The Beijing Municipal Medical Insurance Bureau has announced the initiation of pilot work aimed at enhancing access to drugs from the National Reimbursement Drug List (NRDL). This program involves 23 designated medical institutions within the city, chosen for their high outpatient volumes and low procurement of national negotiation drugs, which will serve as “dual channel” management pilots.
Dual Channel Management Pilots
The bureau will designate one retail pharmacy near each of the selected medical institutions to supply nationally negotiated drugs. These pharmacies will enter into a drug supply agreement with the medical institutions, ensuring a streamlined process for drug distribution. These designated retail pharmacies will provide essential nationally negotiated drugs that participating medical institutions may temporarily lack, allowing patients to purchase these drugs using external prescriptions issued by doctors, with drug expenses being settled in accordance with NRDL regulations.
Unified Payment Standards and Reimbursement Process
Nationally negotiated drugs will have unified payment standards and prices across pilot medical institutions and pharmacies. Insured individuals will be able to present their prescriptions at the designated pharmacy to purchase medication, with the individual’s portion paid directly and the remaining expenses settled between the medical insurance agency and the pharmacy.
Hospitalization and Reimbursement
During hospitalization, insured individuals will purchase nationally negotiated drugs at the designated pharmacy, with initial expenses being advanced by the insured or the pilot medical institutions. These pilot institutions will then reimburse the individual’s advances, and the discharge settlement will follow the regulations of basic medical insurance.
Budget Management and DRG Exemptions
The incremental costs of nationally negotiated drugs for pilot medical institutions and pharmacies will be settled separately outside the hospital budget. Nationally negotiated drugs may be exempted from DRG calculations under specific conditions, including new generic drugs/medical devices approved within three years, drugs with significant functional or indication changes due to increased efficacy, and medical devices that can be charged separately due to price adjustments within three years.
Feedback Mechanism and External Prescriptions
Pilot medical institutions are required to provide timely feedback to pharmacies regarding the temporary unavailability of nationally negotiated drugs needed for clinical purposes. Pharmacies, in turn, must provide these drugs promptly according to the institutions’ needs. The pilot medical institutions will maintain records of nationally negotiated drugs in their hospital’s HIS system, ensuring that doctors can issue external prescriptions as needed when insured patients seek treatment.-Fineline Info & Tech
