Focus on the treatment of new coronary pneumonia drugs and release signals that encourage innovation-the relevant person in charge of the National Medical Insurance Bureau answers reporters' questions on the adjustment of the 2020 medical insurance catalog
Xinhua News Agency, Beijing, August 28 - Title: key consideration new crown pneumonia drugs, the release signal encourage innovation - National Insurance Bureau responsible person answering reporters' questions on the 2020 health insurance directory to adjust
Xinhua News Agency reporter Qu Ting
The National Medical Security Administration recently announced the "Work Plan for the 2020 National Medical Insurance Drug List Adjustment", clearly proposing to include respiratory disease drugs related to the treatment of new coronary pneumonia and urgently needed innovative drugs in the scope of application.
"In this year's medical insurance drug catalog adjustment, we will focus on the treatment drugs included in the new coronary pneumonia diagnosis and treatment plan to provide support for normalized epidemic prevention and control." On the 28th, the relevant person in charge of the Medical Management Department of the National Medical Insurance Administration adjusted the 2020 medical insurance catalog. Responded to this year's adjustment focus and many hot issues.
Make room for good drugs with high clinical value
The reporter asked: What are the changes in the adjustment of the National Medical Insurance Drug List this year compared with the past? For what reason?
The person in charge answers: Compared with the previous rounds of catalog adjustments, this adjustment has the following characteristics: First, it supports the prevention and control of the new crown pneumonia epidemic with practical actions. Incorporate the non-catalog varieties in the ongoing national new coronary pneumonia diagnosis and treatment plan into the scope of adjustment to comprehensively assist the prevention and control of the epidemic and make due contributions to the response to the epidemic.
Secondly, in terms of review procedures, for the first time, enterprises have implemented independent declarations. Starting this year, the declaration system will be adopted for the admission of drugs not listed in the catalog. Enterprises submit declaration materials as required, and those who meet the declaration conditions will be included in the scope of review after review.
Third, in terms of the scope of review, the drugs included in the review will be further focused. The scope of adjustment for drugs not in the catalog in 2020 includes 7 categories, such as drugs newly marketed from January 1, 2015 to the release of the work plan (August 17, 2020), as well as national essential drugs, drugs for the treatment of new coronary pneumonia, etc. Then, all the listed drugs are included in the review, and the scope is more focused and accurate.
The fourth is to release a signal to encourage innovation. In the 7 cases, the newly launched drugs or the drugs with major changes in indications/functions and indications during the period from January 1, 2015 to the release of the work plan (August 17, 2020) are included in the scope of review, reflecting the distinctiveness of encouraging innovation guide.
The fifth is to determine the medical insurance payment standards simultaneously. In accordance with the requirements of the "Interim Measures for the Administration of Drugs for Basic Medical Insurance", this adjustment will simultaneously determine the medical insurance payment standards through negotiation and bidding for all drugs in the new access catalog, which is conducive to improving the efficiency of fund use.
Sixth, we will continue to insist on having ins and outs and optimize and upgrade. After comprehensive consideration, drugs that are considered to be more risky than benefits, “zombie drugs” in the catalog, drugs that are generally delisted internationally, and exclusive drugs that can be replaced with high prices but unsuccessful negotiations will be transferred out of the catalog and become clinical Good medicines of high value make room.
Local reimbursement varieties are included in the national catalog to ensure safety
The reporter asked: Before December 31, 2019, the main active ingredients of the drugs listed in the latest edition of the basic medical insurance drug list at the provincial level or above were listed in the "First Batch of National Key Monitoring Drugs List (Chemical Drugs and Drugs). Biological products)” except for. Why is this adjustment made?
The person in charge answered: The newly promulgated "Interim Measures for the Administration of Medications for Basic Medical Insurance" redefines and divides the authority for adjusting the medical insurance drug catalog at the national and provincial levels. Among them, the Interim Measures canceled the previous provision that “provincial medical insurance departments can add varieties on the basis of the national medical insurance catalog, and the number of supplements does not exceed 15% of the total number of category B in the national catalog." The provincial medical insurance departments can only add varieties to Ethnic medicines, preparations for medical institutions and Chinese herbal medicines. At the same time, in order to achieve the basic uniformity of the basic drugs used in the country, the National Medical Insurance Bureau is currently pushing the provincial medical insurance bureaus to digest the original self-added varieties.
Under such a background, the varieties that have entered more than 5 provinces will be included in the scope of this year's national adjustment. Among the varieties that are mainly added at the provincial level, it is not ruled out that some varieties can meet the national access standards and better meet the patients' medication demand. Incorporating some varieties with high clinical value and being reimbursed locally in the catalog can ensure the continuity and stability of medication for these patients. At the same time, objectively it can also alleviate the pressure of local digestion of varieties.
Of course, it is undeniable that some of the drugs included in the provincial list of local adjustments in the early stage also include some drugs with inaccurate efficacy, easy to abuse, and large fund occupation. Therefore, we also stipulate that the drugs included in the national key monitoring rational use list will not be considered for transfer this year.
Give faster access to newly approved innovative drugs
The reporter asked: Compared with the draft for comments, the deadline for new drugs to be added has been significantly relaxed. What is the reason for the adjustment by the Medical Insurance Bureau?
The person in charge answered: During the process of soliciting opinions, some innovative drug companies and industry associations put forward suggestions on the deadline for new drugs. Our bureau seriously considered research and relaxed the deadline for new drugs from the end of last year to before the publication of this year's catalog adjustment plan, that is, August 17, 2020. This fully reflects our bureau's attitude of encouraging and supporting innovation. For those newly approved innovative drugs, especially those with independent intellectual property rights, faster access will be given. At the same time, including eligible new drugs into the catalog will also benefit the majority of insured patients earlier.
Innovative drugs need to be "made within one's ability" for medical insurance
The reporter asked: Under the background that the country encourages innovation, many innovative drugs hope to enter the medical insurance to achieve an increase in volume. A large number of innovative drugs have entered the catalog, what is the impact on the fund?
The person in charge answers: In recent years, with the reform of the new drug review and approval system of the drug regulatory department, my country's new drug market has accelerated significantly. At the same time, my country's drug independent research and development strength has continued to increase, and new drugs with independent intellectual property rights have also continued to emerge. From the perspective of the medical insurance department, on the one hand, we hope that more and better medicines can be marketed in the morning, enter clinical application early, be included in the payment scope, and benefit patients early. On the other hand, China is still a developing country with basic medical insurance. Financing is limited. In 2019, the per capita funding for resident medical insurance is only about 800 yuan, two-thirds of which are still derived from financial subsidies. Therefore, it is necessary to emphasize and adhere to the system positioning of "basic protection", do your best, do your best, and make the price reasonable , Drugs that are highly economical and meet basic medical needs are included in the catalog. In this year’s medical insurance drug catalog entry negotiations, we will organize experts to strictly grasp the relevant standards and conditions. We also ask the society and pharmaceutical companies to have reasonable expectations for the negotiations, and the success rate may not be very high.
In addition, according to the actual situation of our country, the solution to the availability of innovative drugs cannot rely solely on basic medical insurance. It is necessary to give full play to the functions of various supplementary insurance and commercial health insurance, and establish and improve a multi-level medical security system with Chinese characteristics. To better meet the medication needs of different levels.
According to the current schedule, if the progress goes smoothly, this catalogue adjustment will be completed before the end of the year, and we will strive to implement it from next year, so that the majority of insured persons will benefit soon.