The medical insurance reimbursement conditions of pabolizumab are mainly determined according to the national and local medical insurance policies. Generally speaking, medical insurance reimbursement must meet the following main conditions: first, the patient must be diagnosed as a disease that meets the indications of pabolizumab; Secondly, pabolizumab must be the basic drug in the patient's treatment plan; Thirdly, patients need to receive treatment in medical institutions designated by medical insurance and issue corresponding invoices and prescriptions for medical expenses; Finally, patients need to complete the relevant reimbursement procedures in accordance with the medical insurance policy.

I. Indications of diseases

Pabolizumab, as an immunotherapy drug, is mainly used to treat a variety of malignant tumors. Therefore, patients first need to be diagnosed as diseases that meet the indications of pabolizumab. This usually requires professional doctors to make comprehensive judgments based on the patient's medical records, examination results and clinical manifestations.

Second, the necessity of treatment plan

Pabolizumab must be used as part of the treatment plan. The doctor will comprehensively consider whether to use Pabolizumab according to the patient's condition, physical condition, treatment expectation and other factors. Pabolizumab will be included in the treatment plan only when it is confirmed that the drug has a significant therapeutic effect on patients and other alternative drugs cannot meet the treatment needs.

Three, designated medical institutions and prescriptions

When receiving treatment, patients need to go to the designated medical institutions for medical insurance. These medical institutions usually have cooperative relations with the medical insurance department and can provide medical services for patients in accordance with the medical insurance policy. At the same time, patients need to issue corresponding invoices and prescriptions for medical expenses at the time of seeing a doctor as the basis for subsequent reimbursement.

Fourth, reimbursement procedures.

After the patient completes the treatment, he should go through the relevant reimbursement procedures in accordance with the medical insurance policy. This usually includes submitting medical expense invoices, prescriptions, medical records and other related materials to the medical insurance department for review. After approval, patients can enjoy the corresponding medical insurance reimbursement treatment.

To sum up:

The medical insurance reimbursement conditions of Pabolizumab mainly include: the patient is diagnosed as a disease with drug indications, Pabolizumab is the basic drug in the treatment plan, the patient receives treatment in the designated medical institution of medical insurance and issues relevant invoices and prescriptions, and the patient completes the reimbursement procedures according to the medical insurance policy. Only when these conditions are met can patients enjoy the medical insurance reimbursement treatment of pabolizumab.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28 provides that:

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

"Implementation Opinions on Improving the Dynamic Adjustment Mechanism of Drug List of Basic Medical Insurance"

It clearly States:

For drugs with high clinical value, obvious benefit to patients and excellent economic evaluation, the transfer standard can be relaxed. At the same time, for varieties with uncertain curative effect and easy clinical abuse, bring up the catalogue.