Zhejiang Province Including Compound Western Medicine in Basic Payment Area

Business Club August 6th

Municipal, county (city, district) Personnel Labor and Social Security Bureau (Labor and Social Security Bureau), Price Bureau, Jiaxing Social Security Bureau:

In order to safeguard the health protection entitlements of the insured persons, the compound western medicines outside the “Catalogue of Basic Medical Insurance, Industrial Injury Insurance, and Maternity Insurance Drugs of Zhejiang Province” (hereinafter referred to as the “Drug List”) are included in basic medical insurance, industrial injury insurance, and maternity insurance payments. The scope of work is based on the “Notice on Printing and Distributing the National Basic Medical Insurance, Industrial Injury Insurance, and Maternity Insurance Drugs Catalogue” (Ministry of Human Resources and Social Development [2009] No. 159). Now it is included in the basic medical insurance for compound western medicine, The relevant issues regarding the payment coverage of work-related injury insurance and maternity insurance are as follows:

1. Drugs consisting of 2 or more medicines in the "Clinical Drug List", including drug-containing large infusions and compound packaging (hereinafter referred to as "Compound western medicine"), meet the following three conditions, and verify the variety and price of drugs. Afterwards, it can be included in the payment scope of basic medical insurance, work-related injury insurance and maternity insurance in Zhejiang Province:

(1) Compound western medicines whose generic names are not listed in the Drug List;

(2) All independent medicines (hereinafter referred to as component medicines) that make up the compound western medicines, and their generic names and dosage forms have been listed in the "Drug List";

(3) The price of compound western medicine is not higher than the sum of the prices of medicines in the catalogue corresponding to all constituent medicines.

2. Fixed-point medical institutions and pharmaceutical production enterprises can submit composite western medicine materials to the Provincial Department of Human Resources and Social Security, and fill in the “Comprehensive western medicine situation description form” (see the attachment, which can be downloaded from the official website of Zhejiang Human Resources and Social Security Department, Website: WWW.zjhrss.gov.cn), and provide relevant materials such as drug instruction manuals, drug production quality standards, etc., and affix the official seal of the reporting unit; the materials submitted by the designated regional medical institutions shall be coordinated by regional human resources and social security departments. After the collection, it is reported to the Provincial Office of Human Resources and Social Security. The Provincial Department of Human Resources and Social Security is responsible for verifying the varieties and dosage forms of composite western medicines. Provincial Price Bureau is responsible for verifying the prices of composite western medicines. The verification results are announced in the provincial human resources and social security network.

(a) verification of compound western medicine varieties. The generic name of the constituent drugs is determined according to the general name principle of the Drug List. The names of all component drugs should be the same as the generic name of the corresponding drug in the Drug List. If the chemical name of the drug is used, there should be clear evidence that the chemical name and the generic name of the drug in the catalog belong to the same drug. If it is difficult to identify the names of the constituent drugs, experts’ arguments may be organized; if there is a dispute over the identification of generic names, follow the “Notice on Strengthening Departmental Collaboration, Further Regulating the Use of Medicines, and Controlling the Expenses of Pharmaceuticals” (Zhejiang Liezhifa [2006] No. 12). The regulations are dealt with.

(b) Compound western drug-based verification. The dosage form of the compound western medicine should be the same as that of all the medicines in the catalog corresponding to the constituent medicines; the compound medicines belong to the slow-release and controlled-release dosage forms, and the main constituent medicines should be the same dosage form as the corresponding medicines in the catalogue, and the secondary constituent medicines should correspond. The list of drugs can be an immediate release dosage form.

(c) Verification of compound western drug prices. The Provincial Price Bureau verifies the price of compound western medicine, and verifies and publishes the maximum retail price of compound western medicine based on the highest retail price, the retail price of the winning bid, and the quality level of the drug in the catalog corresponding to the constituent drugs.

Third, after the price department verified the price, the province's Human Resources and Social Security Department gave the drug number, which was lower than the corresponding quality level suggested to pay the reference price for compound western medicine, and was included in the basic medical insurance, work injury insurance and maternity insurance payment. The compound western medicine included in the payment scope shall be paid according to the basic medical insurance category B drugs after the centralized bidding and procurement of the drugs, and the proportion of the individual self-care shall be executed with reference to the ratio of the self-care agents of the same type of drug as the main constituent drugs; the limited payment scope shall be principally composed of the drugs in principle. The limited payment provisions are enforced. The main component drug of compound western medicine is the category A antimicrobial drug. The limited payment is in principle implemented according to the limited payment of the same type B drug, and the specific payment regulations are issued together with the verification opinion.

IV. All co-ordinating regions shall strengthen the management of compound western medicines according to the verification results of compound western medicines promulgated by the Department of Human Resources and Social Security of the province, determine the proportion of self-care of compound western medicines in a timely manner, and ensure the rights and interests of the insured personnel; the medical insurance agency It is necessary to update the medical insurance information management system drug database in time, strengthen the price review of compound western medicine, ensure reasonable and timely payment of related expenses; fixed-point medical institutions should consciously abide by the various regulations of western medicine, strengthen the internal management of medicines and prices, and rationally use drugs. Reasonable treatment.

5. This notice shall be implemented from October 1, 2010. The drug-containing large infusions that have been included in the payment scope should be submitted to the Provincial Office of Human Resources and Social Security before December 31, 2010 for review. The drug-containing infusions that have not been reviewed since January 1, 2011 will be related to medical insurance suspension. cost. If there are problems in the implementation of the various localities, please contact the Medical Insurance Department of the Provincial Human Resources and Social Security Office.

Zhejiang Human Resources and Social Security Department

July 28, 2010

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