Many experts explained in detail: Why can't I buy medicines that are covered by medical insurance in the hospital?
A few days ago, a set of data released by the Chinese Pharmaceutical Association showed that as of the third quarter of 2020, about 25% of the oncology innovative drugs included in the National Medical Insurance List in 2018-2019 were admitted to the 1,420 sample hospitals.
Why can't the innovative drugs that have entered medical insurance through "soul bargaining" be bought in the hospital?
On April 9, the China Medical Insurance Research Association convened a number of industry experts to explain this in detail and put forward suggestions.
Price reduction will not become the leading direction for drugs to enter the hospital's selection of drug catalogs
Zhao Bin, deputy director of the Department of Pharmacy of Peking Union Medical College Hospital, said at the meeting that when drugs enter a hospital’s catalog, they must first meet clinical treatment needs. This is the first factor that the hospital must consider, “especially the irreplaceability of disease treatment. Safety and comparison with existing drugs will be given key considerations, and the price reduction of drugs will not become the dominant direction in its selection."
Zhao Bin said frankly that it takes a long process for a drug to be marketed to be understood by doctors in detail.
Because the number of cases included in the pre-market research of drugs is often relatively small, the research time is relatively short, the age range of the experimental subjects is also narrow, and the conditions for drug use are very strict.
Therefore, compared with the actual needs of hospitals for applying drugs to a wide range of people, newly marketed drugs still have certain limitations, "for example, the limitations of drug effectiveness evaluation, the safety of medications for special populations, and the occurrence of rare adverse reactions. "Rate, etc.", all need to be considered.
Zhao Bin pointed out that the serious adverse reactions of many drugs were discovered only a few years after the market, with the increase in the number of users.
Therefore, it will take a long time for clinicians to objectively grasp drug effectiveness and safety information and accumulate sufficient evidence.
Shi Luwen, director of the Department of Pharmacy of Peking University, pointed out that with the normalization and standardization of my country's medical insurance access, even drugs that have just been approved can participate in medical insurance negotiations. For example, the negotiation time for national medical insurance drugs in 2020 is as of August of that year, and the negotiations are successful. Among the drugs, Zebutinib and Initumumab were just approved for marketing in my country in June 2020. “Some drugs need to use sufficient evidence to determine their actual clinical value.”
Drugs need to pass multiple tests to enter the hospital
In addition to factors such as the effectiveness and safety of drugs, the cost of drugs has also become another important factor restricting its entry into the hospital catalog.
"After the full implementation of the drug zero markup policy, drug equipment, storage, and wear have become the costs of public hospitals." Cao Zhuang, an associate researcher at the National Institute of Medical Security, Capital Medical University, said that drugs have changed from a profit factor to a cost for medical institutions. Factors that affect the willingness of medical institutions to allocate medicines.
In addition, according to relevant drug management regulations, public hospitals with more than 800 beds are required to be equipped with no more than 1,500 types of drugs, including 1,200 types of Western medicines and 300 types of proprietary Chinese medicines.
Cao Zhuang pointed out that for some hospitals that have been fully equipped, if they want to add new medicines, they need to call out a corresponding amount of medicines at the same time, which is relatively difficult and difficult.
Zhao Bin added: “Hospitals of different regions, different levels, and different locations have different disease spectrums and different treatment needs for clinical drugs. Therefore, the selection of hospital drugs is mainly related to the functional orientation of the hospital and the professional direction of clinical departments. Very close relationship. Therefore, the drug catalogs of different hospitals are also very different."
At the same time, the entry of drugs into the hospital catalogue also needs to be reviewed by the Pharmaceutical Affairs Management and Pharmacotherapy Committee (hereinafter referred to as the "Committee").
Cao Zhuang said that the setting of the committee's review procedures will also have an important impact on whether drugs can enter the hospital and the length of time it takes to enter the hospital.
Zhao Bin said: “When the doctor confirms that it needs to submit a drug application for a new drug, the clinical department of the doctor will organize a preliminary selection of experts in the department, and then submit the selection results to the hospital’s committee. The committee will review the drug’s application. New additions, eliminations, and suspension of use will be reviewed."
However, the frequency of committee meetings is not fixed.
Shi Luwen said that some hospitals are opened once a year, and some are opened once every two years. It is up to the hospital to decide.
"Dual Channel" Drug Guarantee Mechanism Alleviates the Insufficient Supply of Negotiated Drug Hospitals
According to incomplete statistics, more than 20 provincial-level medical insurance departments have issued relevant policies, implementing a "dual-channel" guarantee policy for some negotiated drugs, that is, the use and reimbursement of some high-value or special drugs for the insured persons, and the implementation of designated medical care The method of joint guarantee between institutions and designated pharmacies.
Cao Zhuang said: "This has largely solved the problem of insufficient supply of negotiated medicines in hospitals. We believe that this approach should be encouraged in areas where medical guarantees cannot be completely resolved through hospital channels."
Cao Zhuang pointed out that the "dual-channel" medication guarantee policy is a management innovation based on realistic conditions, and it is also a choice for listening to the voice of the masses and addressing reasonable needs.
The implementation of a dual-channel guarantee policy puts forward a new requirement for medical insurance management.
Many regions that implement the "dual channel" policy have established supporting management policies such as designated treatment institutions, designated responsible physicians, real-name management, and designated drug supply institutions to strengthen drug management while meeting drug demand and supply.
In addition, Cao Zhuang also believes that relevant policies and regulations should be improved to provide support for medical institutions with negotiated drugs.
There are also attempts in some areas. For example, in Yunnan Province, in order to do a good job in the implementation of negotiated drugs, the medical insurance united health department has solved the problem of difficulty in hospitalization for negotiated drugs by canceling the proportion of drugs.
China Youth Daily·China Youth Daily reporter Liu Changrong Source: China Youth Daily
Version 08, April 13, 2021