News from our newspaper (Reporter Yang Xujun) Starting today, the new version of the medical insurance drug catalog has been officially launched. 119 drugs have been added to the catalog, 29 are recalled, and 17 types of outpatient special diseases have reached the city’s urban employees, urban and rural residents, etc. The burden of seeing a doctor will be further reduced.
"The information system of the whole hospital has been successfully switched. Patients can go to the medical insurance consultation window on the first floor of the hospital to learn about the latest situation." said Nie Guangmeng, director of the medical insurance office of Beijing Tsinghua Chang Gung Memorial Hospital. In order to allow patients to enjoy the latest medical insurance reimbursement policies, the hospital procurement department The Pharmaceutical Sunshine Purchasing Platform obtains the drugs involved in the medical insurance catalog in a timely manner, and checks the price information; the price office and the pharmacy department updated the drug prices and medical insurance benefits according to the price changes, and everything is currently operating normally.
In this adjustment, all the 119 drugs added by the state have been included in the city's medical insurance drug list, and the prices of many drugs that are necessary for clinical treatment of cancer, chronic diseases, and children's diseases have been greatly reduced.
Take the psoriasis biologic drug interleukin 17A inhibitor as an example. Before the medical insurance catalogue was adjusted, according to the estimation of two injections per month during the maintenance period, the patient's annual treatment cost was more than 70,000 yuan. After being included in the medical insurance reimbursement, it fell to about 6,000 yuan per year. The burden on patients is greatly reduced.
"Among the successfully negotiated drugs in the country, Beijing Tsinghua Chang Gung Memorial Hospital involved a total of 33 product regulations, and the average price drop reached 45%," Nie Guangmeng introduced.
In addition, after this adjustment, there are 17 types of special diseases in outpatient clinics in Beijing. For patients with serious illnesses who require long-term outpatient treatment and higher costs, the burden of drug costs will be greatly reduced.
According to relevant policies, outpatient special diseases and related medical expenses incurred in outpatient treatment are reimbursed in accordance with the hospital reimbursement ratio and reimbursement standards, and only one deductible line is charged within 360 days.
In this regard, Nie Guangmeng explained that patients with 17 types of outpatient special diseases need to find a relevant doctor to open an outpatient special disease application form, and then take the medical insurance card and application form to the medical insurance consultation window to complete the relevant procedures to obtain the outpatient special disease status.
From the completion of the first outpatient special disease settlement, the next 360 days will be a settlement cycle. During the settlement period, the outpatient treatment of related diseases will be incurred and the hospitalization reimbursement standard will be implemented.
"According to the current Beijing medical insurance policy, the outpatient deductible line is 1,800 yuan, the capped line is 20,000 yuan, and the settlement cycle is one year; the inpatient deductible line is 1,300 yuan, and the capped line is 500,000 yuan, and the settlement cycle is calculated in a single time. In other words, the reimbursement level for special diseases in outpatient clinics is calculated as hospitalization, and when approaching the outpatient clinic in the settlement cycle, the people really enjoy the benefits.” Nie Guangmeng said.
It is worth noting that in the adjustment of the medical insurance catalogue, the outpatient special disease "idiopathic pulmonary fibrosis anti-fibrosis treatment" is adjusted to "pulmonary interstitial disease anti-fibrosis treatment", which broadens the scope of disease adaptation and benefits patients more many. "However, at present, a special outpatient disease can only be filed in one hospital. If you change the hospital for treatment, you need to cancel the previous hospital and file again." Nie Guangmeng reminded.