A batch of good medicines and new medicines are coming to us
The adjustment of the National Medical Insurance Catalog is unprecedented, and it is the first attempt to negotiate a price reduction for the drugs in the catalog.
In the future, the annual adjustment of the medical insurance drug catalog will become the norm. It is expected to further expand the breadth and depth of medical insurance in terms of "cost-effectiveness", effectively reduce the financial burden of patients, and let the people enjoy the reform results.
A few days ago, the National Medical Insurance Bureau and the Ministry of Human Resources and Social Security announced the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog (2020)" (referred to as the "Catalog").
In this adjustment, 119 kinds of medicines were transferred, 29 kinds of medicines were transferred out, the final "Catalogue" has 2800 kinds of medicines, of which 1426 kinds of Western medicines, 1374 kinds of Chinese patent medicines, the ratio of Chinese and Western medicines is basically the same.
The new version of the "Catalogue" will be officially implemented on March 1 this year.
The adjustment of the National Medical Insurance Catalog is unprecedented, and it is the first attempt to negotiate a price reduction for the drugs in the catalog.
A total of 162 drugs were negotiated, the most in history.
The newly transferred drugs include 96 exclusive drugs and 23 non-exclusive drugs, involving a total of 31 clinical groups, accounting for 86% of all clinical groups.
Experts said that the new shortlisted drugs have achieved "higher cost performance" in terms of price reduction and clinical effects.
What impact will the adjustment of the National Medical Insurance Catalogue have on the common people?
The reporter interviewed relevant persons in charge, experts and business people of the National Medical Insurance Bureau.
Drug prices dropped sharply
The National Medical Insurance Bureau stated that in this adjustment of the Catalog, a total of 162 drugs were negotiated, 119 drugs were successfully negotiated, with a success rate of 73.46%, and the average price of the drugs successfully negotiated was reduced by 50.64%.
Take the most concerned anti-cancer drugs as an example. In 2018, the National Medical Insurance Bureau organized special access negotiations for anti-cancer drugs. In the end, 17 drugs were successfully included in the list through negotiations, and the agreement expired at the end of 2020; 14 exclusive drugs were in accordance with the rules The contract was renewed or negotiated again, with an average drop of 14.95%, and individual first-line anticancer drugs dropped by more than 60%.
"According to estimates, the price reduction of 14 anticancer drugs is expected to save cancer patients more than 3 billion yuan in 2021. This adjustment adds 17 new anticancer drugs, including new drugs and good drugs such as lenvatinib, and cancer in the catalog The level of protection for medication has been significantly improved.” Xiong Xianjun, Director of the Medical Service Management Department of the National Medical Insurance Administration, said that the successfully negotiated drugs involved 31 clinical groups, accounting for 86% of all clinical groups, and patients benefited very broadly.
"The new oncology drugs newly launched in 2020 are all newly listed mainstream drugs in the past two years and have clear clinical indications." Shi Yuankai, vice president of the Cancer Hospital of the Chinese Academy of Medical Sciences, said that the "Catalogue" basically covers cancers in all major organs. The mainstream treatment drugs, common lung cancer and breast cancer drugs have increased, and some uncommon tumors have also available drugs.
When talking about medications for children, Ji Xiaohua, chief physician of the Pediatrics Department of Xiyuan Hospital of the Chinese Academy of Chinese Medical Sciences, said that a total of 7 pediatric medications were included in this medical insurance negotiation. The safety and effectiveness of the medications were fully considered, and the medications were mainly oral liquids and granules. , Easy for patients to take.
The supplemented children's medications are the most commonly used clinically. Since the respiratory and digestive diseases of the pediatric clinic account for a large proportion, this adjustment of medication is specifically included for these two diseases.
The National Medical Insurance Bureau estimates that most of the newly added 119 drugs are exclusive drugs that have been negotiated to achieve price reductions. It is expected that the increased fund expenditures in 2021 will be basically equivalent to the space vacated by negotiations and the transfer of drugs.
On the other hand, from the perspective of patient burden, through negotiation of price cuts and medical insurance reimbursement, it is expected that the cumulative burden of patients will be reduced by about 28 billion yuan in 2021.
Economical improvement of medical insurance
The reporter learned from the National Medical Insurance Bureau that from October to December 2020, on the basis of enterprise declarations, the National Medical Insurance Bureau established a database for review drugs.
Go through the expert review stage to the negotiation stage to conduct calculations on the drugs to be negotiated.
During the period, enterprises were invited to communicate face-to-face one by one, fully listened to their opinions and suggestions, and organized negotiation experts to carry out their work intensively.
"To put it simply, it is to guide pharmaceutical companies to give the lowest acceptable price under the negotiation rules." said Gong Bo, director of the Pharmaceutical Price and Bidding and Purchasing Department of the Shanghai Medical Security Bureau, and must not neglect to participate in insurance because of personal sympathy. The negotiating responsibilities of personnel striving for the greatest concession should never be "stopped" in the negotiation.
"Our fund measurement team tries to comprehensively and comprehensively consider various factors in the calculation process, broaden the breadth and depth of calculation, objectively evaluate and evaluate the true value of negotiated drugs, while taking into account the affordability of the fund to give a reasonable negotiated price , In order to protect the basic medical needs of the people, so that most patients can enjoy the results of the negotiation of drugs." said Zheng Jie, director of the Beijing Medical Insurance Center and leader of the National Medical Insurance DRG Payment Technology Steering Group.
In fact, the drug negotiations set the application conditions to prepare for a rainy day: one is to better meet clinical needs, and the other is to better integrate with new drug approval work, to achieve a "seamless connection" between drug approval and medical insurance review, reflecting the encouragement of new drug creation The third is to take care of the continuity of clinical medication.
Even for the drugs in the original catalog, the economy must be continuously improved.
A feature of this negotiation is the first attempt to negotiate a price reduction for drugs in the catalog.
According to the procedures, the review experts selected 14 exclusive drugs with high prices or costs and a large amount of funds for price reduction negotiations. The 14 drugs were successfully negotiated and retained in the "Catalog", with an average price reduction of 43.46%.
Xiong Xianjun said: "It will become the norm for my country to carry out the adjustment of the medical insurance drug catalog every year, and expand the breadth and depth of medical insurance in terms of'cost-effectiveness'."
Support new drug declaration
It is worth noting that in order to better meet the needs of patients for newly-listed drugs, the adjustment of the medical insurance catalogue will include all drugs that will be marketed before August 17, 2020, and 16 newly-listed drugs in 2020 will be included in the "Catalogue" ".
The business community said that this negotiation has released a clear orientation of supporting new drugs and focusing on the needs of patients. While ensuring that patients can use reduced-price drugs, they have also made efforts to ensure that patients can use new drugs in a timely manner, which has further encouraged companies. The confidence to develop new drugs.
"Everyone knows how difficult it is to innovate, especially making original innovative drugs more difficult-the drug development cycle takes at least ten or even decades; high investment, high risk, and long return on investment cycle. If you can't enter medical insurance in time, It will seriously affect the development and even survival of pharmaceutical companies." Huang Yuesheng, chairman of Beijing Wuhe Boao Pharmaceutical Co., Ltd., the holder of the total alkaloids listing license, said that the "catalog" has been adjusted to implement the enterprise declaration system, and the channels are more smooth Efficient.
Thanks to the reform of the policy to adjust the medical insurance catalogue in 2020, the new blood sugar lowering drug "Mulberry total alkaloids" is fortunate to become one of the few varieties that was approved that year and entered the national medical insurance policy that year.
Huang Yuesheng said: “Although the price of the product was lowered as soon as it was launched, as a corporate representative, I still felt the recognition and strong support given by the National Medical Insurance Bureau and experts to innovative drugs. We are willing to invest in the market with meager profits to promote the healthy development of the industry.”
"Medical insurance negotiations and related supporting policies are aimed at giving companies a stable expectation of price-for-quantity. While lowering drug prices, reducing the financial burden of patients, and reducing the pressure on medical insurance funds, it also provides companies with reasonable profit margins for continuous innovation and development. For example, Huang Bin, vice president of AstraZeneca Pharmaceuticals China, said that AstraZeneca’s osimertinib tablet is a third-generation targeted drug for the treatment of non-small cell lung cancer, which has obvious clinical advantages over previous products.
After successfully passing two rounds of medical insurance catalogue negotiations for new indications in 2018 and 2020, the current domestic price of osimertinib tablets is far lower than other countries and regions, which fully reflects the commitment to benefit patients as much as possible .
(Economic Daily-China Economic Net reporter Wu Jiajia)