Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE

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204 Special Solidarity Fund KCE Reports 133 9.17.2 France The assessment of the cases is based on telephone interviews with experts and desk research. The desk research consisted from an in-depth analysis of the Nomenclature database, available at www.ameli.fr. This database contains all products and services that are reimbursed under the Assurance Maladie Obligatoire. The Excel sheet uses the Codification language which is used by the French nomenclature of Medicines, Products and Services. The nomenclature distinguishes between: • CIP codes (Club Inter Pharmaceutique), which reflect the Marketing Authorisation of a specific medicine and ensure the traceability of drugs. CIP codes, consisting from 7 numbers, are administered by the Club Inter Pharmaceutique and the AFSSAPS. CIP codes can be further split up between: o Drugs, for which only so-called collectivités (hospitals, residential homes for the elderly…) are recognized agents; o Drugs, that are remboursable aux assurés sociaux and/or agree aux collectivités. • UCD codes (Communes de Dispensation Utilisées à l’hôpital) are only attributed to medicines that are used within hospitals or other health institutions. The UCD codification is still in use as the exchange standard regarding reimbursements of services (tarification à l’activité, T2A) and so-called rétrocession (medicines that are prescribed and purchased intra muros for patients that are not hospitalized). In case of rétrocession, the costs of drugs are not charged on the hospital budget. Also UCD codes are being developed and administered by the CIP.
KCE Reports 133 Special Solidarity Fund 205 Name Active substance Indication CIP UCD Source Adagen Pegademase bovine a type of SCID (severe combined immunodeficiency syndrome) caused by the chronic deficiency of the adenosine deaminase (ADA) enzyme Vidaza Azacitidine myelodysplastic syndrome Kuvan sapropterin dihydrochloride Cellcept Mycophenolate mofetil phenylketonuria (PKU) - tetrahydrobiopterin defiency auto immunology diseases - neophrotic syndromegreffe pulmonaire-greffe des ilots de Langhermans Mabthera Rituximab Heamatologic oncology (leukemia - lymphoma) Avastin Bevacizumab brain tumors (glioblastoma) - eye disorders-cancer colon métatasé 2ième intention-tumeur de l'ovaire Not found= not reimbursed under the statutory Not found= not reimbursed under the health insurance (l'Assurance Maladie statutory health insurance (l'Assurance obligatoire) Maladie obligatoire) CIP: Médicament NON Remboursable aux Assurés Sociaux (A) / Agrées aux collectivités: sinds 01/2009 CIP: Médicament NON Remboursable aux Assurés Sociaux (A) / Agrées aux collectivités: sinds 04/2009 CIP: depending on the product; Homologation Assurés Sociaux (A) - 100% - since 10/01/2006 (re-examined in 2013) + Homologation Collectivité C: since 10/01/2006 CIP: Médicament NON Remboursable aux Assurés Sociaux (A) / Agrées aux collectivités C: since 1998 CIP: Médicament NON Remboursable aux Assurés Sociaux (A) / Agrées aux collectivités C: sinds 07/2005 UCD: Rétrocession: 100% - sinds 18/02/2009 - Médicament Non facturable en sus de la TAA UCD: Rétrocession: 65% (sinds 24/04/2009) - Médicament Non facturable en sus de la TAA Not found= not reimbursed under the statutory health insurance (l'Assurance Maladie obligatoire) UCD: Rétrocession: 100% (since 11/05/2005) - TAA: 11/05/2005 UCD: Médicament Non Remboursable au titre de la rétrocession - TAA: 09/2005 Mrs. Isabelle Chenney + Nomenclature Assurance Maladie Mrs. Isabelle Chenney + Nomenclature Assurance Maladie Mrs. Isabelle Chenney + Nomenclature Assurance Maladie (Base des médicament et informations tarifaires) Mrs. Isabelle Chenney + Nomenclature Assurance Maladie (Base des médicament et informations tarifaires) Mrs. Isabelle Chenney + Nomenclature Assurance Maladie (Base des médicament et informations tarifaires) Mrs. Isabelle Chenney + Nomenclature Assurance Maladie (Base des médicament et informations tarifaires) Bi-myconase and/or sucraid Ointmenst, disinfectants, glucamylase & invertase (saccharase) enzyme deficiency sucrose isomaltase Not found in the nomenclature Not found in the nomenclature No information found painkillers, tape, food supplements epidermolysis bullosa - ichthyosis Not found in the nomenclature Not found in the nomenclature No information found Implantable cardiac valves (aortic valves) degenerative valve disease (aged persons) Not found in the nomenclature Not found in the nomenclature No information found Implantable pulmonary valves congenital cardiac malformations (children) Patients who have no remaining auditory nerves (ex. Not found in the nomenclature Not found in the nomenclature No information found Brainstem implant Bilateral vestibular schwannomas tumors on both balance nerves) Not found in the nomenclature Not found in the nomenclature No information found Not found= not reimbursed under the statutory Not found= not reimbursed under the Nomenclature Assurance Maladie: Neuro stimulator of the stomach Severe gastro paresis health insurance (l'Assurance Maladie statutory health insurance (l'Assurance Liste des prestations et des Services obligatoire) Maladie obligatoire) (LPP) Flolan époprosténol pulmonary hypertension CIP: Médicament NON Remboursable aux Assurés Sociaux (A) / Agrées aux collectivités UCD: Rétrocession: 100% (sinds 1/05/2004) - TAA: 05/2005 Mrs. Isabelle Chenney + Nomenclature Assurance Maladie (Base des médicament et informations tarifaires) Legende CIP (Club Inter Pharmaceutique): remboursables aux assurés sociaux et agréés aux collectivités (maisons de rétraites, hôpitaux) UCD (unités communes de dispensation): rétrocédés et facturables en sus des GHS par les établissements de santé
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Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE

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