What drugs can be reimbursed, and what is the difference between Class A and Class B? This query entry has been added and launched ->Catalog | Drugs | Query
In order to further provide more convenient medical insurance directory drug query service for the insured, the WeChat official account of the National Medical Insurance Bureau is currently online with the national basic medical insurance drug directory query function on the basis of the previous query entry such as the State Council client applet.
What medications can be reimbursed?
In order to ensure the basic medical needs of insured persons and standardize the management of basic medical insurance drugs, the country has formulated a list of basic medical insurance drugs. The medical expenses incurred by insured individuals in designated medical institutions that comply with the medical insurance drug catalog shall be paid by the medical insurance fund in accordance with regulations.
Since its establishment in 2018, the National Medical Insurance Administration has established and improved a dynamic adjustment mechanism for the list of medical insurance drugs. The list of medical insurance drugs should be adjusted once a year in principle, and drugs that meet basic conditions such as clinical necessity, safety and effectiveness, and reasonable prices should be included in the list of medical insurance drugs.
At present, there are 2967 kinds of Chinese and western medicines and traditional Chinese patent medicines and simple preparations in the 2022 Drug Catalogue, including 1586 kinds of western medicines and 1381 kinds of traditional Chinese patent medicines and simple preparations. In addition, there are 892 types of traditional Chinese medicine decoction pieces that the fund can pay for.
Which drugs are not included
National Medical Insurance Drug Catalogue?
Medicines that mainly have a nourishing effect;
Medicines containing precious and endangered wild animal and plant medicinal materials from the country;
Health drugs;
Preventive vaccines and contraceptives;
Medicines that mainly enhance sexual function, treat hair loss, lose weight, improve beauty, quit smoking, quit alcohol, and other effects;
Drugs that cannot be charged separately due to being included in the diagnosis and treatment program or other reasons;
Wine preparations, tea preparations, various fruit flavored preparations, oral administration and oral effervescent agents, etc;
Other drugs that do not comply with the basic medical insurance medication regulations.
In the reimbursement category
What do Class A and Class B mean?
Class A drugs refer to drugs that are necessary for clinical treatment, widely used, have definite therapeutic effects, and have lower prices or treatment costs among similar drugs. When insured individuals use such drugs, they can be fully included in the reimbursement scope, and then reimbursed according to the prescribed proportion. Class B drugs refer to drugs that are available for clinical treatment, have definite therapeutic effects, and have slightly higher prices or treatment costs than Class A drugs among similar drugs. When insured individuals use such drugs, they need to pay a certain proportion of their own expenses, and the remaining amount will be included in the reimbursement scope, and then reimbursed according to the prescribed proportion.
How to search for drug information in the medical insurance catalog?
Take the new WeChat official account query portal of the National Health Insurance Administration as an example:
Step 1: enter the WeChat official account of the "National Medical Insurance Bureau", click WeChat Service → National Medical Insurance Drug Directory Query to enter the query page.
Step 2: Enter the specific drug name, click search to learn detailed information such as whether the drug is within the scope of the medical insurance directory, the classification of the drug, and the specific reimbursement category.
You can also select "Drug Classification" or "Medical Insurance Reimbursement Category" to filter according to your own needs.