Chronic disease diabetes subsidy policy

It covers both employees and residents. After the chronic disease qualification is determined, the cost of conventional anti-diabetic drugs and related complications treatment can be reimbursed at a rate of 50%-80% within the annual limit. In most areas, the annual reimbursement amount ranges from 3,000 yuan to 8,000 yuan. The policies of different coordinating areas vary greatly.

I helped my second uncle from my hometown in Shandong apply for this application last year. He is covered by urban and rural residents' medical insurance and has had type 2 diabetes for almost six years. It used to cost more than 200 yuan a month to buy medicine. After receiving the chronic disease subsidy, regular drugs such as insulin aspart and metformin are reimbursed, and the monthly out-of-pocket payment is only more than 40 yuan, which saves more than 2,000 yuan a year. To put it bluntly, this chronic disease qualification certificate opens an exclusive medical insurance reimbursement channel for patients with diabetes. The reimbursement amount is much higher than that of ordinary outpatient clinics, and the ratio is also more cost-effective.

At this point, some people may ask, why can’t you report so much where you are? This is normal. After all, diabetes chronic disease subsidies are coordinated at the municipal level, and the policies vary greatly from place to place. A diabetes patient I know who is covered by employee medical insurance in Shanghai has mild diabetic peripheral neuropathy. The local annual reimbursement limit can reach 12,000, and the reimbursement ratio is 70%. In addition to anti-diabetic drugs, methylcobalamin and neurotrophic drugs can also be subsidized, and the self-paying drug cost is just over a thousand dollars a year. But a fellow villager I met at a free clinic in Yunnan was not so lucky. He paid for the local residents’ medical insurance. He had been diagnosed with diabetes for three years but had no complications. The local requirement requires at least one clear diabetes complication to apply for chronic disease subsidies. He was not able to apply for the chronic disease subsidy. He could only go to the general outpatient clinic for reimbursement. The annual limit is only 1,000, which is not enough.

In fact, there are a lot of controversies about chronic disease subsidies for diabetes. The most prominent one is the issue of recognition threshold. The medical insurance department has its own considerations: According to internal calculations in the medical insurance system, if all patients diagnosed with diabetes across the country were included in the scope of chronic disease subsidies, the medical insurance fund would have to spend at least 30 billion yuan more every year. For some underdeveloped areas where medical insurance co-ordination funds are already tight, the pressure is indeed not small, so many places will use "complications" as the entry threshold, giving priority to patients with more severe conditions. However, the feedback from the clinical side is just the opposite. Many endocrinologists have made a calculation: if hypoglycemic drugs are reimbursed for people with diabetes without complications, each person will only need to spend a few hundred yuan more per year. However, if the reimbursement is delayed until complications such as kidney disease, foot disease, cardiovascular and cerebrovascular disease occur, the per capita annual expenditure will rise to tens of thousands of yuan, which will consume more medical insurance funds, which is equivalent to "saving a small amount of money and spending a lot of money." In the past two years, the National Medical Insurance Administration has also issued documents to encourage various regions to relax standards. More than a dozen provinces, including Zhejiang and Guangdong, have included simple type 2 diabetes in the scope of subsidies, and you can apply without waiting for complications.

Another point of contention is the scope of reimbursement. Subsidies in most areas now only cover conventional oral hypoglycemic drugs, human insulin, and analogues, such as GLP-1 receptor agonists, which have become popular in recent years, and consumables for dynamic blood glucose monitoring (such as instantaneous probes). Most areas have not been included in the subsidy catalog. Pharmaceutical companies and some clinical experts have been calling for its inclusion, saying that such drugs and consumables can help patients better control their sugar, reduce the probability of long-term complications, and save medical insurance funds in the long run. ； However, calculations by the medical insurance department show that the current price of this type of product is still high. If fully included, the funds in some coordinating areas may not be able to support it. Currently, only a few economically developed areas are including it on a pilot basis, and patients in ordinary areas still have to pay for it themselves.

Let me talk about my little experience after going to the window several times. When applying, don’t just bring the blood sugar test form of the current month. It is best to bring the medical records and medication prescription list of the past three months. It would be safer if you have a diagnosis certificate or hospitalization summary from a second-level hospital or above, so as to avoid traveling back and forth. Nowadays, in many places, you can submit materials through the medical insurance app without having to go to the government service center. The results will be available within 3-7 days after uploading. After that, you can directly use your medical insurance card to buy medicines in designated hospitals and pharmacies, and you will be automatically reimbursed for subsidies. There is no need to pay separately and go through the process.

Anyway, my impression after contacting them is that the diabetes subsidy policy has indeed become more relaxed in the past two years. Last year, several provinces also included GLP-1 hypoglycemic drugs in the scope of reimbursement, which is a real benefit for people with diabetes who need to use such drugs. If you have someone with diabetes at home, you might as well take the time to open the official account of the local medical insurance bureau to check the latest policies. You may be able to save a lot of money on medicines.