What is “NHI (the national health insurance) drug price standard not listed”?

Did you notice that the box says that the drug price standard is not listed?
Drugs that are not listed in the drug price standard are drugs that are not listed in the drug price standard.

NHI drug price standard and insurance medical treatment VS NHI drug price standard not listed and free medical treatment
The drug price standard is the item of medicines that can be used for insurance medical treatment and their prices set by the Minister of Health, Labor and Welfare.
(Common to medical insurance systems such as health insurance, national health insurance, and various mutual aid systems)
Currently, about the items (listed in the drug price standard) notified in the official bulletin as ethical drugs used for insurance medical treatment at medical institutions, etc. There are about 16,000. The drug price standard defines drugs that can be used in insurance medical care, and has a function as an item list. When an insurance medical institution or an insurance pharmacy makes an insurance claim, the drug fee is based on the price specified in the drug price standard. Calculate. Of these, drugs that have new indications and effects, whose efficacy and safety have been confirmed by clinical trials (clinical trials), etc., and have been approved are called “generic drugs”, and after the patents for the original drugs have expired. , A drug that has the same ingredients and specifications as the original drug and is approved as being therapeutically equivalent is called a “generic drug” (so-called generic drug).

Having an approval / permit number means that it has been approved by the Pharmaceuticals and Medical Devices Agency and the Ministry of Health, Labor and Welfare. If it is approved but the drug price standard is not set, it means that it is not covered by insurance. Among the prescription drugs, contraceptive agent to become off the subject of drug price standards listed, ED treatment agent , male pattern baldness treatment agent , in addition to the radioactive removal agent, contains, such as vaccines. In other words, even if an insurance medical institution prescribes a drug (not listed in the drug price standard) for ED treatment or AGA treatment, it will not be covered by insurance .

As an exception, even if the drug is approved as a generic drug, there are generic drugs that are not subject to calculation such as addition in medical fees if the drug price is the same as or higher than that of the original drug. In addition, even if it is a “generic drug with a generic drug”, if it is the same amount as the generic drug or the drug price is low, it is treated as a “generic drug with a generic drug” that is not subject to calculation such as addition in medical fees.

reference

Sales of drugs not listed in the NHI drug price standard
(April 1, 1976) (Pharmacist No.327)
( Notice to the Governor of each prefecture, Director of the Pharmaceutical Affairs Bureau, Ministry of Health and Welfare) (April 1, 1976) ( Yakuhin No.
326 ) (Notice of Director of Pharmaceutical Affairs Bureau, Ministry of Health and Welfare to Chairman of Japan Pharmaceutical Association, Federation of Japan Pharmaceutical Wholesalers, Japan Pharmaceutical Association)

It is well known that drugs not listed in the NHI price standard cannot be used in insurance medical care under the current system. Of course, even if these drugs are approved for manufacture under the Pharmaceutical Affairs Law, they can be sold legally under the same law, but under such a medical insurance system, Depending on the sales method of the drug manufacturer, importer / distributor or distributor (hereinafter referred to as “pharmaceutical manufacturer / distributor”), it is possible that the insurance medical institution may be misunderstood. As a manufacturer and distributor of pharmaceutical products, it is necessary to strictly refrain from such sales methods. As shown in the attached copy today, we have just notified the related organizations about this, but even if you are in your position, let the drug manufacturers and distributors fully understand the purpose of the drug price standard system, and sell drugs that are not listed in the drug price standard. In this case, a method that may be misleading, such as clearly indicating that the drug is an unlisted drug by displaying it on the container, encapsulation, etc. of the drug in the future, and giving an explanation that is contrary to the facts. We ask for your further cooperation in the guidance so that it will not be sold by.

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