National medical insurance bureau： preventive vaccine is not included in basic medical insurance
Yangcheng Evening News Reporter Chen Hui reports: On July 31st, the National Medical Insurance Bureau announced the Interim Measures for the Administration of Medication in Basic Medical Insurance (hereinafter referred to as the Measures). The "Measures" clarified eight categories of drugs that are not included in the basic medical insurance, including drugs that mainly play a nourishing role, drugs containing national precious and endangered wild animals and plants, preventive vaccines and contraceptives. The Measures shall come into force as of September 1, 2020.
8 kinds of drugs are not included in the Catalogue of Drugs for Basic Medical Insurance.
The "Measures" clarify that eight types of drugs are not included in the "List of Drugs for Basic Medical Insurance" (see chart for details).
Drugs in the Drug List will be directly transferred out of the Drug List after expert review in any of the following circumstances: 1. Drugs whose drug approval documents have been revoked, revoked or cancelled by the drug regulatory authorities; 2 drugs listed in the negative list by the relevant departments; 3. Drugs whose risks outweigh the benefits after comprehensive consideration of clinical value, adverse reactions, drug economy and other factors; 4. Drugs that enter the Drug List through fraud and other illegal means; 5 other circumstances stipulated by the state that should be directly transferred out.
"Preventive vaccines are not included in basic medical insurance" was clarified last year.
The news that preventive vaccines are not included in basic medical insurance has attracted attention. The reporter learned from relevant parties that in fact, as early as April last year, when the National Medical Insurance Bureau made a policy interpretation of the Work Plan for the Adjustment of the National Medical Insurance Drug List in 2019, it was clear that public health drugs such as preventive vaccines could not be included in the catalogue.
The interpretation of the National Medical Insurance Bureau pointed out: "According to the functional orientation of the medical insurance system and the basic principles of medical insurance drugs, some drugs cannot be included in the catalogue: for example, drugs that mainly play a nourishing role, drugs containing endangered wild animals and plants, preventive vaccines and contraceptives, and drugs used for weight loss, beauty, smoking cessation, etc. Some of these are to improve the quality of life, some are preventive, and some are within the scope of public health protection, and they are not included in the scope of catalogue adjustment. "
It is understood that according to China’s relevant laws and regulations, vaccines are divided into two categories: the first category of vaccines refers to vaccines provided by the government to citizens free of charge, and citizens should be vaccinated according to government regulations, such as national immunization standard vaccines; The second kind of vaccine refers to other vaccines that citizens vaccinate at their own expense and voluntarily. Last year, Shang Ruifen, a deputy to the National People’s Congress, suggested that "Class II" vaccines should be included in medical insurance reimbursement. In this regard, the National Medical Insurance Bureau replied in September last year that according to the Social Insurance Law, the medical expenses that should be borne by public health are not included in the payment scope of the basic medical insurance fund, so projects such as disease prevention and control including vaccines should be solved through public health service channels. The National Medical Insurance Bureau also said that judging from the overall development of the medical insurance system at this stage, the people’s demand for disease treatment, and the financing level and anti-risk ability of the medical insurance fund, the current basic medical insurance system mainly focuses on meeting the basic medical needs, and has no ability to expand the scope of payment to include non-therapeutic and preventive items such as the second-class vaccine.