Schlagwort: ‘Reimbursement’
Beijing: promoting policies on long-term prescriptions for outpatient chronic disease patients
On March 6th, the Beijing Municipal Medical Security Bureau issued the “Implementations on Promoting Long-Term Prescriptions for Outpatient Chronic Disease Patients.” The Implementation required that community healthcare institutions should purchase and store common medications for chronic diseases that are always available in tertiary hospitals, as well as provide long-term prescription services by ensuring drug safety. Secondary and tertiary hospitals are encouraged to send medical data for their patients with chronic diseases such as diabetes and hypertension to community healthcare institutions where contracted family doctors work, thereby providing these patients with ongoing health management services. Online treatment and online billing of medical insurance should be promoted, and medical institutions are encouraged to deliver drugs to the homes of the elderly and other mobility-impaired people. The reimbursement policy was changed so that insured persons do not have to pay 10% of the drug price upfront when they purchase drugs from community healthcare institutions. Manufacturers in Beijing are encouraged to alter packaging specifications, ensuring that drug packages for chronic diseases meet patients’ needs by being multiples of the seven-day dosage.
北京：切实推进门诊慢性病长处方政策落实若干措施
来源：医药网 2024.03.06
3月6日，北京市医疗保障局发布《关于切实推进门诊慢性病长处方政策落实的若干措施》。《措施》提出，社区卫生服务机构应对照三级医疗机构慢性病常用药品品种规格做好相应的药品采购和储备，在保证用药安全的前提下，提供处方延续服务；支持将二、三级医疗机构诊断的高血压、糖尿病患者信息数据推送至其健康档案或签约家庭医生所在地社区卫生服务机构，方便为患者提供连续性健康管理服务；加快推进线上诊疗和线上医保支付，鼓励医疗机构为老年患者等行动不便者提供送药上门服务；参保人员在社区卫生服务机构就诊取药的，研究调整部分药品报销政策，取消10%个人先行负担比例；鼓励北京市药品上市许可持有人调整药品包装规格，变更慢性病药品包装规格为7天用量的倍数，以满足临床实际需求。
NHSA: launching intelligent supervision system for medical insurance fund
On September 13th, the National Healthcare Security Administration (NHSA) issued the “Notification on Deepening the Intelligent Audit and Monitoring of the Medical Insurance Fund.” The Notification stated that by the end of 2023, all medical insurance coordination regions should launch intelligent supervision sub-systems, and audit and monitoring data should be accurately uploaded to the national medical insurance information platform, thereby achieving the “one network” of intelligent monitoring of the national medical insurance fund. The Notification indicates that these intelligent supervisory sub-systems of designated medical institutions should be interconnected.
医保基金“安全”保障新手段！智能监管系统年底前上线
来源：医药网 2023.09.14
9月13日，国家医保局印发《关于进一步深入推进医疗保障基金智能审核和监控工作的通知》。《通知》明确，到2023年底前全部医保统筹地区应上线智能监管子系统，将审核和监控数据准确上传国家医保信息平台，初步实现全国医保基金智能监控“一张网”。《通知》提出，鼓励定点医疗机构对接各地智能监管子系统。
NHSA: new feature for checking the supply of reimbursed drugs
Recently, the National Healthcare Security Administration’s (NHSA) official WeChat account introduced a feature for searching for medical institutions supplied with reimbursed drugs. After entering the drug name on the search page, the insured person can see information about the insurance payment standard and how long this drug will be on the reimbursement list. In addition, insured person can also check the stock status of the required drugs in local designated medical institutions and retail pharmacies.
国家医保局“功能上新” “国谈药”配备机构有哪些？
来源： 医药网 2023.09.06
日前，国家医保局微信公众号开通“国谈药”配备机构查询功能。参保人员在查询页面输入药品名称后，可看到医保支付标准、药品协议有效期的信息。此外，参保人员人员还可查询到所需药品在各地的定点医疗机构及定点零售药店的储备情况。
NHSA: releasing the “Standards of the Contract Renewal of Reimbursed Drugs”
Recently, the National Healthcare Security Administration (NHSA) adjusted and released the “Standards of the Contract Renewal of Reimbursed Drugs,” which clarified the adjusted payment standards covering the entire life-cycle of drugs: A drug that has been on the reimbursement list for 8 years will stay on the list permanently; the price reduction of a reimbursed drug would be halved if this drug has been on the reimbursement list for more than 4 years and the price reduction is triggered by contract renewal or additional indications for this drug; innovative drugs, biological goods, and traditional Chinese medicines that have already been approved by the Measures for the Administration of Drug Registration can renew the contract through renegotiations with the state if the price reduction is triggered.
基本覆盖药品全生命周期 国家医保局发布谈判药品续约规则
来源：广东省人民政府 2023.07.24
国家医保局日前对《谈判药品规则续约》进行调整完善并发布，明确建立基本覆盖药品全生命周期的支付标准调整规则：对达到8年的谈判药纳入常规目录管理；对未达8年的谈判药，连续协议期达到或超过4年的品种以简易方式续约或新增适应症触发降价的，降幅减半；对于按照现行注册管理办法批准的1类化药、1类治疗用生物制剂，1类和3类中成药，在续约触发降价机制时，可以申请以重新谈判的方式续约。
NMPA: 16 measures for health insurance services
On June 17, the NMPA released a “Notification on the Implementation of Sixteen Measures for Health Insurance Services.” Eight of them concern cross-provincial billing of medical costs. The Notification calls for the use of electronic health insurance IDs for medical treatment and drug purchases, so as to realize that insured residents can visit a doctor and buy medicines simply by scanning the QR code on this e-ID instead of holding a physical card or by using their face ID.
与你有关！16项医保服务便民措施来了
来源：医药网 2023.06.19
6月17日，国家医保局发布了《关于实施医保服务十六项便民措施的通知》。《通知》中有八项涉及跨省异地就医直接结算。《通知》要求，要在全国范围内推动实现医保电子凭证在就医购药全流程应用，实现医保参保人员不需要持实体卡，仅凭医保电子凭证二维码或刷脸就可以看病买药。
Anhui: measures for prescription sharing
Recently, the Anhui Provincial Health Insurance Bureau, Anhui Provincial Health Commission, and Anhui Provincial Bureau of Pharmaceutical Supervision released the “Plan on Promoting the Application of the E-Prescription Sharing Platform.” The Plan proposes establishing a provincial E-Prescription Sharing Platform and connecting it to medical institutions’ HIS systems, retail pharmacies’ drug management systems, and health insurance billing systems. Medical institutions should take the initiative to upload e-prescriptions to this platform. Pharmacies should dispense drugs and handle insurance-based drug purchases based on the above interconnected systems. The Plan also suggests exchanging information among insured residents, Internet hospitals, and designated retail pharmacies through data sharing between national and Anhui provincial medical insurance information platforms and online drug purchase platforms. This creates a cycle where hospitals create e-prescriptions, insured residents purchase pharmaceuticals online, pharmacists check prescriptions online, pharmacies dispense drugs, and medical insurance settles medical bills online.
安徽省医保局发文，处方流转难题可解！
来源：医药网 2023.06.07
近日，安徽省医保局、安徽省卫健委、安徽省药监局三部门联合印发《关于推进医保电子处方流转应用工作的实施方案》。《方案》提出，应建设全省统一的电子处方流转平台，并实现该平台与医疗机构HIS系统、零售药店药品管理系统和医保结算系统的互联互通。医疗机构应主动上传电子处方至电子处方流转平台。药店应依据上述互联系统提供配药和医保结算服务。《方案》提出，通过国家、安徽省医疗保障信息平台与线上购药平台的数据共享，使参保人员、互联网医院与定点零售药店实现信息互通，实现医院开具电子处方、参保人员在线购药、药师在线审方、药店实施配药、医保在线结算的全流程服务。
NMPA: encouraging the reimbursement of payments incurred at designated retail pharmacies by medical insurance
On February 15th, the NMPA published a “Notification on Reimbursement of Payments incurred at Designated Retail Pharmacies by Medical Insurance companies.” The Notification states that the integrated fund will pay the costs incurred by insured persons when purchasing drugs that are included in the national reimbursement drug list at designated retail pharmacies based on prescriptions from designated medical institutions. The Notification clarifies that the implementation of the electronic prescription center should be accelerated by relying on the national unified health insurance information platform to achieve a smooth flow of electronic prescriptions from designated medical institutions to designated retail pharmacies. The designated medical institutions can issue long-term prescriptions for eligible patients for up to 12 weeks.
国家医保局：支持定点零售药店开通门诊统筹服务
来源：医药网 2023.02.17
2月15日，国家医保局印发《关于进一步做好定点零售药店纳入门诊统筹管理的通知》。《通知》明确参保人员凭定点医疗机构处方在定点零售药店购买医保目录内药品发生的费用可由统筹基金按规定支付。《通知》明确要依托全国统一的医保信息平台，加快医保电子处方中心落地应用，实现定点医疗机构电子处方顺畅流转到定点零售药店。定点医疗机构可为符合条件的患者开具长期处方，最长可开具12周。
Shandong: Using medical insurance to purchase drugs online
Recently, the first batch of designated pharmacy branches in Shandong began offering “Buying Drugs Through Medical Insurance” service in Alipay. An insured person can use Alipay to search for “Buying Drugs Through Medical Insurance,” select drugs or pharmacy branches marked “Available to Reimbursement,” and then pay for their drugs online using their medical insurance. Ele.me will deliver drugs in a short period of time following a successful payment.
外卖购药，可以刷医保卡啦！
来源：大众日报 2021.12.29
近期，山东省首批试点定点零售药店在支付宝开通“医保买药”服务。参保市民可通过支付宝搜索“医保买药”，选择有“医保支付”标识的品种或药店下单，在线医保支付。支付成功后，由“饿了么”平台提供即时配送服务。
“Dual-Channel Policy” for Medicines under National Medical Insurance Negotiation
Recently, the NMPA and the National Health Commission jointly issued the “Opinions on Establishing and Improving Dual-Channel Management Mechanisms for Medicines under National Medical Insurance Negotiation”. According to the “Opinions”, the reasonable usage of these reimbursed drugs, such as supply and clinical use, will be met through two channels, namely designated medical institutions and designated retail pharmacies, with drug payment covered by the medical insurance payment mechanism. Eligible designated retailed pharmacies should be connected to the Medical Insurance Information Platform and the Electronic Prescription Sharing Platform, and a compliant storage and distribution system should be established to ensure drug safety.
医保药品可“双通道”购买
来源：中华人民共和国中央人民政府 2021.05.11
近期，国家医保局会同国家卫健委出台了《关于建立完善国家医保谈判药品“双通道”管理机制的指导意见》。《意见》提出，将通过定点医疗机构和定点零售药店两个渠道满足医保谈判药品供应保障、临床使用等方面的合理需求，并同步纳入医保支付；符合纳入“双通道”管理的定点零售药店要与医保信息平台、电子处方流转平台等对接，并建立符合要求的储存、配送体系，确保药品质量安全。
Medical Reform involving all urban employees
Recently, the State Council issued the “Opinions on Improving the Mutual-Aid Mechanism for Covering Outpatient Bills in the Employed Medical Insurance System.” According to the “Opinion”, employees’ medical insurance premiums paid by their employers should be consolidated into a fund that can cover outpatient bills to improve the Mutual-Aid Mechanism. The “Opinion” clarifies that individual insurance accounts can be used to pay for the medical cost incurred by the insured person, his or her spouse, parent and children at designated medical institutions, as well as the cost incurred by the insured person for the purchase of drugs, medical equipment and medical devices at designated retailed pharmacies.
涉及3亿多参保人，这项医保改革有哪些重点？
来源：医药网 2021.04.23
日前，国务院办公厅印发《关于建立健全职工基本医疗保险门诊共济保障机制的指导意见》。《意见》提出，将单位缴纳的医疗保险费全部计入统筹基金，并将门诊费用纳入统筹基金支付范围，健全门诊共济保障机制。 《意见》明确，个人账户可以用于支付参保人员本人及其配偶、父母、子女在定点医疗机构就医发生的由个人负担的医疗费用，以及在定点零售药店购买药品、医疗器械及医用耗材发生的由个人负担的费用