Henan proposes severe and major disease drug reimbursement



Henan province’s Healthcare Security Administration (HHSA) bureau released a notification in relation to severe and major disease drug reimbursement in the outpatient setting. The provincial government makes it clear that drugs involved in the reimbursement drug list (RDL) through national price negotiations will be covered by medical insurance funds under different categories according to use characteristics, use cycle, course expenditure and other factors.

Nationally negotiated drugs for the treatment of cancer, rare diseases and other serious and catastrophic diseases, which are clinically essential, relatively expensive and suitable for outpatient treatment but have proven efficacy and clear indications, will be designated as “outpatient-specific drugs” and managed under one roof. Miglustat and 26 other drugs that went through national price negotiations in 2019 are tentatively designated as such drugs.

The reimbursement scope and conditions for severe and major disease drugs in Henan province, including trastuzumab and eight others, will be adjusted to match national standards.

For drugs not designated “outpatient-specific drugs”, the coordinated areas may, on the premise of securing medical insurance funds and rational medication, involve those eligible in the medical insurance coordinated funds payment through the outpatient special chronic disease treatment channel, or make use of cost controls such as diagnosis related group (DRG)-style payments.

There is no deductible for those insured in Henan who claim reimbursement for outpatient-specific drug expenses involved in the coordinated basic medical insurance funds. Initial out-of-pocket for Class B outpatient-specific drugs is set at 20% across the province.

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