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北京医保报销药品明起增513种

2017-08-31 09:51:25   新华网

近年来,北京不断完善门诊特殊病政策,将门诊特殊病范围从最初的3种扩充到9种。据市人社局相关负责人介绍,此次纳入报销范围的36种谈判药品中,大部分是需要长期门诊治疗、费用较高的药品,年均治疗费用在7万元到10万元左右,患者普遍反映负担较重。

“这次对门诊特殊病的调整,调整1种,增加2种,就是为了回应群众关切。”这位负责人介绍,以治疗乳腺癌的靶向药“曲妥珠单抗(赫赛汀)”为例,国家谈判前年均药品费用23万多元,谈判后年均药品费用约9万,纳入门诊特殊病报销后退休人员个人负担约为1万元。

同时,治疗“多发性硬化”的靶向药“重组人干扰素β-1b(倍泰龙)”,国家谈判前年均药品费用近15万,谈判后年均药品费用约10.6万,纳入门诊特殊病报销后退休人员个人负担约为1.2万元,大大减轻了患者的医疗费用负担。

据测算,此次门诊特殊病政策调整将为大病患者减轻医疗费用负担约3.5亿元。

“门诊特殊病”如何按住院比例报销?

  360天内只收取一个起付线

 ■ 释疑

对于在职职工,北京市门诊报销起付线为1800元,住院第一次报销的起付线为1300元,且门诊和住院的报销比例也不一样。

北京市在职职工在门诊医院的报销比例为70%,而如果符合11种特殊病范围,参保职工的报销将全部按照住院报销的起付线和报销比例报销。在职职工在三级医院,扣除起付线外,花费4万以上的医疗费用,报销比例可达到95%。

“‘门诊特殊病’外,参保人员按住院报销的结算周期是90天。90天内,第一个起付线的标准是1300元。如超过90天的周期,就要按第二次起付线‘650元’的标准,再计算一个起付线标准。”市人社局医保处相关负责人解释。

不过,如果符合11种特殊病范围,参保职工按照住院报销的结算周期则为360天,在360天内只收取一个起付线。“也就是说,只要超过了1300元,在360天的结算周期里,都可以按住院比例报销,不再另计算起付线。”这位负责人解释。

“门诊特殊病”如何走完备案流程?

 在医院“一站式”完成备案

在门诊特殊病审批流程简化之前,参保人员需经过就诊医院领取申报审批单、医生签字,参保单位盖章以及区医保经办机构办理审批等多个环节,参保人员普遍反映手续复杂、办理时间长,加之患特殊病的参保人员健康状况欠佳,往返奔波很不便。

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