On November 5, the Information Office of the Shandong Provincial People's Government held a press conference on improving the outpatient medication guarantee mechanism for hypertension and diabetes for urban and rural residents.

It was learned from the press conference that the cost of blood pressure-lowering and hypoglycemic drugs incurred in outpatient clinics of medical institutions for patients with "two diseases" will be included in the payment scope of the medical insurance overall fund, and the payment ratio within the scope of the policy must reach more than 50%.

The Shandong Provincial Medical Insurance Bureau, together with the Provincial Department of Finance, the Health Commission, and the Food and Drug Administration, issued the "Implementation Plan for Improving the Outpatient Drug Guarantee Mechanism for Hypertension and Diabetes for Urban and Rural Residents" to deploy and improve the outpatient drug guarantee mechanism for "two diseases" for urban and rural residents.

The plan determines that the protection targets are urban and rural residents who suffer from "two diseases" and have been diagnosed and confirmed by first-level and above medical institutions, excluding urban employees, in order to be more in line with the actual situation of rural work in our province.

In addition, the plan requires that drugs for lowering blood pressure or blood sugar in outpatient clinics for patients with "two diseases" shall be based on the varieties listed in the new version of the national basic medical insurance drug catalog and the transitionally reserved varieties in our province. Priority shall be given to Category A drugs in the catalog, national essential drugs, and those that have passed the consistency test.

The varieties evaluated, centralized procurement and use of pilot projects will be expanded to include selected drugs.

In order to formulate a reasonable level of protection, the plan proposes that the payment ratio of drug costs within the scope of the policy shall not be less than 50%; the threshold and ceiling lines shall be set by each city based on the fund's affordability and the outpatient drug use of "two diseases".

The institution does not set a deductible, but can set a cap line based on disease types; for patients with hypertension, diabetes, and those taking insulin treatment, the cap line can be appropriately raised to reduce their medication burden.

After the policy implementation of this plan, the province's urban and rural residents' medical insurance fund will increase its expenditure by more than 3 billion yuan, and related expenditures will increase by another 10%. Therefore, all localities are required to strengthen the implementation of supporting policies while also doing a good job in risk prevention and control.

In order to implement the program policy, it is also necessary to connect it with the existing outpatient security policy to ensure that the treatment level of the people is not reduced, and to ensure that the "two diseases" outpatient medication policy is consistent with the current outpatient coordination policy, outpatient chronic diseases (special diseases) and hospitalization

The guarantee policies must be organically connected.