The 2020 medical insurance drug catalogue has been adjusted
Reduce the medical burden of the masses and improve the level of drug security
□ Our reporter Hou Jianbin
With the completion of the adjustment of the medical insurance drug catalogue in 2020, the burden of medical care for the people will be further reduced in the new year.
The National Medical Insurance Bureau and the Ministry of Human Resources and Social Security recently jointly issued a notice to officially print and distribute the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog (2020)" (hereinafter referred to as the "Catalog"). The "Catalog" will be launched in 2021. It will be officially implemented on March 1.
The "Catalogue" contains a total of 2,800 types of Western medicines and proprietary Chinese medicines, including 1,264 types of Western medicines, 1,315 types of Chinese patent medicines, and 221 types of drugs negotiated during the agreement period.
Xiong Xianjun, Director of the Medical Service Management Department of the National Medical Insurance Administration, pointed out that through the negotiation of the national medical insurance drug catalog entry, the medical insurance fund and the drug expenditure of the insured patients have not increased significantly. Under the premise that the fund safety is generally controllable, the medical insurance drug protection capability And the level is improved.
More importantly, it can further guide pharmaceutical companies to form a reasonable and healthy value orientation, and ultimately by supporting innovation and value purchases, it will vigorously promote the high-quality development of my country's pharmaceutical industry from the perspective of strategic purchase, and promote the deepening of the supply-side reform of the pharmaceutical industry.
Wide range of benefits
"Compared with previous years, an important feature of this adjustment is that the number of drugs negotiated for price reductions is the largest, and the treatment fields benefited the most." Xiong Xianjun said that a total of 162 drugs were negotiated, and 119 were successfully negotiated. 96 kinds outside, 23 kinds in the catalog), the success rate is 73.46%, and the average price is reduced by 50.64%.
A total of 119 new drugs (including 96 exclusive drugs and 23 non-exclusive drugs) were added to this catalogue adjustment. These drugs involve a total of 31 clinical groups, accounting for 86% of all clinical groups, and patients benefit from a wide range of products. The patient's sense of gain will be stronger.
According to reports, different from the previous rounds of adjustments that included "all marketed drugs" in the scope of review, the declaration system will be implemented for the first time in 2020, that is, drugs that meet the conditions listed in the adjustment plan can be included in the scope of adjustment.
The adjustment scope of drugs outside the catalogue has been transformed from "sea selection" to "preferred".
According to the "2020 National Medical Insurance Drug List Adjustment Work Plan", the adjusted non-listed drugs mainly include 7 categories: drugs for the treatment of respiratory diseases related to new coronary pneumonia; drugs included in the "National Essential Drug List (2018 Edition)"; related The department included in the list of urgently needed new drugs overseas, encouraged the catalog of generic drugs, or encouraged the development and application of drugs in the children’s drug list; included the drugs that were successfully collected in the national centralized procurement scope; drugs approved for marketing after January 1, 2015, and January 2015 Drugs with major changes in indications, functions and indications after January 1.
At the same time, "drugs included in the catalog of 5 or more provincial medical insurance drugs" are included in the adjustment scope.
Xiong Xianjun said that for drugs not in the catalogue, in reviewing, calculating, and determining the scope of payment for medical insurance funds, all factors such as the current level of my country’s economic and social development, medical insurance funds and the affordability of insured persons have been comprehensively considered, and the settings conform to the "basic insurance" "Positioning technical standards to ensure that the negotiated payment standards meet expectations.
For the drugs in the catalog, experts are specially organized to review, negotiate and reduce prices for the products that have not been negotiated into the catalog and have high prices or costs, and guide the payment standards for the drugs in the catalog to gradually return to reasonable.
Xiong Xianjun pointed out that in accordance with the requirements of "doing our best and doing what we can", this adjustment has established the adjustment ideas of "highlighting key points, filling shortcomings, optimizing structure, and encouraging innovation", and strive to achieve a more optimized drug catalog structure and use of medical insurance funds. More efficient, basic medical insurance drug protection capabilities and higher level goals, to better meet the basic drug needs of the majority of insured persons, and help solve the people's worries about seeing a doctor.
Squeeze the price of water
According to reports, this catalogue adjustment adheres to the functional positioning of "guarantee basic" to ensure that the medical insurance fund expenditure is controllable.
Xiong Xianjun said that in the catalog adjustment process, adhere to the basic principle of "do everything possible to guarantee the basics and always adhere to the sustainability", firmly grasp the functional positioning of "basic protection", and negotiate to reduce the costs in the catalog by calling out drugs with low clinical value. Obviously high prices of drugs and drugs that have expired in special negotiations, especially in recent years, have concentrated on purchasing "quantity for price" to further squeeze the price of drugs, achieve "free cages for birds" and ensure a basic balance of funds.
At the same time, it also tried for the first time to negotiate a price reduction for the drugs in the catalog, which significantly improved the economy.
It is understood that the review experts selected 14 exclusive drugs with high prices or costs and a large amount of funds for price reduction negotiations. The annual sales of these drugs exceed 1 billion yuan.
After negotiation, the 14 drugs were successfully negotiated and kept in the catalog, with an average price reduction of 43.46%.
Xiong Xianjun pointed out that this adjustment attaches great importance to the protection of drugs related to the treatment of new coronary pneumonia. Ribavirin injection, Abidol granules and other drugs have been added to the catalog. The drugs listed in the latest version of the national new coronary pneumonia diagnosis and treatment plan have been included. National Medical Insurance Drug List.
In addition, in order to better meet the needs of patients for newly-listed drugs, the drugs that will be marketed before August 17, 2020 are included in the adjustment scope, and finally 16 drugs are included in the catalog.
In this adjustment, 29 drugs were removed from the catalog.
Xiong Xianjun said frankly that the drugs brought out of the catalog are mainly of low clinical value and can be substituted, or have been revoked by the drug regulatory authority to become "zombie drugs" and other varieties.
“The recall of these drugs has been repeatedly demonstrated by experts and determined in strict accordance with the procedures.” During the review process, the experts took substitutability as an important indicator, and all the drugs that were recalled had equivalent or better curative effects. Good medicine can be substituted.
At the same time, the release of these drugs has made room for more new and good drugs to be included in the catalog.
Ensure fairness
According to preliminary calculations, price cuts through negotiations and the catalogue are recalled to make room for the fund.
Xiong Xianjun said that in the process of catalogue adjustment, the National Medical Insurance Administration strictly controlled the economics of drugs. Most of the newly added 119 drugs were exclusive drugs that were negotiated to achieve price reductions. It is expected that the increased fund expenditures in 2021 will be negotiated and transferred. The space vacated is basically the same.
From the perspective of patient burden, through negotiation of price reduction and medical insurance reimbursement, it is expected that the cumulative burden of patients will be reduced by about 28 billion yuan in 2021.
How to ensure fairness and justice in the adjustment of the medical insurance drug catalogue?
In this regard, Xiong Xianjun pointed out that the National Medical Insurance Administration attaches great importance to strengthening the construction of the supervision mechanism in the adjustment of the medical insurance drug catalogue. On the one hand, it has formulated clear system measures for experts, staff and corporate personnel in response to the risk points that are prone to catalog adjustments. Prevent risks at the source.
On the other hand, in determining the list of experts, assigning calculations, and negotiating tasks, strictly adhere to the principle of benefit avoidance and randomness, and all experts are randomly selected.
Experts are required to be on-the-job, and each expert only participates in one session.
Expert review, calculation and other links are fully closed.
In addition, actively accept the supervision of all parties and accept complaints and reports from all walks of life.
The adjustment of the catalogue invites the media, discipline inspection and supervision and other parties to participate. The whole negotiation process is recorded and recorded, so that all evidence can be traced and all parties can appeal.