Is "weight loss miracle drug" included in medical insurance or not? Detailed explanation from the National Medical Insurance Administration

2024-04-17

As spring approaches, the weight loss industry has been put on the agenda by many friends. A drug called "Smegglutide" is highly sought after by many beauty enthusiasts. So, as a drug that has already been launched in China, has Smegglutide been included in medical insurance? Recently, the National Health Insurance Bureau released relevant information on its WeChat official account. As a drug that has already been launched in China, has Smegglutide been included in medical insurance? Undoubtedly, Smegglutide Injection has indeed been covered by medical insurance. The 2023 edition of the National Medical Insurance Drug Catalogue contains 3088 drugs, covering over 90% of the drug usage in public hospitals nationwide. Among them, there are 7 hypoglycemic drugs that belong to the category of glucagon like peptide-1 (GLP-1) receptor agonists. These drugs stimulate insulin secretion in a glucose dependent manner to lower blood sugar, and Smegglutide Injection is one of them. In December 2017, the drug was approved by the US FDA for "blood glucose control in adult type 2 diabetes patients", and in 2020, the FDA further approved "for adult type 2 diabetes patients with cardiovascular disease to reduce the risk of related diseases". Thanks to the annual adjustment mechanism of the national medical insurance drug catalog, the above two indications of Smegglutide Injection were approved in China in April 2021 and included in the national medical insurance catalog through negotiations that year, with prices less than one tenth of those in the United States. According to statistical data, from January to February 2024 alone, Smegglutide was reimbursed by more than 700000 people nationwide through medical insurance. Coupled with negotiation and medical insurance reimbursement factors, the burden of medication on patients has been greatly reduced. Since it has been included in medical insurance, does it mean that weight loss can also be reimbursed by medical insurance? In order to promote the construction of a healthy China, ensure the basic medication needs of insured individuals, and improve the scientific and refined management level of basic medical insurance medication, the National Medical Insurance Administration issued the "Interim Measures for the Administration of Medication in Basic Medical Insurance" in 2020, which clearly stipulates that there are 8 types of drugs that cannot be reimbursed by medical insurance. The drugs that mainly enhance sexual function, treat hair loss, weight loss, beauty, quit smoking, and alcohol are one of the categories that can improve living conditions. Not only our country, but also some other countries have similar regulations. The reason for doing so is to protect and make good use of everyone's "life-saving money". The employee medical insurance fund is mainly paid by employers and individual employees, and two-thirds of the resident medical insurance fund comes from financial subsidies. Every penny is hard won and must be used to treat diseases and save people. Everyone can understand it this way: if a drug's main function is to lose weight, medical insurance will definitely not report it. If it can both treat illness and lose weight, the indication for treating illness may be reimbursed by medical insurance, but the indication for losing weight must not be reported by medical insurance. For example, although Lilalutide injection, which is similar to Smeaglutide, has been approved by China's drug regulatory authorities for weight loss, the 2023 version of the National Medical Insurance Drug Catalog stipulates that it can only be reimbursed when it is used to treat adult type 2 diabetes. Similarly, the payment scope of Smeglutide injection is limited to two cases related to adult type 2 diabetes. That is to say, weight loss is not within the scope of payment, and medical insurance cannot be reimbursed. If you lie that you have diabetes or give your medical insurance card to someone with diabetes

Edit:GuoGuo    Responsible editor:FangZhiYou

Source:People.cn

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