Author: Zhang Lihua
On January 3, Beijing Aunt Xue, who suffers from cardiovascular and cerebrovascular diseases, went to a hospital in Beijing to prescribe medicine as usual on this day every month, but was told that the colleague Niuhuang Qingxin pills she had been taking all year round was no longer available. "I have been suffering from high blood pressure and cardiovascular and cerebrovascular diseases. I have been taking Niuhuang Qingxin Pills for more than ten years, but today I was told that my colleagues Niuhuang Qingxin Pills have been withdrawn from the medical insurance catalog and I can no longer be prescribed," Aunt Xue told reporter.
What Aunt Xue referred to as colleagues Niuhuang Qingxin pills withdrawing from the medical insurance list refers to withdrawing from the provincial medical insurance catalog.
From December 31, 2022, the drugs in the supplementary catalog of provincial medical insurance bureaus across the country will basically be withdrawn.
For more than ten years, my colleague Niuhuang Qingxin Pills, which had been purchased from the catalog of the Beijing Local Medical Insurance Bureau, was also cleared.
Since the release of the 2017 version of the National Medical Insurance Catalogue, considering the differences in living environment and eating habits in various regions of the country, and the regional differences in high incidence, the National Medical Insurance Department reserves the right to adjust 15% of the Class B drugs in the local medical insurance catalogue.
In July 2019, the National Medical Insurance Administration issued a document stipulating that the adjustment rights of 15% of the original local medical insurance catalog B drugs should be transferred to the central government, and a transition period of 3 years was given for this purpose.
December 31, 2022 is the day when the transition period expires.
From January 1, 2023, one medical insurance catalog will be used nationwide.
The era of local medical insurance catalog additions is over.
The currently implemented national medical insurance catalog is the 2022 version, and Niuhuang Qingxin pills are included in the national medical insurance catalog as a "basic" drug.
However, Tongren Niuhuang Qingxin Pills was not included in the national medical insurance catalog because the registered product name was "Tongren Niuhuang Qingxin Pills".
Tongren Niuhuang Qingxin Wan is produced by Beijing Tongrentang (600085.SH).
According to the reporter's interview, more than 30 years ago, Tongren Niuhuang Qingxin Wan improved and innovated on the basis of the bureau's prescription, and removed the two medicines.
In order to protect the improved variety of traditional Chinese medicine, Beijing Tongrentang registered the name of the product as "Tongren Niuhuang Qingxin Wan". It is this special name that makes this product, which was once listed as a national protected variety of traditional Chinese medicine, not included National Medical Insurance Directory.
Similar to Tongren Niuhuang Qingxin Pills, Tongren Wuji Baifeng Pills and Tongren Dahuo Luo Pills are nationally protected varieties of traditional Chinese medicines that have been removed from the local medical insurance catalog but failed to be included in the national medical insurance catalogue.
The reason is that the name of the product contains the word "Tongren", which is not included in the generic name of the drug in the catalogue.
According to industry insiders, the names of drugs included in the national medical insurance catalog are all generic names of drugs, and Tongren Niuhuang Qingxin Pills, Tongren Wuji Baifeng Pills, and Tongren Dahuoluo Pills cannot be included in general names, and the country The drug name of a certain manufacturer cannot be included as one of the catalog items alone, thus forming a situation of slipping through the net.
Changes in the local medical insurance catalog
In 2022, the local bureau supplementary catalog will be limited, which will have a huge impact on a considerable number of pharmaceutical companies and drugs that have entered the local supplementary catalog list.
Taking Pudilan Anti-inflammatory Oral Liquid as an example, on the evening of December 28, 2022, Jichuan Pharmaceutical (600566) announced that the varieties of Pudilan Anti-inflammatory Oral Liquid and iron protein succinate of its wholly-owned subsidiary Jichuan Pharmaceutical Group Co., Ltd. Oral solutions, etc. have not been included in the national medical insurance catalog, but have been included in some provincial medical insurance catalogs. However, with the implementation of supporting policies in various provinces and the adjustment of local medical insurance catalogs, the above products will be gradually adjusted out of the scope of medical insurance payment before December 31.
In addition, among the proprietary Chinese medicines, Compound Digestive Enzyme Tablets, Qianshan Huoxue Ointment, Gentongping Tablets, Shengu Capsules and many other medicines with wide coverage and high dosage have also been reported to have been removed from the provincial medical insurance drug list.
Tongren Niuhuang Qingxin Pills are also Chinese patent medicines, but unlike the above-mentioned Chinese patent medicines that were removed from the provincial medical insurance catalogue, the latter, as a generic name, does not exist in the national medical insurance catalogue.
However, the reporter inquired in the National Medical Insurance Drug Catalog Inquiry System that, as a generic name, "Niuhuang Qingxin Pills" is listed in the "Class B" list of the National Medical Insurance Catalogue.
But "Tongren Niuhuang Qingxin Pill" was not included.
The reporter learned that when local medical insurance bureaus still had 15% discretion, many local medical insurance bureaus used the word "Tongren" as the name of the manufacturer and included it in the detailed list of local medical insurance purchases.
Before the deadline on December 31, 2022, local medical insurance bureaus will continue to use this approach, so this problem has not come to the fore.
However, with the arrival of the deadline, starting in 2023, the provincial-level "code implementation standard" (commonly known as "code filling" in the medical industry) authority has been withdrawn by the National Medical Insurance Bureau. Fuzzy" no more.
The reporter interviewed a person in the medical field. The drugs included in the medical insurance list are generic names. For example, "Niuhuang Qingxin Pills" as a generic name is included in the national medical insurance directory. Drugs approved by the Food and Drug Administration can all be included in the medical insurance catalog and enjoy the policy of medical insurance reimbursement.
Previously, provincial-level local medical insurance bureaus had the authority to "code and implement standards". For example, for Niuhuang Qingxin Pills in the medical insurance catalogue, provincial-level local medical insurance can assign a label similar to "ID card" to manufacturers that meet the requirements.
"But this authority has been taken up, and the country has unified the code." The above-mentioned person in the medical field told reporters.
Tongren Niuhuang Qingxin Pills, is it Niuhuang Qingxin Pills?
And why is "Tongren Niuhuang Qingxin Pills" not considered "Niuhuang Qingxin Pills"?
Why is it different from other brands, Tongren Niuhuang Qingxin Pills need to add the word "Tongren" when registering?
The reporter compared the drug inserts of Niuhuang Qingxin Pills and Tongren Niuhuang Qingxin Pills. For Niuhuang Qingxin Pills produced by general manufacturers, the generic name in the instructions is displayed as: Niuhuang Qingxin Pills; while the drug description for Tongren Niuhuang Qingxin Pills shows that the generic name is: Tongren Niuhuang Qingxin Wan.
Aunt Xue, who has taken Tongren Niuhuang Qingxin Pills for more than ten years, told the reporter that the ingredients of Tongren Niuhuang Qingxin Pills are 27 herbs. Compared with other "Niuhuang Qingxin Pills", two herbs are missing: cinnabar and realgar.
CCTV once invited Wang Guowei, vice president of Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, to talk about the efficacy and clinical application of Tongren Niuhuang Qingxin Pills.
According to his introduction in the program, there are mainly three types of Niuhuang Qingxin Pills in clinical use, Wanshi Niuhuang Qingxin Pills, Jufang Niuhuang Qingxin Pills and Tongren Niuhuang Qingxin Pills.
Among them, Wanshi Niuhuang Qingxin Pill Wanshi comes from the Ming Dynasty's "Pocket World Medical Heart Method", which has been passed down for more than 470 years. There are only six herbs, all of which are mainly used to clear away heat and have no tonic ingredients.
Both Jufang and Tongrenfang come from the "Taiping Huimin Heji Jufang" in the Northern Song Dynasty. The originator of this prescription is Zhang Zhongjing's "Shu Ling Wan" in the Han Dynasty. It has been passed down for more than a thousand years.
The former is composed of 29 herbs, and the latter is composed of 27 herbs.
According to Dr. Wang Guowei, Tongren Niuhuang Qingxin Pills, compared with Jufang Niuhuang Qingxin Pills, only removes cinnabar and realgar. These two medicines have certain toxicity, and long-term use may have certain damage to the human body’s righteousness.
In clinical practice, Tongren Niuhuang Qingxin Pills are widely used especially in the north.
The story of colleagues Niuhuang Qingxin Pills was also recorded in the archival documentary broadcast by Beijing Satellite TV.
According to the film, during the Asian Games held in China in 1990, Beijing Tongrentang's Niuhuang Qingxin Pills attracted the attention of the international market, but foreign media reported that heavy metals exceeded the standard.
Jin Aiying, the deputy quality director of Beijing Tongrentang at that time, led Tongrentang to improve the formula.
In 1994, the safety and efficacy of Niuhuang Qingxin Pills without two herbs passed the expert appraisal.
Since then, Beijing Tongrentang's Niuhuang Qingxin Pills have been registered as "Tongren Niuhuang Qingxin Pills".
The "embarrassing situation" of traditional Chinese medicine in the west
According to the Drug Inquiry System of the State Food and Drug Administration, Niuhuang Qingxin Pills produced by Tongrentang have three approved national drug names, and their registered names are all "Tongren Niuhuang Qingxin Pills".
Similar to Tongren Niuhuang Qingxin Pills, Tongren Wuji Baifeng Pills and Tongren Dahuoluo Pills were also removed from the medical insurance catalog because of the word "Tongren" in their registered product names.
According to what the reporter learned from Beijing Tongrentang, Tongren Wuji Baifeng Pills use three-claw black-bone chicken from Taihe County, Jiangxi Province, and Tongren Dahuoluo Pills also add two kinds of medicines than other Dahuoluo Pills, which makes the three Chinese patent medicines of Beijing Tongrentang Different from similar products with other common names, the registration of the word "Tongren" is actually a prescription for protecting the improvement and innovation of Chinese patent medicines.
According to the annual reports of Beijing Tongrentang over the years, Tongren Wuji Baifeng Pills, Tongren Dahuoluo Pills, and Tongren Niuhuang Qingxin Pills are all classic medicines of the time-honored Tongrentang for many years, and they are regarded as the "Top Ten Trumps" of Beijing Tongrentang.
People in the medical field said that Beijing Tongrentang's main product was removed from the medical insurance list, which is just a manifestation of the "discomfort" of traditional Chinese medicine managed by Western medicine for many years.
In 1998, the "National Traditional Chinese Medicine Protection Variety Announcement" (No. 17) issued by the Ministry of Health showed that Tongren Niuhuang Qingxin Pills, Tongren Niuhuang Qingxin Pills (Shuimi Pills), Tongren Dahuoluo Pills, Tongren Dahuoluo Pills (Shuimi Pills), Tongren Wuji Baifeng Wan (Shui Mi Wan) is listed as a national protected variety of traditional Chinese medicine.
The reporter called the official phone number of the National Medical Insurance Bureau, but no one answered the phone.
Aunt Xue walked out of the hospital and bought three boxes of Tongren Niuhuang Qingxin Pills at her own expense. 80% of the drug expenses originally paid by the medical insurance were paid by herself.
Aunt Xue finally paid more than 50 yuan for each box of medicine.
"Eat this all the time, and counting the monthly amount, my colleague's is still much cheaper than others."
Aunt Xue made a calculation. Based on her monthly supply of 10 boxes, she will spend more than 500 yuan on this medicine every month in the future.