After three years of medical insurance reform, how will people benefit from medication?

【Reading Tips】

  Since 2018, the National Medical Insurance Administration has adjusted the list of medical insurance drugs for three consecutive years and organized five batches of national drugs for centralized procurement.

Many common diseases, major diseases, and drugs for rare diseases are included in medical insurance, benefiting the general public.

  Fang Guiqing, 80, from Kuancheng, Hebei, was diagnosed with viral hepatitis C during a cold treatment two years ago.

The attending doctor said that if the disease is left untreated for a long time, it may develop into liver cancer.

  Taking into account the high cost of treatment, Uncle Fang never treated it.

Until June of this year, the attending doctor told him that hepatitis C treatment drugs were covered by medical insurance and could be reimbursed. It used to cost 100,000 yuan for the treatment, but now it only costs 20,000 yuan, and then Uncle Fang was admitted to the hospital.

  Recently, the Chinese Pharmaceutical Association and the China Medical Insurance Research Association jointly issued the "Blue Book on the Progress and Effectiveness of Medical Insurance Drug Administration Reform" (hereinafter referred to as the "Blue Book"), pointing out that the

National Medical Insurance Bureau has carried out adjustments to the national medical insurance drug catalogue for three consecutive years since its establishment in 2018. Work, adding 433 new drugs and good drugs to the catalog, and organizing five batches of national drug centralized procurement, covering 218 varieties, and accumulative cost savings of about 250 billion yuan.

Chronic diseases, common diseases medication prices drop

  The reporter learned that the "Blue Book" tracked and analyzed the use of drugs in 804 hospitals (including 596 tertiary hospitals and 218 second-level hospitals) in 31 provinces in China, and found that the level of protection for major diseases and medication for special populations has been obvious since the reform of medical insurance. improve.

  According to the "China Cardiovascular Health and Disease Report 2020", the prevalence of cardiovascular disease in my country continues to rise, with about 330 million patients currently suffering, including 245 million patients with hypertension.

According to Liu Huiyang, director of the Science and Technology Development Center of the Chinese Pharmaceutical Association, the latest data show that there are about 130 million diabetic patients, and the number of patients with diabetes ranks first in the world.

  Hypertension and diabetes have a large number of patients, and they are also called "two diseases".

Increasing the medication protection for this part of the patient group and reducing the burden of seeing a doctor is one of the priorities of the medical insurance reform in recent years.

  The "Guiding Opinions on Improving the Guarantee Mechanism for Outpatient Medication for Hypertension and Diabetes in Urban and Rural Residents" issued in October 2019 clarified that the proportion of outpatient medication reimbursement for patients with "two diseases" exceeds 50%.

Among them, the most widely used hypertension medication amlodipine besylate tablets were reduced by 79%, the diabetes medication metformin hydrochloride tablets were reduced by 53%, and the blood lipid-lowering drug atorvastatin calcium tablets were reduced by 80%.

  This year, the National Medical Insurance Administration and the Ministry of Finance jointly proposed to launch a pilot program for direct settlement of treatment costs related to chronic diseases in 5 outpatient clinics, including hypertension and diabetes, and increase the proportion of outpatient drug fund payment for the "two diseases".

At present, the National Medical Insurance Bureau is taking demonstration city activities as its starting point to promote the "two diseases" outpatient medication protection special action. The number of benefit recipients has exceeded 100 million, and the reimbursement ratio within the policy scope has continued to stabilize at more than 50%.

Life-saving medicine is included in medical insurance

  At present, the dynamic adjustment mechanism of the pharmaceutical drug catalog has been initially established, and the adjustment period has been shortened from the longest 7 years to 1 year.

The medical insurance drug catalog is dynamically adjusted to remove drugs with low clinical value from the catalog, and drugs with high clinical value and good economy are transferred to the catalog.

  Tumor is a major disease threatening national health.

The continuous reform of medical insurance in recent years has had a significant impact on the field of cancer treatment.

Leng Jiahua, director of the Medical Insurance Service Department of Peking University Cancer Hospital, has a deep understanding of this change.

  "Before the dynamic adjustment of the medical insurance drug catalogue, tumor treatment often faced a'smart woman's difficulty in cooking without rice'." Leng Jiahua said.

On the one hand, with the development of cancer clinical treatment to precision medicine, innovative drugs such as biological targeting, immune and cell gene therapy are increasing, and the anti-tumor drugs in my country's medical insurance reimbursement catalog are still mainly cytotoxic drugs.

On the other hand, many tumor treatment guidelines recommend the use of innovative drugs, but patients are often blocked by expensive, non-standard clinical use channels, and limited market supply.

  Leng Jiahua used his own colorectal cancer treatment as an example. Before the dynamic adjustment of the medical insurance drug list, there were only cytotoxic drugs in the list, and no targeted drugs were available.

Today, with the adjustment of the medical insurance drug catalogue and the introduction of anti-tumor drugs, especially life-saving drugs, first-, second- and third-line targeted therapy drugs have been included.

  The "Blue Book" pointed out that the price of new drugs should be reduced through access negotiations and that exclusive drugs must be negotiated.

There are a total of 2,800 types of Western medicines and proprietary Chinese medicines in the current catalog, covering chronic diseases, malignant tumors and other fields. Patients' access to innovative drugs has been greatly improved, and clinical drug hunger and thirst have been effectively alleviated.

Medicines for patients with rare diseases and children are protected

  Cao Xi's mother is a patient with Huntington's disease.

This is a rare autosomal dominant genetic disease. Patients will experience uncontrollable hand dances, mental and cognitive symptoms, and cannot take care of themselves.

  In May 2020, the first new drug deuterium tetrabenazine for Huntington's disease was approved for marketing in China.

After knowing the news, Cao Xi and other patients and their families were very happy, but worried that the price of the medicine was too high. In addition, Huntington's disease is a genetic disease that cannot be covered by personal commercial insurance. They are afraid they cannot afford it.

  In September last year, patients heard that deuterium tetrabenazine was eligible to enter medical insurance negotiations.

Three months later, the new version of the National Medical Insurance Catalogue was released, and the drug was included in the catalogue.

Cao Xi said that this made the patients feel that their lives had turned for a better time and saw hope.

At present, the drug is available in more than 20 provinces across the country, and patients have truly enjoyed tangible benefits.

  With the adjustment of the national medical insurance catalogue, more and more rare disease drugs are included in the medical insurance, and the coverage of rare diseases has also increased significantly.

  The "Blue Book" shows that the 2009 version of the medical insurance catalog contains 22 drugs for rare diseases, covering 13 rare diseases; the 2020 version of the medical insurance catalog includes 45 drugs for rare diseases, covering 22 rare diseases.

At the same time, more drugs available for children have been transferred to the medical insurance catalog, and the level of protection has been continuously improved.

  Li Danqing/Workers' Daily

Li Danqing/Workers' Daily