In this adjustment, * * *11drugs were added to the list, and 3 drugs were transferred out of the list. Judging from the negotiation and bidding, 147 drugs out of the catalogue participated in the negotiation and bidding (including the negotiation on updating the drugs in the original catalogue), and 12 1 drugs succeeded in negotiation or bidding, with an overall winning rate of 82.3%. The average price of new drugs dropped by 60. 1%. After this round of adjustment, the total number of drugs in the national medical insurance drug list reached 2967, including western medicine 1586, Chinese medicine 138 1; There are still 892 kinds of Chinese herbal pieces that have not been adjusted.
In this adjustment, on the basis of strengthening research and argumentation and soliciting opinions extensively, the National Medical Insurance Bureau introduced the bidding mechanism, improved the contract renewal rules, optimized the evaluation procedures, and the scientific, standardized and refined level of catalogue adjustment reached a new level. In the adjustment, the National Medical Insurance Bureau firmly grasps the functional orientation of "ensuring basics", regards the fund affordability as the "bottom line" that must be adhered to, and tries its best to meet the basic drug demand of the majority of insured people; Keep a close eye on the overall situation of national COVID-19 epidemic prevention and control, include qualified COVID-19 therapeutic drugs in the catalogue, and help the epidemic prevention and control with practical actions; Introduce varieties with higher clinical value and cost performance, and successfully upgrade drug safety. At the same time, on the basis of ensuring the safety of the fund, this adjustment continues to appropriately relax the payment scope of some varieties in the catalogue, and the accessibility and fairness of drug use have been further improved.
Since the establishment of the National Medical Insurance Bureau, the drug list has been adjusted for five consecutive years, with a total of 6 18 drugs added, and a number of drugs with uncertain curative effect and easy clinical abuse or elimination have been transferred out of the list, resulting in profound changes in the drug users. The Blue Book on the Progress and Effectiveness of Medical Insurance Drug Management Reform in China issued by China Pharmaceutical Association shows that since 20 18 years, the proportion of medical institutions using medical insurance drugs has increased year by year, the dominant position has been further consolidated, and the rationality of clinical drug use has been positively improved. At the same time, the speed of innovative drugs entering medical insurance has obviously accelerated, the price level of commonly used drugs has obviously dropped, and the level of drug protection for major diseases and special populations has been greatly improved, which has obviously reduced the drug burden of the people.
In the next step, the National Medical Insurance Bureau and Ministry of Human Resources and Social Security will conscientiously implement the spirit of the 20th National Congress of the Communist Party of China, work hard, forge ahead, pay close attention to the implementation of the new catalogue, and strive to improve the people's drug security level. At the same time, we will do a good job in guiding the price of therapeutic drugs and ensuring medical expenses in COVID-19, and help the epidemic prevention and control and the construction of healthy China with practical actions.
Ministry of Human Resources and Social Security released by the National medical insurance bureau
Notice on the National Drug List of Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (2022)
Medical insurance [2023] No.5
All provinces, autonomous regions, municipalities directly under the central government and Xinjiang Production and Construction Corps Medical Security Bureau, Human Resources and Social Security Department (bureau):
In order to implement the decision-making arrangements of the CPC Central Committee and the State Council, and further improve the level of medication security for insured persons, according to the Interim Measures for the Administration of Medication in Basic Medical Insurance and the Work Plan for the Adjustment of the National Drug List of Basic Medical Insurance, Work Injury Insurance and Maternity Insurance in 2022, the National Medical Insurance Bureau and Ministry of Human Resources and Social Security organized and formulated the National Drug List of Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (2022) (hereinafter referred to as "2022"). The relevant matters are hereby notified as follows:
First, timely adjust the scope of payment.
In 2022, the drug list included 2967 kinds of western medicine and Chinese patent medicine, including western medicine 1586 kinds and Chinese patent medicine 138 1 kind. In addition, there are 892 kinds of Chinese herbal pieces that can be paid by the fund. All localities should strictly implement the drug list in 2022, and may not adjust the drug varieties, remarks and classification of Party A and Party B in the list by themselves. It is necessary to update the information system and database in a timely manner, include the newly added drugs in this adjustment into the scope of fund payment according to regulations, synchronously transfer the drugs out of the scope of fund payment, maintain them in the intelligent supervision subsystem in time, and strengthen fund supervision.
Second, standardize payment standards.
During the agreement period, the negotiated drugs (hereinafter referred to as negotiated drugs) and competitive drugs shall implement the unified national medical insurance payment standard, and each co-ordination area shall determine its self-payment ratio and reimbursement ratio according to the fund's affordability. For bidding drugs, if the actual market price exceeds the payment standard, the excess shall be borne by the insured; If the actual market price is lower than the payment standard, it shall be shared by the medical insurance fund and the insured according to the actual price. Encourage local medical insurance departments to carry out exploration, give priority to the varieties whose prices are not higher than the payment standard under the generic name of bidding drugs into the scope of designated medical institutions and "dual-channel" pharmacies, support clinical priority use, and reduce the burden on patients.
During the validity period of the agreement, if the negotiated drugs or competitive drugs have specifications not specified in the 2022 Drug Catalogue and need to be included in the scope of medical insurance payment, the enterprise shall apply to the National Medical Insurance Bureau, which will determine the payment standard according to the terms of the agreement and implement it nationwide. During the agreement period, there are drugs with the same general name as those listed in the negotiation, and their online prices shall not be higher than the medical insurance payment standard of the same specification determined through negotiation. The provincial medical insurance department can adjust the medical insurance payment standard of the drug according to the market competition and the price of similar generic drugs. During the agreement period, if the negotiated drugs or competitive drugs are included in the centralized drug procurement organized by the state or government pricing, the provincial medical insurance department may adjust the payment standard of drug medical insurance according to relevant regulations.
If the medical insurance payment standard in the 2022 drug list is marked with "*", the local medical insurance and human resources and social security departments shall not publish their medical insurance payment standards in public documents, news propaganda and other public channels.
Third, solidly promote the listing of drugs.
In 2022, the drug list was officially implemented on March 1 day, 2023 (the new medical insurance payment standard for azifudine tablets and Qingfei Paidu granules in the negotiated drugs was implemented on April 1 day, 2023). "The National Health Insurance Bureau, Ministry of Human Resources and Social Security on the issuance of
Notice (medical insurance [202 1] No.50) shall be abolished at the same time from March12023.
Centralized drug procurement institutions of all provinces, autonomous regions and municipalities directly under the Central Government should directly link and negotiate drugs on the provincial centralized drug procurement platform before the end of February 2023. The online price of negotiated drugs is not higher than the payment standard. Enterprises participating in the catalogue access bidding, within the validity period of the payment standard, the online price of bidding drugs is not higher than the quotation at the time of bidding (specific enterprises, drugs and quotations will be notified separately).
Provincial medical insurance departments should follow the requirements of Guiding Opinions on Establishing and Perfecting the "Dual-channel" Management Mechanism of National Medical Insurance Negotiation Drugs (No.28 of Medical Insurance Fa [2021]) and Notice on Adapting to the Normalization of National Medical Insurance Negotiation and Continuously Doing a Good Job in the Landing of Negotiated Drugs (No.2021]182). Standardize the access procedures of "dual-channel" pharmacies, and further improve the coverage of "dual-channel" pharmacies in rural areas, remote areas and economically underdeveloped areas. Before June 5438+February 3, 20231,all provinces should establish and improve a unified, efficient and standardized prescription circulation mechanism in the province, relying on the national unified medical insurance information platform electronic prescription center, and realize the "dual-channel" prescription circulation in the province. Continue to improve the monitoring mechanism for the landing of negotiated drugs, and regularly report the use and payment of negotiated drugs in the drug list in 2022 to the National Medical Insurance Bureau as required.
Local medical insurance departments shall, jointly with relevant departments, guide designated medical institutions to rationally equip and use drugs in the catalogue, and make reasonable adjustments to their annual total amount in combination with the actual drug use of medical institutions. It is necessary to strengthen the agreement management of designated medical institutions with medical insurance, medical institutions with industrial injury insurance agreements and institutions with industrial injury rehabilitation agreements. It is necessary to incorporate the rational allocation and use of drugs in the drug list in 2022 into the agreement and actively promote the implementation of the new list.
Four, standardize the management of ethnic medicines, medical preparations, Chinese herbal pieces.
The provincial medical insurance departments shall, in accordance with the requirements of the Interim Measures for the Administration of Medication in Basic Medical Insurance, improve procedures, refine standards and make scientific calculations, and include ethnic medicines, preparations of medical institutions and Chinese herbal pieces that meet the clinical needs, reasonable prices and exact curative effects into the scope of fund payment. Conditional areas can simultaneously determine the payment standard of medical insurance. At the same time, establish a dynamic adjustment mechanism to transfer unqualified drugs out of the payment scope in time.
During the implementation of the drug list in 2022, major issues will be reported to the National Medical Insurance Bureau and Ministry of Human Resources and Social Security in time.
Attachment: National Drug List of Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (2022)
First of all, each example
Second, the western medicine part.
Third, the part of Chinese patent medicine.
Four. Drugs negotiated during the agreement period (including competitive drugs)
Verb (abbreviation of verb) Chinese herbal pieces
National Medical Safety Administration (NHSA)
Ministry of Human Resources and Social Security
65438+1October 65438+March 2023