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Notice on matters related to the implementation of the National Drug Catalogue for Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (ZMIIF [2019] No. 26)

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Zhejiang Provincial Medical Security Bureau Zhejiang Provincial Human Resources and Social Security Department on the implementation of National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug List" related matters notice

Medical Insurance Bureau and Human Resources and Social Security Bureau of each city, county (city, district).


     In order to implement the National Health Insurance Bureau and the Ministry of Human Resources and Social Security's Notice on the Issuance of the National Drug Catalogue for Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (Medical Insurance Fa [2019] No. 46), the Notice on the Adjustment and Standardization of Some Drug Names, etc. of the National Drug Catalogue for Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (Medical Insurance Fa [2019] No. 64) and the Notice on the Inclusion of the 2019 Negotiated Drugs in the National Drug Catalogue for Basic Medical Insurance, Work Injury Insurance and Maternity Insurance 2019 negotiated drugs into the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug List" category B notice (Medical Insurance Fa [2019] No. 65) requirements, now on the relevant matters are as follows.


     First, the province's basic medical insurance, work injury insurance and maternity insurance unified implementation of the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug List (2019 Edition)" (hereinafter referred to as the "National Drug List"), the drugs listed in the National Drug List are included in the scope of payment of the basic medical insurance, work injury insurance and maternity insurance fund of Zhejiang Province in accordance with the provisions. Simultaneous implementation of the "notice on the adjustment of the standardization of the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug List" part of the drug names, etc.
       

       Second, the state through negotiations into the basic medical insurance, industrial injury insurance and maternity insurance fund payment range of 97 drugs, in accordance with the agreement period in accordance with the relevant provisions of class B drugs, the strict implementation of the national unified limited payment range and payment standards. For patients who have started to use the national negotiated access in 2017 before December 31, 2019 and failed to successfully renew the contract in 2019 negotiations, a transition period has been formulated, which will last until June 30, 2020. The health insurance fund can continue to pay during the transition period, while the designated medical institutions are instructed to replace the treatment drugs in due course.


       In accordance with the payment standard for direct antiviral (DAA) drugs for hepatitis C included in the 2019 national negotiations, the payment standard for hepatitis C by disease as stipulated in the Notice on the Payment of Outpatient Medical Expenses for Hepatitis C (Antiviral Treatment) by Disease for Basic Medical Insurance (ZMHI Union Issue [2019] No. 3) will be adjusted to 19,000 yuan.


          Third, stop paying for the drugs deleted during the adjustment of the National Drug Catalogue. The first batch of deleted drugs will stop being paid from January 1, 2020, in accordance with the national requirements for the gradual digestion of drugs in category B that have been added to the original provincial drug catalog in accordance with the regulations. The first batch of deleted drugs will cease to be paid from January 1, 2020. If the state provides otherwise, it will follow its provisions.


              Fourth, the province of Chinese medicine from the "National Drug Catalog" listed in the beverage and "basic medical insurance, work injury insurance and maternity insurance in Zhejiang Province, the classification of the management of Chinese medicine beverage catalog (for trial implementation)" listed in the beverage combined implementation. Stop paying for the Chinese medicine beverages listed in the "National Drug Catalogue" that will not be paid. Chinese medicine tablets and Chinese medicine formula granules are cancelled for categorical management, no personal self-care ratio is set, and the scope of payment for Chinese medicine formula granules is still implemented according to the current policy.


         Fifth, Class A drugs do not set a personal self-care ratio, paid by the basic medical insurance fund in accordance with the provisions, Class B drugs can set a certain personal self-care ratio, paid by the basic medical insurance fund in accordance with the provisions. Municipal medical security departments in accordance with the requirements of the municipal coordination, combined with the affordability of medical insurance funds and management requirements, the development of a unified category B drugs self-care ratio, and reported to the provincial medical security bureau for the record. Worker's compensation insurance and maternity insurance payment of drugs does not distinguish between category A and category B.


           Sixth, the provincial medical security bureau in accordance with the national medical insurance information standardization work deployment, the establishment of the province's unified drug database, the realization of western medicine, Chinese medicine, Chinese medicine, hospital preparations of the code unified management, around the drug database should be completed in a timely manner to update the maintenance work.


        Seventh, medical security departments at all levels to take effective measures to protect the supply of drugs in the catalog, be sure to do a good job of negotiating the supply and rational use of drugs. Encourage the designated retail pharmacies to provide drugs for the insured, play an active role in the supply of medical insurance drug security.     


   Eighth. Medical insurance departments at all levels should strictly follow the management regulations of the National Drug Catalogue and the prescription management methods, clinical technical operation specifications, clinical diagnosis and treatment guidelines and guidelines for clinical application of drugs formulated by relevant departments, improve the intelligent monitoring system, strengthen the management of drug payments, and include the implementation of the use of the National Drug Catalogue by designated pharmaceutical institutions into the management and assessment of designated service agreements.


        Ninth. This notice shall be formally implemented from January 1, 2020. The Notice on the Implementation of the <National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug List (2017 Edition)> and Other Related Matters (Zhejiang Human Resources and Social Security Development [2017] No. 100) is also repealed.

Zhejiang Provincial Medical Security Bureau     Zhejiang Provincial Department of Human Resources and Social Security   

        December 27, 2019