🏥 FY2026 Medical Fee Revision: How Hospital Pharmacists' Daily Work Will Change [Effective June 1, 2026]

📝 v3 Final Confirmed Version (June 1, 2026): Following the final audit on the effective date, the following 6 points have been added/reinforced.
🔴 A244 Add-on 1/2 can only be filed for one or the other per medical institution (confirmed in Q&A No. 5; cannot be mixed by ward) changed ① clearly stated at the beginning
⚠️ Organized the necessity numerical notation in the TOP 5 table to include both "Criteria 1 and Criteria 2"; added a note to "confirm with notification" for the Acute Care 2 figures and the emergency patient acceptance coefficient values
🆕 Added the staffing requirement for Add-on 1: "dedicated for 20 hours or more per week"; added a note regarding the coordination add-on on the B014 side to the end of the A250 explanation
🆕 Added reduction of Short-stay 1 (-793 points); Inpatient Surgery Support Add-on (lens 548 points, colon polyp 366 points); and new classification for subcutaneous injection chemotherapy (351 points)
📌 Added a disclaimer to refer to the latest Q&A No. 3 to No. 7 (up to May 29, 2026)

June 1, 2026.

For hospital pharmacists, this is the day when "business as usual" will no longer suffice.

In this article, I will focus on "what will change" in daily work as a ward pharmacist.

I will write from the perspective of "how it will affect work starting Monday," rather than the official stance of the system.

📋 First, a "3-line summary" of the revision

• ① From structure to performance: A shift to a structure where evaluation is based not just on having pharmacists on the ward, but on the "number of cases" of polypharmacy measures and information provision at discharge.

• ② Strengthening inter-facility coordination: Providing document information to insurance pharmacies at the time of discharge or transfer is now effectively mandatory.

• ③ Acceleration of the shift to outpatient care: Short-stay surgery basic fee 3 will be applied uniformly even for DPC-target hospitals.

🔴 Top 5 Changes Hospital Pharmacists Need to Grasp

[Priority ★★★]

• A244 Three-tier reorganization of the Inpatient Pharmaceutical Care Addition
  → Potential for 120 points to transform into 300 points

• A250 Comprehensive Pharmaceutical Assessment and Adjustment Addition: 100 → 160 points
  → Polypharmacy countermeasures become a pillar of revenue

• A400 Unification to Basic Fee for Short-Stay Surgery 3
  → DPC hospitals will also bill Short-Stay 3 for cataracts, etc.

[Priority ★★]

• Expansion of the Inpatient Base-up Evaluation Fee tiers
  → 250 → 500 tiers; re-notification required

• Review of Nursing Necessity Standards
  → Acute Care 1 (Necessity II): 20 → 27% (Standard 1) / 27 → 34% (Standard 2). Acute Care 2 also increased

💊 Change 1: Three-tier reorganization of the Inpatient Pharmaceutical Care Addition (A244)

What has changed?

It will be reorganized into a three-tier structure from the conventional 'Addition 1 (120 points)' and 'Addition 2 (100 points/day)'.

Classification Point Calculation Unit TargetAddition 1 (Newly Established)300 pointsHospitals meeting the weekly performance requirement (Selected by medical institution) Addition 2 (Former Addition 1) 120 points Weekly as before (Selected by medical institution) Addition 3 (Former Addition 2) 100 points per day ICU/HCU, etc. treatment rooms (Can coexist with Addition 1/2)

Performance requirements for obtaining Addition 1 (300 points)

Both of the following must be met simultaneously.

• ☐ Comprehensive Medication Assessment and Adjustment Addition (A250): Calculated 10 or more times in the last 3 months

• ☐ Medication Information Management and Guidance Fee at Discharge (B014): Calculated for 40% or more of discharged patients in the last 3 months

Staffing requirements for Addition 1 (Caution)

💡 What this means as a ward pharmacist

120 points → 300 points. If calculated once a week, there is a significant annual difference per bed.

However, to obtain it, it is a prerequisite to thoroughly eliminate calculation omissions for A250 and B014.

Did you provide discharge guidance the day before discharge? Was there an omission in recording in the medication notebook?
These two points directly affect whether or not Addition 1 can be obtained.

💰 Change ②: Comprehensive Medication Assessment and Adjustment Addition (A250) 100 → 160 points

What has changed

An increase of 60 points (100 → 160 points). At the same time, the existing "Discharge Medication Information Linkage Addition (60 points)" has been abolished and integrated into the main body. The reality of the increase is "absorption through integration."

Target patients (Note 1 a/b)

Target ClassificationNote 1a: Patients prescribed 6 or more oral medications that have been taken for 4 weeks or longer prior to admission (PRN medications and medications started within the last 4 weeks are excluded). Note 1b: Patients admitted to a psychiatric ward who were taking 4 or more antipsychotic medications immediately before admission or 1 year before discharge, whichever is later.

The accurate requirement is not "taking 6 or more medications before admission," but rather "6 or more oral medications that have been continued for 4 weeks or longer." Newly started medications and PRN medications are excluded from the count.

A250 Base (160 points) Calculation Flow

1. Screen the above target patients

2. Comprehensive evaluation of prescription details through multidisciplinary collaboration (physicians, pharmacists, nurses, etc.)

3. Modify prescription details and provide necessary guidance and information coordination for treatment (*reduction of medication is not mandatory)

4. Create a document at discharge and provide it to the patient/family, and provide information in writing to at least one insurance medical institution, pharmacy, nursing care facility, etc. (New for FY2026; mandatory)

5. Calculated once at discharge

Medication Adjustment Addition (+150 points) — Medication reduction requirements are independent here

This is an addition applied on top of the A250 base (160 points) when medication reduction requirements are met.

Classification Calculation Requirements Note 1a: After meeting the A250 base requirements, oral medications are reduced by 2 or more in the discharge prescription, and are expected to be continued for 4 weeks or longer. Note 1b: Cases where antipsychotic medications are reduced by 2 or more by the discharge date (or other equivalent cases).

→ A250 Base 160 points + Medication Adjustment Addition 150 points = Maximum 310 points.

The key point is that "reducing 2 or more medications" is a requirement for the Medication Adjustment Addition, not a requirement for the A250 base.

The discharge information provision requirement (new for FY2026) is effectively a mandatory requirement.

🏥 Change 3: Unification to Basic Fee for Short-Stay Surgery, etc. 3 (A400) ★Most Important★

Main cases that will be affected at your hospital

• Cataract surgery (lens reconstruction)

• Inguinal hernia surgery

• Colorectal polypectomy (endoscopic)

• Other cases subject to Short-Stay 3 with discharge within 5 days

Impact on ward pharmacists

• Day surgery → Calculated under Short-Stay 1 → Ward Pharmacy Practice Addition cannot be calculated

• 1-night stay to discharge within 5 days → Calculated under Short-Stay 3 → Ward Pharmacy Practice Addition cannot be calculated

• Continued hospitalization from the 6th day onwards → Calculated via standard DPC, etc. → Ward Pharmacy Practice Addition Calculation allowed

Significant reduction in Short-Stay 1 / Inpatient Surgery Support Addition (newly established)

In parallel with the unification to Short-Stay 3, Short-Stay 1 has also been significantly reduced.

Category Old Points New Points Increase/Decrease Short-Stay 1 (with anesthesia) 1,588 points 795 points ▲793 points Short-Stay 1 (without anesthesia) 1,359 points 680 points ▲679 points

In addition, an 'Inpatient Surgery Support Addition (newly established)' has been set up for representative Short-Stay target surgeries performed during hospitalization.

Surgery Inpatient Surgery Support Addition Lens reconstruction surgery 548 points Endoscopic colorectal polyp/mucosal resection 366 points

Lens reconstruction surgery itself has also been increased to 17,457 points → 18,001 points (※Please confirm details in the notification).

Since the revenue structure for cases previously handled under Short-Stay 1 will change significantly, if your hospital performs these surgeries, it is useful for the pharmacy department to be aware of this to help prioritize postoperative management and brought-in medication handling.

💴 Change 4: Inpatient Base-Up Evaluation Fee (Point scale expansion + re-notification required)

What has changed?

Hospital pharmacists have traditionally been included in the target professions, but with this revision, the point scale will be significantly expanded.

• From June 2026: 1–250 points (250 levels)

• From June 2027: 1–500 points (500 levels)

By increasing the number of levels, more precise point settings according to the number of target personnel and actual wage increases at your hospital will become possible.

📊 Change ⑤: Review of Severity, Medical and Nursing Care Need A-Items

Changes Directly Affecting Pharmacists

① Management of 3 or more injectable drugs (A3 item)

• Evaluation period capped at up to 7 days of hospitalization (New in FY2024 revision, continued in FY2026 *Correction 2026/5/18: It was an error to state 'New in FY2026' in v1)

• Intravenous nutritional drugs (amino acids, glucose, electrolytes, vitamins, etc.) are excluded (already excluded in FY2024 revision, continued)

→ Total Parenteral Nutrition (TPN) continues to be excluded from the injectable drug count.

② Antineoplastic agents (injectable)

• Some drugs excluded due to the introduction of an inpatient usage rate threshold

• Points allocation reviewed (please check the official notification for specific points)

③ Antineoplastic agents (oral)

• Some drugs excluded due to the introduction of an inpatient usage rate threshold (from the perspective of promoting outpatient chemotherapy)

④ Standard values for the proportion of applicable patients for Acute Care General Inpatient Fees (Important)

• Acute Care General Inpatient Fee 1 (Need II): Ratio 1 27% or higher (formerly 20%) / Ratio 2 34% or higher (formerly 27%)

• Acute Care General Inpatient Fee 2 (Nursing Need II)：Ratio 1 22% or higher (formerly 21%) / Ratio 2 28% or higher (※Please reconfirm the specific values for Acute Care 2 in the official notification）

• Evaluation axis: Concept changed from "Applicable Patient Ratio" to "Ratio Index (Applicable Patient Ratio + Emergency Patient Acceptance Coefficient)." The emergency patient acceptance coefficient is the number of annual emergency transport acceptances per bed × 0.005, with a cap of 10% (※Please confirm the coefficient and cap in the official notification）

• Transitional measures: Until September 30, 2026 calculation under the old criteria is permitted

🧬 Other changes (briefly)

Generic drugs and biosimilars

A243 "Generic Drug Usage System Addition" will be abolished at the end of May 2026. It will transition to the new addition "Regional Support and Drug Supply Response System Addition" (hospitals/clinics with beds, first day of hospitalization). For hospitals, it is a 3-tier structure (based on the generic drug usage ratio).

Category Points Generic Drug Usage RatioAddition 187 points90% or more Addition 282 points85% or more but less than 90% Addition 377 points75% or more but less than 85%

• Main facility standards: Collection and evaluation of quality, safety, and stable supply information for generic drugs by the pharmacy department, adoption decisions by the Pharmacy and Therapeutics Committee, and systems for responding to prescription changes during supply instability.

• Transitional measures: Drugs with supply instability can be excluded from generic drug ratio calculations until September 2026.

Generic Name Prescription Addition (Outpatient)

Category PointsGeneric Name Prescription Addition 110 pointsGeneric Name Prescription Addition 28 points

Biopharmaceuticals with biosimilars are also added to the scope. Calculation requirements now include maintaining treatment continuity plans during supply shortages, patient explanation, and in-hospital posting.

Pharmacy Operations Improvement Addition (Newly established in FY2024, continued in FY2026)

This is an addition that evaluates the robust training system for hospital pharmacists (new employee training, comprehensive training programs), and it was newly established in the FY2024 revision.

• Points: 100 points (per week)

• Target: Patients for whom the A244 Ward Pharmacy Operations Implementation Addition is calculated

• Facility Standards: Appointment of a new pharmacist training supervisor, training implementation status review committee, guidance by experienced pharmacists, training progress evaluation, and a comprehensive training program including pharmacy operations, ward operations, team medical care, and drug information management

In the FY2026 revision, reorganization of the linked ward addition categories has been carried out due to the 3-tier structuring of the A244 Ward Pharmacy Operations Implementation Addition (please check the notification for details). Please understand this as 'continuation of existing additions + operational reorganization' rather than a 'newly established addition'.

New category for chemotherapy via subcutaneous injection (within the scope of Outpatient Tumor Chemotherapy Management Fees)

Within the scope of Outpatient Tumor Chemotherapy Management Fees, a new category for evaluating subcutaneous injection administration has been established.

• Points: 351 points

• Calculation Requirements: Applicable to subcutaneous administration products that do not require 30-60 minutes of infusion time

• Representative drug examples: Oxaliplatin subcutaneous injection, Pertuzumab/Trastuzumab combination subcutaneous injection, etc.

Pharmacists in charge of outpatient cancer chemotherapy must confirm the handling of target drugs and the organization of billing categories.

Additional fee for enhancing cancer drug therapy systems

A new additional fee for the use of closed-system transfer devices during administration has been established, recognizing improvements in exposure prevention and safety management standards. The importance of side effect assessment and supportive care proposals by pharmacists before physician consultations will increase.Confirm specific points in the MHLW notification.

Multidisciplinary collaboration for heart failure, etc.

In the continuous management fee for preventing heart failure readmission, a multidisciplinary management system including pharmacists is recognized. For pharmacists working with cardiology departments, the basis for their involvement becomes clearer.

📅 Notification Schedule

[Must reach the Regional Bureau of Health and Welfare by: May 18 (Mon)]

• Inpatient Pharmaceutical Service Implementation Addition 1 (300 points): New notification

• Inpatient Pharmaceutical Service Implementation Addition 2 (120 points): Category change

• Pharmaceutical Service Improvement Addition: New notification

• Regional Support/Drug Supply Response System Addition: Category change

[Must reach the Regional Bureau of Health and Welfare by: June 1 (Acceptance starts May 7)]

• Inpatient Base-up Evaluation Fee: Re-notification required

[No notification required]

• Comprehensive Pharmaceutical Evaluation and Adjustment Addition (160 points): Note changes to billing requirements and document formats

✅ Self-checklist for ward pharmacists

When considering a transition to Addition 1 (300 points)

• ☐ Confirmed the number of A250 billings in the last 3 months (Requirement is 10 times or more)

• ☐ Verified the B014 calculation ratio for the last 3 months (Requirement: 40% or more of discharged patients)

• ☐ Organized denominator exclusions for B014 calculation (death at discharge, short-stay 3 cases, and readmissions within the same period)

Workflow at Discharge

• ☐ Routinized medication guidance during rounds on the day before discharge

• ☐ Ensured no omissions in recording major drug names in medication notebooks (Requirement for B014 calculation)

• ☐ Established a workflow for providing document information to community pharmacies upon discharge of A250-eligible patients

Handling Short-Stay 3 Cases

• ☐ Identified cases discharged within 5 days, such as cataracts, inguinal hernias, and colon polyp resections

• ☐ Acknowledged that the ward pharmacy service addition cannot be calculated for these cases

Handling Nursing Necessity

• ☐ Acknowledged that intravenous nutrition (TPN, etc.) is excluded from the 3-type injection count

• ☐ Established a system to check for missing receipt computer codes for antineoplastic agents

• ☐ Started simulation of eligibility rates toward the new standard (Necessity II 27%)

🌿 Summary: The Revision in a Nutshell

This is the core of the FY2026 revision. For ward pharmacists, the quality and volume of daily records will directly reflect in revenue.

Conversely, this is a rewarding revision where hospitals that perform well will see higher evaluations.

There is little time left until the June 1st implementation. I recommend starting the confirmation of notification schedules and your hospital's performance requirements this week.🌿

📋 Summary of Key Points in This Article

• 💊 A244 Addition 1 (300 points) can be obtained by clearing 2 performance conditions

• 💰 A250 increased to 160 points + mandatory documentation linkage

• 🏥 DPC hospitals also unified to short-term 3 → Caution regarding cases excluded from additional point calculations

• 💴 Inpatient base-up evaluation fees require re-notification and phased point expansion

• 📊 Acute Care 2 Nursing Necessity (Necessity II) threshold raised (Ratio 1: 21→22%, Ratio 2: 28%) *Final values require confirmation via official notification

• 📅 Notifications must be received by 6/1 (5/18 is the recommended early submission date / missing this means calculation starts from July or later)

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📝 Update History

• June 1, 2026 v3 Final Verified Version: Added/reinforced based on final audit on the effective date

  • 🔴 A244 Addition 1/2 can only be filed by one or the other per medical institution (Changed based on Q&A No. 5, finalized May 8, 2026) Added to the beginning

  • ⚠️ Organized the necessity score values in the TOP 5 table to include both 'Criteria 1 and Criteria 2'

  • ⚠️ Added a note to 'confirm requirements in the notification' for the necessity score values and emergency patient acceptance coefficient for Acute Care 2

  • 🆕 Added staffing requirement for Addition 1: 'Dedicated for 20 hours or more per week'

  • 🆕 Added a note at the end of the A250 explanation regarding the Family Pharmacist Collaboration Addition on the B014 side

  • 🆕 Added a supplementary note that Pharmaceutical Management Guidance Fees (B008) can still be calculated even if subject to Short-term 3 comprehensive coverage

  • 🆕 Added the -793 point reduction for Short-term 1 and the Inpatient Surgery Support Addition (548 points for crystalline lens, 366 points for colon polyp)

  • 🆕 Added the new category for subcutaneous injection chemotherapy (351 points, within the scope of Outpatient Tumor Chemotherapy Management Fees)

  • 📌 Added a reference to the latest Q&A No. 3 through No. 7 to the disclaimer

• May 18, 2026 v2 released: Fact correction based on primary source verification

  • A250 calculation unit: 'Once during hospitalization' → 'Once at discharge'

  • A250 main requirement: 'Reduction of 2 or more types' → 'Prescription change + information coordination'; medication reduction listed separately as Medication Adjustment Addition (+150 points)

  • Pharmaceutical Operations Improvement Addition: 'FY2026 new' → 'FY2024 new, FY2026 continued'

  • Nursing necessity/Injection drug 3-type management 7-day cap: 'FY2026 new' → 'FY2024 new, FY2026 continued'

  • Notification deadline: 'Must arrive by 5/18' → 'Must arrive by 6/1; 5/18 is the recommended early submission date'

  • Aligned the timeline for generic prescription additions, generic drug additions, and base-up evaluation fee step-wise expansion with primary sources

• May 2026 (First Edition): v1 released