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Municipal Medical Insurance Bureau regulates payment management of special drugs

Reduce the cost burden of patients with serious illness

Tianmen.com (All media reporter Xie Hongyan correspondent Zou Chonggao) On the 26th, the reporter learned from the Municipal Medical Security Bureau that the Bureau issued the "Detailed Implementation Regulations on the Payment Management of Special Medicines for Basic Medical Insurance in Tianmen City" in August this year to regulate the management of special medicine payments and reduce The burden of expenses for patients with serious illnesses. As of now, the bureau has accepted 1,186 applications for reimbursement for special drugs, and the reimbursement expenses are 4,474,500 yuan.
The "Detailed Rules" specify that the protection object for special drugs is patients who participate in our city's basic medical insurance and who normally enjoy the benefits of basic medical insurance. The city implements the "three fixed" management of special medical institutions, fixed physicians, and retail pharmacies for special drugs. The city's first people's hospital is designated as a special medical use designated medical institution, and more than 40 senior medical institutions are selected by the hospital. Physicians with technical titles and good medical ethics serve as responsible physicians for special drugs, and select retail pharmacies with full preparations and good reputation as the designated supply units for special drugs. Insured patients can be reimbursed according to the process after the special drug qualification is filed for inpatient or outpatient use; for patients who have lived in a different place for a long time, the cost of purchased medicines can be returned to the city with regular invoices and other materials.
In addition, the "Detailed Rules" stipulates that the cost of special medicines is not included in the calculation range of in-patient medicines in designated medical institutions and the per capita inpatient cost assessment indicators to ensure that anticancer drugs "have entered the medical insurance and also entered the hospital", allowing insured patients to buy I get, use, and get reimbursed, and I really enjoy the dividends of medical insurance reform.
At present, the city has included 57 special drugs into the basic medical insurance coverage, covering non-small cell lung cancer, breast cancer, colorectal cancer, lymphoma, acute leukemia, hemophilia and other major diseases.

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