Medical insurance catalog adjustment, new coronary pneumonia related treatment drugs and clinically urgently needed innovative drugs are included in the scope of application

  Please come in for life-saving medicine "Zombie medicine" please go out

  Recently, the National Medical Insurance Administration initiated the adjustment of the medical insurance catalog, proposing to include drugs for the treatment of respiratory diseases related to new coronary pneumonia, the second batch of nationally organized drugs for centralized procurement, and innovative drugs that are urgently needed in clinical applications.

At the same time, after comprehensive consideration, drugs that are assessed 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. Catalog, make room for good drugs with high clinical value.

  According to the work plan, this round of adjustments is divided into the preparation phase, the declaration phase, the expert review phase, the negotiation and bidding phase, and the results announcement phase.

It is currently in the declaration stage, and the much-watched negotiation and bidding stage will take place from October to November.

  This year's medical insurance drug catalog adjustment will still consider the functional positioning of basic medical insurance, the clinical needs of drugs, and the affordability of funds.

Compared with the previous rounds of catalog adjustments, the relevant person in charge of the National Medical Insurance Bureau pointed out that this year will include the non-catalog varieties in the national new coronary pneumonia diagnosis and treatment plan that is being implemented into the adjustment scope.

  The reporter learned that as of the end of July this year, medical insurance had settled 173,000 diagnosed and suspected patients with new coronary pneumonia, and the settlement cost was about 1.8 billion yuan, of which 1.27 billion yuan was spent on basic medical insurance.

At the same time, localities have included the cost of new coronary pneumonia testing into the scope of medical insurance payments, and paid for eligible patients.

The person in charge said that the inclusion of new coronary pneumonia treatment drugs in the scope of declaration will support the prevention and control of the epidemic with practical actions.

  In addition, drugs included in the 2018 edition of the Essential Drug List, included in the list of urgently needed overseas new drugs, encouraged generic drug lists, or encouraged to research and develop drugs for the children's drug list, can be declared and transferred to the medical insurance list.

  The person in charge revealed that in recent years, more and more innovative drugs have accelerated into the market.

From the perspective of medical insurance, it is hoped that valuable innovative drugs can be included in medical insurance as soon as possible.

However, the financing of basic medical insurance in my country is limited. In 2019, the per capita financing of resident medical insurance is only about 800 yuan, of which two-thirds is also derived from financial subsidies. The required drugs are included in the list.

  The reporter noticed that in the past, the medical insurance catalogue was adjusted and the threshold for drug access was generally as of the end of the previous year.

For the first time this year, the time has been extended to the day the plan was announced, which is August 17.

This means that newly approved drugs, especially innovative drugs with independent intellectual property rights, have faster access opportunities.

At the same time, including eligible new drugs into the list will also benefit the majority of insured patients earlier.

  The newly promulgated "Interim Measures for the Administration of Drugs for Basic Medical Insurance" cancels the previous requirement that "provincial medical insurance departments can add varieties on the basis of the national medical insurance catalog, and the number of supplements shall not exceed 15% of the total number of category B in the national catalog." The items that can be added by the provincial medical insurance department are limited to ethnic medicines, preparations for medical institutions, and decoction pieces of Chinese medicine.

  It is understood that at present, the National Medical Insurance Administration is pushing the provinces to digest the originally supplemented drugs.

In this catalog adjustment, drugs that have entered the latest edition of the provincial-level basic medical insurance drug catalogue are included in the adjustment scope. The main consideration is that some provincial-level supplements may meet the criteria for inclusion in the national medical insurance drug catalog.

Including these drugs with high clinical value and being reimbursed locally can guarantee the continuity and stability of medications for relevant patients.

  The medical insurance catalogue is adjusted, and it will also be recalled as it is imported.

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.

  Our reporter Li Danqing