The era of medical insurance access management has arrived, the catalog of consumables has been dynamically adjusted, and many places have clearly supported the entry of new technologies and new consumables into medical insurance.

1. Original, patented and centralized purchasing consumables will be included in the medical insurance catalog with priority

Recently, the Shaanxi Provincial Medical Insurance Bureau issued the "Notice of the Shaanxi Provincial Medical Insurance Bureau on Further Improving the Payment Management of Medical Insurance Medical Consumables" (hereinafter referred to as the "Notice"). It is clarified that the implementation of the access management of the medical insurance medical consumables catalog will be promoted and the province's unified catalog of medical insurance medical consumables will be steadily formulated.

According to the "Notice", the payment management of medical insurance medical consumables must follow four principles: first, ensuring basics, second, encouraging innovation, third, being fair and open, and fourth, dynamic adjustment.

In terms of encouraging innovation, Shaanxi Province specifically proposed that “based on actual clinical needs and taking into account the construction of national and provincial regional medical centers, priority should be given to including original and patented consumables from medical institutions and pharmaceutical consumable companies in the province into the scope of medical insurance payment.”

The document also states that “priority will be given to the consumables selected through centralized mass procurement, consumables that have been included in the medical insurance payment consumables in provinces and cities with the same economic level as our province, and the consumables developed and produced by medical institutions and manufacturing enterprises in the province to be included in the catalog of medical consumables for medical insurance.”

It has been observed that many places have issued documents clearly encouraging innovation in the management of medical insurance payment for consumables.

In July this year, the Shanghai Municipal Medical Insurance Bureau issued the "Working Standards for the Inclusion of Medical Consumables in the Scope of Medical Insurance Payment in Shanghai (Trial)", which also proposed that medical consumables with high clinical value and excellent economic evaluation should be gradually included in the scope of medical insurance payment, with high The level of quality medical protection meets the people’s high-quality medical needs for new technologies and new consumables.

2. The medical insurance catalog of consumables has been unified across the country and promoted intensively in many places.

Nationwide, the unification of the medical insurance catalog of consumables is gradually advancing.

Unlike the pharmaceutical field, the medical insurance catalog of consumables has not yet been unified, and the categories of consumables are complicated. Previously, the names of consumables were not standardized, and the coding methods of various systems were not unified, making management difficult.

After soliciting opinions for many times at the national level, the plan to promote the medical insurance catalog of consumables was formally determined.

According to the "Notice of the National Medical Security Administration on the Management of Payment and Management of Medical Consumables for Basic Medical Insurance" issued in September this year, during the "14th Five-Year Plan" period, the formulation of a unified policy for the entire province (autonomous regions and municipalities) should be completed in accordance with the access law. Basic medical insurance medical consumables catalog. For consumable categories with relatively mature generic name management, the state will gradually formulate a national unified medical insurance catalog and gradually expand the scope of consumable categories covered by the national catalog.

Wang Qiang, a medical device marketing expert, pointed out that the medical insurance catalog of consumables has been advanced for a long time and will be unified at the national and provincial levels in the future. Previously, the consumables catalogs in various places were not unified and difficult to manage. The adjustment cycle of the consumables catalog was very long. Some products that have been gradually phased out by the market are still in the catalog and need to be updated. In the future, the consumables catalog will be dynamically adjusted, some items will be eliminated, and new items will be added in a timely manner.

"Medical insurance access is one of the important links in market access. The new content of the consumables catalog will have a greater impact on related companies. In the process of formulating the catalog, expert opinions are more critical. Experts from major tertiary hospitals will combine it with actual application conditions. We will recommend some projects for inclusion in the catalog. Enterprises can also make suggestions, but whether they will be adopted depends on the actual situation."

It has been observed that at the local level, some regions have launched a unified medical insurance catalog of consumables and implemented access management of the consumable catalog.

For example, Guangdong Province has uniformly implemented the management of diagnostic and treatment items and medical consumables catalog access laws since 2021. In the practice of implementing and revising the medical consumables catalog in the past two years, it has been directly linked to the dynamic maintenance of national medical consumables. At the same time, new medical consumable products will be included in the scope of medical insurance payment according to regulations, and a green channel will be established to ensure that all products are accepted.

In the second half of this year, some regions will continue to promote the establishment of medical insurance catalogs for consumables.

On December 27, the Yunnan Provincial Medical Insurance Bureau began to solicit opinions on the "Yunnan Provincial Basic Medical Insurance Medical Consumables Payment Catalog (2024 Edition)".

On September 30, Jiangxi Province officially implemented the "Jiangxi Province Medical Insurance Medical Consumables Payment Management Catalog (2023)". A total of 3,565 medical consumables with "medical insurance common names" were included in the scope of medical insurance payment, including 223 Category A and 3342 Category B. indivual. It is estimated that after the implementation of Jiangxi's new catalog, the province's average medical insurance reimbursement ratio for medical consumables reached 64.86%, a significant increase from 47.15% before the reform.

With the unification of the medical insurance catalog of consumables, supervision will also be stricter.

The "Notice of the National Medical Security Administration on the Management of Payment and Management of Medical Consumables under Basic Medical Insurance" has made it clear that a monitoring and evaluation mechanism for medical insurance payment must be established.

Each province regularly monitors, compiles, and analyzes the medical insurance access status, medical insurance fund payment status, patient burden, etc. of medical consumables in the province, as well as online procurement status, Internet procurement rate, etc., focusing on high clinical use, large fund consumption, and heavy patient burden. and other medical consumables for monitoring.

With the gradual advancement of the new system, the consumables market will also move towards a new stage of more active and orderly operation.

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