Aunt Li, 62, is a patient with psoriasis. She has been sick since she was 8 years old and has a medical history of more than 50 years.
Adalimumab injection has a good therapeutic effect on Aunt Li’s psoriasis, but this medicine is more expensive, 7900 yuan per piece. Aunt Li is only willing to use it when her condition is severe, and stop the medicine when her condition is relieved. , Resulting in repeated illnesses.
In January 2020, the doctor told Aunt Li that Adalimumab injection was included in the medical insurance, and the cost of each injection was reduced to 1,290 yuan. After the medical insurance was reimbursed, Aunt Li only had to pay more than 200 yuan.
"I need to use two bottles per month. After calculating it, I only need to pay more than 500 yuan a month." Aunt Li said, "Because my disease is a chronic disease. Caused other serious complications. Since the reimbursement, I have been treated according to the regular dosage, the current condition has been completely controlled, and the inspection indicators have basically returned to normal."
In 2018, the National Medical Security Administration was established, and my country's medical insurance drug reform has entered a new stage. Aunt Li is one of many patients who benefited.
Medical insurance drug reform through a series of measures such as the promotion of national centralized procurement of drugs and optimizing the national medical insurance drug catalogue, let 433 new drugs and good drugs enter the medical insurance catalogue, with an average price reduction of 54%, and 183 drugs with inaccurate curative effects and easy clinical abuse were removed from the catalogue. , To provide the people with better quality, fairer and more effective drug protection, and effectively benefit every patient.
On November 3, the Chinese Pharmaceutical Association and the China Medical Insurance Research Association jointly issued the "Blue Book on the Progress and Effectiveness of China's Medical Insurance Drug Administration Reform" (hereinafter referred to as the "Blue Book") in Beijing.
The "Blue Book" analyzes the clinical use of drugs in 804 sample hospitals in China since 2015, revealing the changes in the clinical use of drugs in hospitals after the implementation of the medical insurance drug reform policy.
Based on this, it can be seen that the medical insurance reform has brought various benefits to the common people for medical treatment and medication.
Raise the level of outpatient medication protection for hypertension and diabetes, benefiting more than 100 million people
As a major livelihood project, medical insurance reform will inevitably involve the prevention and treatment of cardiovascular disease and diabetes, which has a large number of patients in my country.
In 2019, the government work report clearly pointed out that the prevention and treatment of common chronic diseases should be carried out, and outpatient drugs such as hypertension and diabetes should be included in the medical insurance reimbursement.
In the same year, the National Medical Insurance Administration, together with the Ministry of Finance, the National Health Commission, and the State Food and Drug Administration issued the "Guiding Opinions on Improving the Guarantee Mechanism for Outpatient Use of Hypertension and Diabetes for Urban and Rural Residents", clearly including diabetes and hypertension medications into outpatient insurance coverage.
At present, the National Medical Insurance Administration is advancing the special action to protect the "two diseases" (hypertension and diabetes) outpatient medication. The number of benefit recipients has exceeded 100 million, and the reimbursement ratio within the policy range has continued to stabilize at more than 50%.
The "China Cardiovascular Health and Disease Report (2020)" shows that the prevalence of cardiovascular disease in China is on the rise. It is estimated that the number of cardiovascular disease patients is about 330 million, of which 245 million are hypertension.
Cardiovascular disease ranks the first cause of death among urban and rural residents in my country.
The "Blue Book" shows that the use of cardiovascular drugs in the first quarter of 2021 in the surveyed hospitals increased by 50% compared to the first quarter of 2015, while the use of cardiovascular drugs in the same period decreased by 5.2%.
Liu Huiyang, an expert from the Science and Technology Development Center of the Chinese Pharmaceutical Association, analyzed at the "Blue Book" press conference that the use of drugs has increased significantly, but the amount of use has not increased but decreased. "This shows that the price of cardiovascular disease drugs has dropped significantly. More patients are protected with less money".
In April this year, the Chinese research team published the latest Chinese diabetes epidemiological survey article online in the top international medical journal "British Medical Journal".
The survey results show that the total prevalence of diabetes in Chinese adults is 12.8%, and the total number of diabetic patients is about 129.8 million.
According to the "Blue Book", the use of diabetes drugs in the first quarter of 2021 increased by 85.2% compared with the first quarter of 2015. Liu Huiyang analyzed: "This shows that the availability of medications for patients has increased, and more patients have received effective medications. At the same time, the increase in the amount of medicines was 48.1%, "this shows that the average price of medicines has fallen."
After the establishment of the National Medical Insurance Bureau, it has organized five centralized drug purchases.
Among them, 21 kinds of hypertension drugs were purchased, accounting for more than 50% of the market size of antihypertensive drugs. The price of the most widely used amlodipine besylate tablet was reduced by 79%, and the annual treatment cost was reduced from 300 yuan to 60 yuan, which greatly improved hypertension. The treatment rate and treatment standardization.
There are 15 types of diabetes medications, and the amount involved accounts for more than 60% of the oral hypoglycemic drug market. After collection, the average price is reduced by 69%. The most widely used metformin hydrochloride tablet is reduced by 53%; the original drug Acarbose from Bayer, Germany, The price before centralized procurement was 1.3 yuan/piece, and after centralized procurement, the price fell to 0.18 yuan/piece, a drop of 86%.
The China Medical Insurance Research Association has analyzed the effectiveness of medical insurance medication management since the establishment of the National Medical Insurance Bureau and found that more than 90% of patients with "two diseases" use catalog drugs, and the cost covers more than 70%. The medication needs of patients with "two diseases" have been met. More comprehensive protection.
Centralized national procurement has significantly increased the availability of new life-saving drugs such as anti-cancer
On November 14, 2018, the Fifth Meeting of the Central Deep Reform Commission approved the "National Organization of Drug Centralized Procurement Pilot Program." +7", my country's drug collection work has thus kicked off.
Up to now, the state has organized five batches of centralized procurement, covering a total of 218 kinds of medicines. The average price of medicines has dropped by over 50%, and the accumulated cost saved is about 250 billion yuan.
Tumor drugs are the focus of attention in centralized procurement.
Leng Jiahua, deputy chief physician of Peking University Cancer Hospital and director of the Medical Insurance Service Department, said that before the national centralized procurement work did not include many new cancer drugs in the medical insurance list, the field of cancer treatment often faced the situation of "skillful women can't cook without rice."
In recent years, cancer treatment is developing in the direction of precision medicine. Innovative drugs such as biological targeted therapy, immunotherapy, and cell gene therapy are increasing. However, most of the cancer drugs in the previous medical insurance catalog in my country are still in the stage of cytotoxic drugs.
Leng Jiahua said that even though the clinical guidelines for many tumors are constantly being updated, and innovative drugs are clearly recommended, patients are often not in urgent need due to the three major obstacles of high price, irregular clinical use path and limited market. "Even high-income patient groups with strong financial ability to pay are unable to use innovative drugs."
The "Blue Book" shows that in the first quarter of 2021, the use of anti-cancer drugs increased by 126.6% compared with the first quarter of 2015. In addition, monoclonal antibodies and protein kinase inhibitors have increased sharply since 2019, while anti-metabolic, plant-based The use of traditional chemotherapeutics such as alkaloids has rapidly declined since 2019.
Liu Huiyang analyzed that new anti-tumor drugs continue to enter medical insurance, partially replacing traditional chemotherapy drugs, and the level of drug protection for cancer patients has been significantly improved.
Leng Jiahua cited the field of colorectal cancer he was engaged in as an example. Before the national organization of centralized procurement, there were only cytotoxic drugs in the medical insurance catalog, and no targeted drugs were available. After the centralized procurement began, the medical insurance catalog had included patients’ information. First-line, second-line and third-line targeted therapy drugs.
In terms of price, taking the tumor treatment drug gefitinib as an example, the pre-collection price was 132 yuan/tablet, and the annual treatment cost was as high as 47,000 yuan. After the collection, the price dropped to an average of 41.8 yuan/tablet, a decrease of 69%. The annual treatment fee is controlled at about 15,000 yuan. After the medical insurance is reimbursed, the individual patient only bears about 6,000 yuan, which greatly reduces the burden.
The "Blue Book" shows that in 2018, the national centralized procurement negotiations succeeded in 17 anti-cancer drugs. In the first quarter of 2021, the consumption of these 17 drugs increased by 25.8 times compared with the previous quarter of the negotiation (the third quarter of 2018). The amount has only increased by 8.8 times.
Leng Jiahua said: "With the establishment of the National Medical Insurance Administration and the establishment and gradual improvement of the dynamic adjustment mechanism of the medical insurance drug catalog, the introduction of a large number of good medicines for first aid has optimized the catalog structure and improved the medical ecology."
Rare disease patients and children and other special populations have increased the level of drug protection
Cao Xi’s mother suffers from Huntington’s disease and has lost the ability to take care of herself. “I need to take care of my father to eat, change clothes and take a bath, and I need to sit in a wheelchair when I go out.” Huntington’s disease is a rare disease. Onset in 2011, showing symptoms of exercise, cognition and mentality.
The disease has an insidious onset and slow progress. It is mainly characterized by choreography-like movements with progressive cognition, mental dysfunction and eventually dementia. Patients usually die 15-20 years after the onset.
In May 2020, deuterium tetrabenazine for the treatment of Huntington’s disease was officially approved for marketing in China through the priority review and approval process. Cao Xi said: “At the time, we were very worried that if the price of this drug is the same as that of the United States (1 box of 3 More than 10,000 yuan, only enough for 100 days), without a medication guarantee policy, ordinary people will definitely not be able to use it."
In December 2020, the new version of the National Medical Insurance Catalogue was released, and deuterium tetrabenazine was included.
Cao Xi said that when seeing this catalog, the patients were very excited. They felt that their lives had turned for a better time and they saw hope.
At present, the drug is available in more than 20 provinces (autonomous regions and municipalities) across the country. "Patients in these places have effectively enjoyed the benefits of medical insurance."
With the adjustment of the national medical insurance catalogue, more and more rare disease drugs are included in the medical insurance catalogue, and the coverage of rare diseases has also increased significantly.
The 2020 medical insurance catalog contains 45 rare disease drugs, covering 22 rare diseases.
The "Blue Book" shows that compared with the 2009 version of the medical insurance drug catalog, the number of rare disease drugs included in the 2020 version of the medical insurance catalog has increased by 105%, and the number of rare diseases covered has increased by 69%.
The "Blue Book" shows that in 2020, the 2019 version of the medical insurance drug catalog will be implemented. In the sample of children's specialty hospitals, the proportion of medical insurance drugs used has increased significantly, as high as 85.3%.
The consumption of medical insurance drugs in children's specialty hospitals has increased significantly, and the consumption in the first quarter of 2020 will account for 79.4%.
The design and implementation of medical insurance policy reforms have fully considered the medication needs of special populations such as patients with rare diseases and children, and more and more related drugs have been included in medical insurance.
Medical security is a major institutional arrangement for reducing the burden of medical care, improving people's livelihood and welfare, and maintaining social harmony and stability. It is an important part of the national governance system.
Since 2018, the new round of medical insurance reform has been underway for three years, and the reform has achieved remarkable results, highlighting the initial aspiration and fundamental adherence to the "people-centered" in the medical insurance reform process, and safeguarding the fundamental health rights and interests of the majority of the people.
China Youth Daily·China Youth Daily reporter Liu Changrong Source: China Youth Daily
November 09, 2021 08 Edition