drugs formulated by the state 15 The "Category B Catalogue" is appropriately adjusted for clinical use, with good efficacy, and the drugs that are slightly higher than the "Category A Catalogue" drugs in the same category.

Legal analysis: Due to the differences in different regions, consumers only need to check the "Notice on Issues Concerning the Inclusion of Special Drugs in the Payment Management of Basic Medical Insurance" of Youli in their city, and they can specifically know which special drugs are included in the scope of medical insurance, which varies from year to year.

Legal basis

Social Insurance Law of the People's Republic of China Article 28 Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be paid from the basic medical care and hunger insurance in accordance with national regulations.