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What are the special drugs for urban and rural residents’ medical insurance?

On December 1, reporters learned from the Jiangxi Provincial Department of Human Resources and Social Security that Jiangxi Province had launched a negotiation mechanism and included five special drugs including imatinib mesylate into medical insurance at group purchase prices for the first time. This move will significantly reduce the medical expense burden of patients insured by medical insurance for major diseases such as leukemia, lung cancer, and breast cancer. The Provincial Department of Human Resources and Social Security issued a notice to remove imatinib mesylate capsules (tablets), pemetrexed disodium for injection, recombinant human intravasostatin injection, trastuzumab for injection and randominib for injection. Five special drugs, including titrexed, are included in the payment scope of the serious illness medical insurance fund for urban employees and urban residents. These drugs come in 5 varieties and 10 specifications, and are mainly used for the treatment of leukemia, lung cancer, breast cancer, etc. The person in charge of the relevant departments of the Provincial Department of Human Resources and Social Security told reporters that these special drugs were originally expensive and were not included in the national medical insurance drug catalog and were self-paid drugs. However, because they are effective and are the first choice drugs for treating serious diseases, patients have to use them, resulting in The burden of medical expenses is heavy. This year, the Provincial Department of Human Resources and Social Security launched the negotiation mechanism for the first time based on fund operation, medical technology development, special needs for disease treatment, etc., and determined the first batch of special drugs to be included in the urban critical illness medical insurance fund for payment in accordance with standard procedures such as expert review and price negotiation. Through negotiations, manufacturers have reduced the medical insurance settlement price of drugs to the lowest in the country, significantly reducing the medical expense burden of insured persons. Take the drug imatinib mesylate for the treatment of leukemia as an example. Patients now spend more than 200,000 yuan a year on the drug out-of-pocket. After being reimbursed through medical insurance, an individual only spends about 60,000 to 70,000 yuan. Starting from January 1 next year, insured persons can purchase these five special drugs by swiping their cards at 24 designated hospitals and 21 designated pharmacies across the province. Each medical insurance agency reimburses drug expenses according to the medical insurance settlement price determined through negotiation, of which 75% is reimbursed for urban employees and 70% for urban residents. The difference between the reimbursement standard and the settlement price shall be borne by the individual insured. If medicines have been provided free of charge by organizations such as foundations or charity federations, neither the critical illness medical insurance fund nor individual patients will pay for special medicines. The medical insurance settlement price already includes hospital drug markups and pharmacy service fees. Designated hospitals and designated pharmacies are not allowed to charge additional fees to individual patients.