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The National Health Insurance Administration and the Ministry of Human Resources and Social Security issued the “Catalogue of Drugs for National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance” and the “Catalogue of Innovative Drugs for Commercial Health Insurance”. Among them, it is proposed to strengthen the management of the scope of medical insurance payments. Strictly implement the requirements of the “Interim Measures on the Administration of Medication Use in Basic Medical Insurance”. Payments can only be made if the diagnosis and treatment are consistent with the condition, the indications in the legal instructions for the drug and the scope of medical insurance payment restrictions. The scope of medical insurance payment is not an amendment to the legal instructions for drugs. Clinicians use medication rationally according to the patient's condition and are not affected by the limited scope of payment. Where the scope of medical insurance payment is simplified, the legal instructions for the drug shall prevail. All regions can regularly collect feedback from management agencies and designated medical institutions on the scope of medical insurance payments, and the National Health Insurance Administration will actively promote the interpretation of the scope of medical insurance payments.

Zhitongcaijing·12/07/2025 04:17:01
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The National Health Insurance Administration and the Ministry of Human Resources and Social Security issued the “Catalogue of Drugs for National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance” and the “Catalogue of Innovative Drugs for Commercial Health Insurance”. Among them, it is proposed to strengthen the management of the scope of medical insurance payments. Strictly implement the requirements of the “Interim Measures on the Administration of Medication Use in Basic Medical Insurance”. Payments can only be made if the diagnosis and treatment are consistent with the condition, the indications in the legal instructions for the drug and the scope of medical insurance payment restrictions. The scope of medical insurance payment is not an amendment to the legal instructions for drugs. Clinicians use medication rationally according to the patient's condition and are not affected by the limited scope of payment. Where the scope of medical insurance payment is simplified, the legal instructions for the drug shall prevail. All regions can regularly collect feedback from management agencies and designated medical institutions on the scope of medical insurance payments, and the National Health Insurance Administration will actively promote the interpretation of the scope of medical insurance payments.