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The National Medical Insurance Administration recently issued the Notice on Doing a Good Job in the Payment and Management of Medical Consumables for Basic Medical Insurance, clarifying that for consumables categories with more mature generic name management, a unified national medical insurance catalogue will be gradually formulated, and the scope of consumables covered by the national catalogue will be gradually expanded.

The notice clarifies the scope of consumables included in medical insurance payment, strengthens the linkage between medical service price items and medical consumables payment management, and gradually includes disposable medical consumables that are not included in the price composition of medical service items into the scope of medical insurance payment management according to regulations. Medical consumables that are not of high clinical value in principle, whose price or cost far exceeds the affordability of the fund and patients, as well as non-therapeutic rehabilitation devices, shall not be included in the scope of medical insurance payment.

In terms of strengthening access to medical insurance, the notice clarifies that all provinces will adopt standardized review procedures, include eligible medical consumables in the catalogue according to procedures, encourage priority to include selected consumables in centralized procurement that comply with the current payment policy into the catalog, and explore access to exclusive or high-value products through negotiation.

At the same time, the notice clearly states that it is necessary to establish and improve the dynamic adjustment mechanism, timely supplement necessary new technology products, withdraw from clinical trials can be better replaced, poor economic evaluation, listed by relevant departments in the negative list, and other products that do not meet the requirements of medical insurance.

In order to promote more scientific and refined payment policies, the circular requires the gradual elimination of more extensive payment policies such as segmented payment based solely on cost levels, one-size-fits-all fixed or limited payments, and each coordinating region can set an advance payment ratio for some medical consumables with higher prices or costs according to the actual situation. Provinces are encouraged to explore the formulation of medical insurance payment standards for medical consumables, which can be dynamically adjusted.

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