The new drug list includes 36 newly negotiated drugs, of which 15 is a targeted drug for the treatment of malignant tumors. It covers lung cancer, liver cancer, breast cancer, kidney cancer and other malignant tumor diseases. Targeted therapy drugs have good therapeutic effect and high price.
The compensation ratio is as follows:
1. Before the targeted drug therapy for malignant tumor is donated by charity, 35% will be paid by urban basic medical insurance pooling fund, 35% by large medical insurance for urban workers and 35% by serious illness insurance for urban residents.
2. The cost of targeted drug treatment for malignant tumors paid within one year shall not exceed the annual maximum payment limit. If it is approved to transfer to designated medical institutions outside the district for targeted drug treatment of malignant tumors, the reimbursement ratio will be reduced by 5% from the overall fund on the basis of the original reimbursement standard.
What are targeted drugs?
For ordinary drugs, usually only a very small part can really act on the lesion after entering the body. This is the fundamental reason that restricts the curative effect of drugs and leads to the toxic and side effects of drugs. It is a human dream and the ultimate goal of drug development to obtain drugs with precise targeting ability like missiles.
Targeted drugs refer to drugs or their preparations endowed with targeting ability. Its purpose is to make drugs or their carriers target specific lesion sites and accumulate or release effective components at the target sites. Targeted preparation can make the drug form a relatively high concentration in the target site, thus improving the curative effect, inhibiting side effects and reducing the damage to normal tissues and cells.
Legal basis:
People's Republic of China (PRC) social insurance law
Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment. Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.