According to the requirements of the National Medical Insurance Administration, the digestion of the three-year local supplementary catalogue of medical insurance should end on the 30th of this month.
After the half-year transition period, my country will realize the basic unification of the national medical insurance drug coverage on January 1, 2023.
In June, Jiangsu, Sichuan, and Fujian provinces promptly issued the third batch of supplementary drug clearance plans, and a large number of drugs were removed from the medical insurance catalog and the time limit for stopping reimbursement was clarified.
Previously, Guangdong, Hebei, Henan and other provinces have completed the digestion of provincial supplementary drugs, and the provincial medical insurance catalog has withdrawn from the historical stage.
What impact will the unification of the National Medical Insurance Catalog have on patients, medical insurance, and pharmaceutical companies?
Many experts interviewed by CBN said that this is an important measure to realize the fairness of medical insurance of "same rights" under the condition that my country's medical insurance does not yet have national overall planning. In the future, medical treatment in different places will be more convenient and efficient.
After the cancellation of the local medical insurance catalog, the normalized adjustment of the national medical insurance catalog is the only access channel for pharmaceutical companies to enter the medical insurance, which also requires pharmaceutical companies to conduct market assessments of products in advance and pay attention to drug innovation.
In response to reports from the public that medical insurance reimbursement treatment has declined in some places, and that the drugs and items that could be reimbursed before could not be reimbursed, the people interviewed by Yicai.com believe that the circumstances of each case are different, and it cannot be ruled out that some of them are due to local withdrawal of supplementary drugs. The resulting inability to reimburse, but this is not because the medical insurance "runs out of money", an important reason is the problem of the medication habits of doctors and patients.
The provincial medical insurance supplementary catalog has withdrawn from the historical stage
In June, many places accelerated the removal of local supplementary catalogues. Jiangsu, Sichuan and other places issued "digestion" announcements to transfer a batch of drugs out of the local medical insurance catalogue.
On June 24, the Fujian Provincial Medical Insurance Bureau issued the "Notice on the Work on the Supplementary Drug Catalogue in Digestive Province", which clarified that the 23 third batch of digestive varieties, including compound Manshan White Syrup, in the original provincial supplementary drug catalogue, will not be used since July 1. It will then be included in the payment scope of the provincial medical insurance pooling fund.
In the next step, if the state issues documents to adjust the policy, it will be implemented in accordance with the national documents.
On the same day, the Zhejiang Provincial Medical Insurance Bureau and the Zhejiang Provincial Department of Human Resources and Social Security jointly issued the "Notice on Doing a Good Job in the Digestion of Supplementary Drugs for Basic Medical Insurance, Work Injury Insurance and Maternity Insurance in the Province". All the basic medical insurance, work-related injury insurance and maternity insurance fund payment coverage have been transferred out.
Before the above-mentioned drugs are transferred out, they will continue to be paid according to the existing regulations.
On June 21, Shanghai also issued the "Notice on Adjusting the Transition Period of Original Supplementary Drugs in the City", proposing that Western medicines and proprietary Chinese medicines that were not included in the "Shanghai Drug Catalog" and originally belonged to Shanghai Medical Insurance in 2021, the transition period will be Adjusted from June 30 to December 31.
During the transition period, the medical insurance fund will continue to pay, and the payment method will continue to be implemented according to the original regulations.
The removal of the local medical insurance catalogue began with the "Notice of the Ministry of Human Resources and Social Security of the National Medical Insurance Administration on Printing and Distributing the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog" issued in August 2019.
This notice pointed out that all localities should strictly implement the "Drug List", and should not make their own lists or use flexible methods to increase the drugs in the list, nor should they adjust the limited payment scope of drugs in the list by themselves.
Before the 2019 version of the drug list, local governments had 15% of the authority to adjust, and provinces could include two or three hundred drugs in the provincial drug list and manage them as Class B drugs. Some drugs that failed to enter the national version of the list would still have the opportunity to enter the provincial drug list. Supplementary directory.
In view of the complexity of the removal of the provincial supplementary catalogue, the National Medical Insurance Administration arranged a transition period of up to three years.
Starting from 2020, all localities will gradually transfer the Class B drugs added to the original provincial drug list according to regulations within three years according to the ratio of 40% in the first year, 40% in the second year, and 20% in the third year. Auxiliary medicines are removed from the catalog first.
Zhang Xiao, director of the Medical Insurance and Social Security Research Center of Southeast University, said that judging from the situation of resignation in various places, this work is progressing smoothly. In recent years, the national medical insurance catalog has been continuously expanded, and some local catalog drugs have entered the national catalog.
There are about 200 categories of catalogues across the country from common names, and about 100 categories can be digested by the national A-category catalogue.
Advancing Medicare Equity
Zhang Xiao said that the supplementary catalogue of local medical insurance is the result of various difficult games in the early stage of medical reform. Now that the construction and management capabilities of the medical insurance system have been greatly improved, the medical insurance catalogue should be developed in a standardized and unified direction to ensure medical insurance. The fairness of the system and the improvement of management efficiency.
After the unified catalog in the future, it will be more convenient to seek medical treatment in different places, the handling efficiency will be higher, and the fairness of medical insurance will be better reflected.
Zhu Minglai, director of the Center for Health Economics and Medical Security Research at Nankai University, said that based on the principle of "same rights as people", it is necessary to unify the national basic medical insurance catalogue.
Because my country's medical insurance funds are currently at the level of prefecture-level overall planning, and provincial-level overall planning is the goal, it cannot be upgraded to national overall planning in the short term. Differences between regions have resulted in large gaps in regional medical insurance financing and treatment.
In this case, unifying the drug list first is conducive to promoting fair medical insurance, improving the differentiation of reimbursement for medical treatment in different places, and improving the efficiency of medical treatment in different places, thereby ensuring people's livelihood.
Zhang Xiao believes that the province's right to self-adjust the medical insurance catalogue not only affects the fairness of medical insurance, but also affects the efficiency of medical insurance. On the issue of benefit transmission, in some places the pharmaceutical industry is relatively strong, and local protection will inevitably occur.
The unified medical insurance catalog helps to establish a unified large market, and by adjusting the catalog in accordance with market rules and market rules, local monopoly or local protection can be broken.
It is worth noting that in response to the recent discrepancy in medical insurance reimbursement reported by the public, industry insiders believe that each province will weigh and evaluate each drug when formulating a digestion plan, and there will be alternative drugs in the national catalog. , which may occur if doctors and patients insist on using the original drug instead of the drug on the national inventory.
"Because our consistency evaluation is not yet perfect, doctors and patients will have distrust in the clinical effects of drugs and will not choose to collect drugs. At present, relevant departments are continuing to improve the consistency evaluation. In addition, patients should not think that the centralized purchase is effective. Drugs are 'cheap but not good', and it should be known that drug prices were very inflated in the past." Zhang Xiao said.
After the abolition of the local medical insurance directory, the normalized adjustment of the national medical insurance directory will be the only access channel for pharmaceutical companies to enter medical insurance.
On June 29, the "2022 National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog Adjustment Work Plan" and related documents were officially announced, marking the official launch of the fifth round of the national medical insurance drug catalog adjustment.
Since the establishment of the National Medical Insurance Bureau, it has adjusted the list of medical insurance drugs for four consecutive years, and a total of 507 drugs have been added to the national medical insurance payment scope.
The total number of drugs in the 2021 National Drug List is 2,860.
How pharmaceutical companies respond
Zhu Minglai also said that pharmaceutical companies should be mentally prepared.
Cancelling the 15% part of the local adjustment authority will definitely hurt them in the short term, so pharmaceutical companies are also actively looking for the next way out.
Some of the drugs that have been removed from the provincial medical insurance catalogue are blockbuster products of some listed pharmaceutical companies.
On the evening of June 28, Jichuan Pharmaceutical (600566.SH) announced that two drugs, Pudilan Anti-inflammatory Oral Liquid and Iron Protein Succinate Oral Solution, of its wholly-owned subsidiary, Jichuan Pharmaceutical Group Co., Ltd., were transferred out of Jiangsu and other provinces. News from the Medicare Catalog.
Pudilan Anti-inflammatory Oral Liquid is an exclusive traditional Chinese medicine product of Jichuan Pharmaceutical, and it is also one of the main sources of revenue for the company.
In 2021, the sales amount of Jichuan Pharmaceutical Pudilan Anti-inflammatory Oral Liquid in Jiangsu, Hunan, Jilin, Qinghai and Tianjin will be about 700 million yuan.
The sales amount of iron protein succinate oral solution in Jiangsu and Hunan is about 100 million yuan.
In 2021, Jichuan Pharmaceutical will achieve an operating income of 7.631 billion yuan, and the net profit attributable to shareholders of the listed company will be 1.719 billion yuan. Among them, the heat-clearing and detoxifying sector to which Pudilan Xiaoyan Oral Liquid belongs will achieve revenue of 2.122 billion yuan.
Prior to this, Jichuan Pharmaceutical has successively announced that Pudilan Anti-inflammatory Oral Liquid has been transferred out of the Xinjiang Uygur Autonomous Region, Xinjiang Production and Construction Corps, Heilongjiang, Shandong, and Hebei provincial medical insurance catalogs.
As a prescription drug, Pudilan Anti-inflammatory Oral Liquid has not yet entered the National Medical Insurance Catalogue.
Today, with the withdrawal from the local medical insurance catalogue, it brings the risk that the sales scale of the hospital market will continue to be compressed.
On June 29, the share price of Jichuan Pharmaceutical fell by 3.64%.
Relevant personnel of the securities department of Jichuan Pharmaceutical told Yicai that the specific sales scale of drugs is not only affected by the medical insurance payment policy, but also by factors such as product efficacy, brand influence and user recognition.
The withdrawal of the company's medicines from the provincial medical insurance list this time will not have an estimated impact on the company's operating performance, and will not have a significant impact in the short term.
At the same time, the company has been increasing the promotion of Pudilan Anti-inflammatory Oral Liquid in retail pharmacies since last year. The ratio of the drug’s sales revenue in the hospital market to that outside the hospital is about 6:4. Currently, the growth rate of revenue outside the hospital is faster than that in the hospital market.
Similar to Jichuan Pharmaceuticals, Buchang Pharmaceuticals (603858.SH) was also removed from the provincial medical insurance directory.
On June 13, the company also announced the news of the withdrawal of medicines from Sichuan and Jiangsu medical insurance, involving three products in total, of which Guhong injection and compound Qutide injection were withdrawn from the medical insurance of these two provinces.
On the whole, these three products account for a large proportion of the company's overall revenue. The highest is Guhong injection, a drug for the treatment of cerebrovascular diseases. The operating revenue of this product in 2021 will be 2.112 billion yuan, accounting for 13.41% of the company's revenue. %.
Before the withdrawal of Sichuan and Jiangsu medical insurance, from July 2021, Guhong injection has been withdrawn by Anhui, Hubei, Heilongjiang, and Yunnan medical insurance.
Affected by the reduction of the company's product medical insurance payment price and the epidemic, Buchang Pharmaceutical's net profit attributable to shareholders of the parent company in 2021 fell by 30.72% year-on-year.
Relevant personnel from the Office of the Secretary of the Board of Directors of Buchang Pharmaceutical replied to Yicai that the company does not rule out seeking to enter the national medical insurance catalogue for the withdrawn products.
However, for pharmaceutical companies, it is not easy to switch to the national medical insurance, which puts forward higher requirements for the clinical necessity and economy of drugs.
In general, with the acceleration of the medical insurance cost control process, many pharmaceutical companies have chosen to increase their layout in the out-of-hospital sales market, but whether the revenue from the out-of-hospital market can make up for the in-hospital market remains to be tested.
Recently, Chen Baiping, managing director of BCG, global partner, and head of the medical and health project in China, told Yicai.com that under the background of the separation of pharmaceuticals, the proportion of retail channels in drug sales will increase significantly. There are still capacity pain points in aspects such as patient stickiness, chronic disease management, pharmacist capacity building, and patient drainage. All parties in the industry need to actively promote the overall ecological construction, strengthen external cooperation, and adopt digital empowerment to help the prescription drug retail industry catch up under the new medical reform. Seize the opportunity and achieve long-term development.
Author: Guo Jinhui ▪ Lin Zhiyin