74 new drugs entered, and the prices of exclusive drugs successfully negotiated were reduced by an average of 61.71%——

Medical Insurance Catalogue "Up New" Expands Beneficiaries

  Our reporter Wu Jiajia

  The National Medical Insurance Administration recently announced the adjustment results of the 2021 National Medical Insurance Drug List.

In this adjustment, a total of 74 drugs have been added to the catalog, including 67 exclusive drugs transferred through negotiation and 7 non-exclusive drugs transferred directly. Exclusive drugs successfully negotiated have an average price reduction of 61.71%, and 11 other drugs have clinical value. Drugs in the original catalog that were not high were transferred out.

After the adjustment, there will be a total of 2,860 drugs in the new medical insurance drug catalog, which will be implemented on January 1, 2022.

  The relevant person in charge of the National Medical Insurance Bureau said that this adjustment has achieved another price reduction of some drugs in the catalog, freeing up fund space for more cost-effective drugs and realizing an upgrade of drug protection.

At the same time, under the premise of ensuring the safety of the fund, the payment restrictions for some drugs have been cancelled, and the newly included drugs can accurately complement the drug demand for tumors, chronic diseases, anti-infections, rare diseases, women and children, expand the beneficiaries, and greatly increase the availability of drugs. And medication fairness.

  In order to better meet the needs of patients for newly-listed drugs, this adjustment of the medical insurance catalogue focuses on adding newly-listed drugs in recent years.

Take Ganlut Sodium Capsules as an example. The drug is China's original and the first international new drug for the treatment of Alzheimer's disease that targets the brain-gut axis.

"The entry of drugs into medical insurance releases the state's clear orientation of supporting new drugs and focusing on patient needs, which further strengthens the confidence of enterprises in developing new drug research and development." "Ninth Phase One" R&D and production enterprise, Executive Officer of Green Valley (Shanghai) Pharmaceutical Technology Co., Ltd. Deputy General Manager Li Jinhe said.

  The new anti-flu drug Sufuda was included in the medical insurance through negotiation after 8 months of approval. This is the first and only single-dose oral drug approved for the treatment of influenza in 20 years.

"Under the severe situation of the'dual pandemic' of influenza and new crown virus, highly effective and innovative anti-influenza drugs were included in the National Medical Insurance List as soon as they were approved for marketing in China, reflecting the country's efforts to benefit more patients." Shanghai Jiaotong University Professor Xu Jie, director of the Department of Infectious Diseases of the Ninth People's Hospital affiliated to the Medical College, said.

  The public is concerned about why a certain “anti-cancer drug” with a dose of 1.2 million yuan is not covered by medical insurance?

"The primary working principle of catalogue adjustment is to'guarantee basic', and fund measurement is an important line of defense to achieve'basic guarantee.' In the entire fund measurement, the role positioning is to fully evaluate the burden level of the fund and patients, and the calculation gives the affordable Recommended payment standards." Zheng Jie, head of the 2021 National Medical Insurance Negotiation Drug Fund Measurement Expert Group, introduced that the 1.2 million yuan-a-dose "anti-cancer drug" is not economical because the price far exceeds the affordability of the fund and the burden level of the common people. Failure to pass the review, in the future, the National Medical Insurance Bureau will continue to eliminate the high-priced drugs into medical insurance, and keep the people's life-saving money.

  In this year’s adjustments, the National Medical Insurance Administration strictly controls the economics of drugs. According to preliminary calculations, the additional fund expenditures for 74 new drugs are expected to increase in 2022, which is basically equivalent to the fund space vacated by the price reduction of drugs in the catalog. Therefore, in the near future Will not significantly increase fund expenditures.

From the perspective of patient burden, compared with the original market price, through negotiation of price reduction and medical insurance reimbursement, this negotiation is expected to reduce the burden of patients by more than 30 billion yuan in 2022.

  "Some people think that negotiation is bargaining, and the lower the better, this is a misunderstanding. Fund calculations are not for the lowest price, but for a reasonable price." Zheng Jie said, considering the per capita disposable income of urban and rural residents in my country, the patient's personal burden can be considered comprehensively. Affordability, through calculations to find a price that most patients can afford, and benefit the people to the greatest extent, so that negotiation is meaningful.

According to the limited scope of payment, the current annual treatment cost of all drugs in the National Medical Insurance Catalog does not exceed 300,000 yuan.