Interim Measures for the Administration of Use of Drugs Covered by the Basic Medical Insurance
Interim Measures for the Administration of Use of Drugs Covered by the Basic Medical Insurance
Interim Measures for the Administration of Use of Drugs Covered by the Basic Medical Insurance
Order of the National Healthcare Security Administration No.1
July 30, 2020
The Interim Measures for the Administration of Use of Drugs Covered by the Basic Medical Insurance, which were deliberated and adopted at the executive meetings of the National Healthcare Security Administration, are hereby issued and shall come into force as of September 1, 2020.
Hu Jinglin, Director
Interim Measures for the Administration of Use of Drugs Covered by the Basic Medical Insurance
Chapter I General Provisions
Article 1 These Measures are hereby formulated in accordance with the Social Insurance Law of the People's Republic of China and other laws and regulations as well as the Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Healthcare Security System in order to advance the building of a healthy China, meet the basic demand of the insured for drugs, manage the use of drugs covered by the basic medical insurance in a more scientific and thoughtfully-designed manner, improve the use efficiency of the basic medical insurance fund, and promote the modernization of governance system and governance capacity.
Article 2 These Measures shall apply to the determination of and adjustment to the scope of the drugs covered by the basic medical insurance by healthcare security departments at all levels, as well as the payment, administration and supervision of the use of drugs covered by the basic medical insurance.
Article 3 The scope of drugs covered by the basic medical insurance shall be administered through the Catalog of Drugs Covered by the Basic Medical Insurance (the "Drug Catalog"). Expenses of drugs in compliance with the Drug Catalog shall be paid from the basic medical insurance fund in accordance with the state provisions. The Drug Catalog shall be managed by generic name, and drugs with the same generic names as those specified on the Drug Catalog shall automatically fall within the payment scope of the basic medical insurance fund.
Article 4 The administration of the use of drugs covered by the basic medical insurance shall adhere to the people-centered development philosophy, and effectively guarantee the reasonable demands of the insured for drugs; adhere to the functional positioning of "guaranteeing the basics" by doing everything within capacity to enable the level of guaranteeing use of drugs to be compatible with the affordability of the basic medical insurance fund and the insured; adhere to hierarchical management with responsibilities and authority of all levels clarified; adhere to expert review and adapt to the advancement of clinical technology to achieve scientific, standardized, refined and dynamic management; and adhere to the equal emphasis on Chinese and western medicines to give full play to their respective advantages.
Article 5 The Drug Catalog consists of five sections, respectively, explanatory notes, western drugs, Chinese patent drugs, negotiation-based drugs within an agreed period, and traditional Chinese medicine ("TCM") decoction pieces. The drugs supplemented by provincial healthcare security administrative departments shall be separately listed in accordance with state provisions. To maintain the safety of clinical drugs and improve the use efficiency of the basic medical insurance fund, the Drug Catalog limits the medical insurance-based payment conditions for some drugs.
Article 6 The administrative department for healthcare security under the State Council is responsible for establishing a management system for the use of drugs covered by the basic medical insurance, formulating and adjusting the scope of drugs covered by the basic medical insurance nationwide, the principles, conditions, standards and procedures of the use and payment, organizing the formulation, adjustment and promulgation of the national Drug Catalog, preparing a unified health insurance code, and administering and supervising the use of drugs covered by the basic medical insurance nationwide. The national healthcare security agency is entrusted by the administrative department for healthcare security under the State Council to organize and implement the adjustment to the national Drug Catalog.
Provincial healthcare security administrative departments are responsible for administering the use of drugs covered by the basic medical insurance in its administrative region, formulating the administrative policies and measures for the use of drugs covered by the basic medical insurance in the region, and supervising and implementing the Drug Catalog. All provinces (autonomous regions and municipalities directly under the Central Government) shall, based on the national Drug Catalog and in accordance with the adjustment authority and procedures prescribed by the state, include the eligible ethnic drugs, preparations of medical institutions, and TCM decoction pieces in the provincial medical insurance-based payment scope, which shall be implemented after being filed with the administrative department for healthcare security under the State Council for the record in accordance with the provisions.
Healthcare security departments of all pooling regions shall be responsible for implementing the Drug Catalog and relevant policies, auditing, supervising and administering the use of drugs covered by the medical insurance by designated medical institutions according to medical insurance agreements, promptly clearing and paying medical insurance costs in accordance with the provisions, and for the relevant statistical monitoring, information reporting, etc.
Chapter II Formulation and Adjustment of the Drug Catalog
Article 7 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, and these drugs shall also satisfy basic conditions, such as being indispensable in clinical treatment, safe and effective, and priced reasonably.
......
Order of the National Healthcare Security Administration No.1
July 30, 2020
The Interim Measures for the Administration of Use of Drugs Covered by the Basic Medical Insurance, which were deliberated and adopted at the executive meetings of the National Healthcare Security Administration, are hereby issued and shall come into force as of September 1, 2020.
Hu Jinglin, Director
Interim Measures for the Administration of Use of Drugs Covered by the Basic Medical Insurance
Chapter I General Provisions
Article 1 These Measures are hereby formulated in accordance with the Social Insurance Law of the People's Republic of China and other laws and regulations as well as the Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Healthcare Security System in order to advance the building of a healthy China, meet the basic demand of the insured for drugs, manage the use of drugs covered by the basic medical insurance in a more scientific and thoughtfully-designed manner, improve the use efficiency of the basic medical insurance fund, and promote the modernization of governance system and governance capacity.
Article 2 These Measures shall apply to the determination of and adjustment to the scope of the drugs covered by the basic medical insurance by healthcare security departments at all levels, as well as the payment, administration and supervision of the use of drugs covered by the basic medical insurance.
Article 3 The scope of drugs covered by the basic medical insurance shall be administered through the Catalog of Drugs Covered by the Basic Medical Insurance (the "Drug Catalog"). Expenses of drugs in compliance with the Drug Catalog shall be paid from the basic medical insurance fund in accordance with the state provisions. The Drug Catalog shall be managed by generic name, and drugs with the same generic names as those specified on the Drug Catalog shall automatically fall within the payment scope of the basic medical insurance fund.
Article 4 The administration of the use of drugs covered by the basic medical insurance shall adhere to the people-centered development philosophy, and effectively guarantee the reasonable demands of the insured for drugs; adhere to the functional positioning of "guaranteeing the basics" by doing everything within capacity to enable the level of guaranteeing use of drugs to be compatible with the affordability of the basic medical insurance fund and the insured; adhere to hierarchical management with responsibilities and authority of all levels clarified; adhere to expert review and adapt to the advancement of clinical technology to achieve scientific, standardized, refined and dynamic management; and adhere to the equal emphasis on Chinese and western medicines to give full play to their respective advantages.
Article 5 The Drug Catalog consists of five sections, respectively, explanatory notes, western drugs, Chinese patent drugs, negotiation-based drugs within an agreed period, and traditional Chinese medicine ("TCM") decoction pieces. The drugs supplemented by provincial healthcare security administrative departments shall be separately listed in accordance with state provisions. To maintain the safety of clinical drugs and improve the use efficiency of the basic medical insurance fund, the Drug Catalog limits the medical insurance-based payment conditions for some drugs.
Article 6 The administrative department for healthcare security under the State Council is responsible for establishing a management system for the use of drugs covered by the basic medical insurance, formulating and adjusting the scope of drugs covered by the basic medical insurance nationwide, the principles, conditions, standards and procedures of the use and payment, organizing the formulation, adjustment and promulgation of the national Drug Catalog, preparing a unified health insurance code, and administering and supervising the use of drugs covered by the basic medical insurance nationwide. The national healthcare security agency is entrusted by the administrative department for healthcare security under the State Council to organize and implement the adjustment to the national Drug Catalog.
Provincial healthcare security administrative departments are responsible for administering the use of drugs covered by the basic medical insurance in its administrative region, formulating the administrative policies and measures for the use of drugs covered by the basic medical insurance in the region, and supervising and implementing the Drug Catalog. All provinces (autonomous regions and municipalities directly under the Central Government) shall, based on the national Drug Catalog and in accordance with the adjustment authority and procedures prescribed by the state, include the eligible ethnic drugs, preparations of medical institutions, and TCM decoction pieces in the provincial medical insurance-based payment scope, which shall be implemented after being filed with the administrative department for healthcare security under the State Council for the record in accordance with the provisions.
Healthcare security departments of all pooling regions shall be responsible for implementing the Drug Catalog and relevant policies, auditing, supervising and administering the use of drugs covered by the medical insurance by designated medical institutions according to medical insurance agreements, promptly clearing and paying medical insurance costs in accordance with the provisions, and for the relevant statistical monitoring, information reporting, etc.
Chapter II Formulation and Adjustment of the Drug Catalog
Article 7 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, and these drugs shall also satisfy basic conditions, such as being indispensable in clinical treatment, safe and effective, and priced reasonably.
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