Interim Measures for the Administration of Use of Drugs Covered by the Basic Medical Insurance (revised in 2020)
ISSUING AUTHORITY:
National Healthcare Security Administration
DATE OF ISSUANCE
July 30, 2020
EFFECTIVE DATE:
September 1, 2020
On July 30, 2020, the National Healthcare Security Administration promulgated the Interim Measures for the Administration of Use of Drugs Covered by the Basic Medical Insurance (“Interim Measures”), which took effect from September 1, 2020.
The major highlight for the insured in the Interim Measures is that it clarifies the drugs that are not included in the Drug Catalog (i.e. drugs which are mainly nourishing in function; drugs containing national precious and endangered wild animal and plant medicinal materials; health care drugs; preventive vaccines and contraceptives, etc.). In addition, the Interim Measures set standards for the inclusion and exclusion of drugs from the Drug Catalog; for instance, Article 7 provides that the drugs included in the national Drug Catalog shall be chemical drugs, biological products, and Chinese patent medicines (ethnic drugs) that have been granted the registration certificates upon approval of the national drug regulator, as well as TCM decoction pieces that are prepared based on the national standard prescriptions. The article also states that these drugs shall also satisfy basic conditions, such as being indispensable in clinical treatment, safe and effective, and priced reasonably. Article 9 and Article 10 directly stipulate that drugs in the Drug Catalog shall and may be excluded from the Drug Catalog after expert review under certain circumstances (i.e. drugs whose approval certificates have been withdrawn, revoked or cancelled by drug regulatory authorities etc. shall be excluded. Drugs with obviously high prices or costs in the same treatment field without reasonable reasons, etc. may be excluded).
With regard to the medical insurance payment methods, the Interim Measures specifies Western medicine and Chinese patent drugs in the national Drug Catalog shall be divided into "drugs of Class A"[1] and "drugs of Class B"[2]. The expenses for "drugs of Class A" used by the insured shall be paid according to the payment standards and sharing measures stipulated for basic medical insurance, while those for "drugs of Class B" shall be first paid by the insured in a certain percentage, and then paid according to the sharing measures stipulated for basic medical insurance.
Reference:
[1]"Drugs of Class A" are drugs which are necessary for clinical treatment, are widely used, have a definite effect, and have a lower price or treatment cost among similar drugs.
[2] "Drugs of Class B" are drugs which may be selected for clinical treatment, have definite effect, and have a slightly higher price or treatment cost than "drugs of Class A" among similar drugs. Negotiation-based drugs within an agreed period are included in the "drugs of Class B" for administration.
