The new catalogue of medicines, which is the basis and standard for health insurance reimbursement, has been released, the range of medicines used has been expanded as appropriate, and municipalities will establish their own out-of-pocket rates of medicines based on the catalogue. On 18 august, journalists were informed by the provincial human resources and social security office that my province had developed a directory of medicines for basic health insurance, industrial injury insurance and maternity insurance in shandong province (2010 edition) (hereinafter referred to as the medicines directory). The medicines catalogue was implemented on 1 september, with a one-month transition period, after which the former shandong province basic medical insurance and industrial injury insurance catalogue (2005 edition) ceased to be used。
The new catalogue expands the range of drugs used
The directory of medicines has been appropriately expanded and improved in the light of advances in clinical medicine science and technology and changes in the demand for medicines by participants. Journalists were informed that the medicines catalogue is divided into west, chinese medicine and chinese tablets. Of these, 1241 western medicines were approved for payment by the basic health insurance, employment injury insurance and maternity insurance fund, 1099 for chinese medicine and 47 for ethnic medicine; only 23 western medicines were granted for payment by the industrial injury insurance fund; and only four western medicines were granted for payment by the maternity insurance fund。
The tablets listed in the chinese tablets are those that are not covered by the basic health insurance, industrial injury insurance and maternity insurance funds, including 127 and one category. The costs of work injury insurance and maternity insurance medicines are paid irrespective of category a and b。
The rate of out-of-pocket contributions is set by the municipality as appropriate
In response to the new directory of medicines, journalists consulted the aoshima city human resources and social security board. The staff members concerned indicated that they had not received notification from the provincial department, but that, based on past experience, the directory of medicines could not be increased or decreased, but that the specific out-of-pocket ratio was set by aoshima itself。
Shandong province requires that the a drugs in the medicines catalogue be paid in the co-ordinated areas in accordance with the basic health insurance provisions and that no separate individual out-of-pocket ratio be set. Under the fund's affordability, a certain individual contribution rate can be set, followed by the basic health insurance. National medicine and chinese tablets are still being implemented in accordance with existing policies。
Chinese generic name to protect against disguised price increases
In order to strengthen the administration of essential health insurance medicines, provincial departments will as soon as possible establish a province-wide database of essential health insurance medicines. This adjustment to the medicines catalogue is based on the 2009 national directory of medicines and the 2005 provincial directory of medicines. No further adjustments have been made to the 2009 version of the national medicines directory. For drugs transferred, materials are drawn from the relevant databases of the ministry of human welfare, the provincial price authority and the provincial food and drug supervisory authority, which do not receive a declaration from the enterprise, do not repeat the tests, and do not charge assessment fees and other fees to the pharmaceutical production and distribution enterprises。
At the same time, the revised catalogue uses a chinese generic name, which cannot be qualified by trade name, and the non-payment of participants ' fees on the grounds that the drug database is not up to date, in order to prevent confusion over the price of the drug, thereby preventing the use of a different name to increase prices。
People's access to medication is restricted
There are some medicines in the medicines catalogue that are covered by payment, even if they are different from the same pharmaceutical formulation type. For example, amocilin, which is also part of the western medicine, has no restriction on the use of the oral chronice, while the oral liquids and granules are intended only for children and people who are in difficulty of swallowing。
Therefore, people must be careful to use restrictions when using medicines in order to avoid non-reimbursement. For example, the “remarks” column, in which the word “” is marked, is used by participants in basic health insurance when hospitalized by the general fund for basic health insurance and by personal accounts when used in outpatient clinics. Employment injury insurance and maternity insurance medicines are not subject to this restriction. Medicines labelled “pregnancy-limit insurance” are those that are only paid for by the maternity insurance fund。
