Guide "sky-priced drugs" to prescribe "civilian prices" adjustments and announcements of the medical insurance catalog
The well-known "expensive drug" Nosinagen Sodium Injection, which cost 700,000 yuan per injection, was included in the new medical insurance catalog after a substantial price cut after negotiations; the annual treatment cost of daratumumab injection exceeded 1 million yuan. The negotiation dropped to less than 300,000 yuan, and it was also included in the new medical insurance catalog...
On December 3, the National Medical Insurance Administration announced the adjustment results of the 2021 National Medical Insurance Drug List.
Shi Yuankai, deputy dean of the Cancer Hospital of the Chinese Academy of Medical Sciences, interpreted the adjustment catalogue one by one. He said that through negotiations to guide these "sky-priced drugs" to reduce their own prices, coupled with medical insurance reimbursement, the burden of treatment costs for patients will be reduced a lot.
"Expensive drug costs not only bring a heavy burden to the common people, but also bring risks to the safety of the fund." Zheng Jie, head of the 2021 National Medical Insurance Negotiation Drug Fund Measurement Expert Group, said that through strict access to drugs outside the catalog, reasonable price reductions of drugs are guided With other measures, the money saved can be used to purchase more cost-effective drugs and achieve a higher level of "basic guarantee".
Reduce the cost of medicines, collect and catalogue access to negotiate "combined punches"
A reporter from the Science and Technology Daily learned from the National Medical Insurance Bureau that in 2021, the total number of drugs in the National Medical Insurance Drug List is 2,860, of which 1,486 are Western medicines and 1,374 are Chinese patent medicines.
There are still 892 kinds of Chinese herbal medicines.
This adjustment has gone through the stages of initiation, application, review, negotiation, and expert review. Among them, 74 new drugs entered the medical insurance drug list and 11 drugs were removed from the list.
In terms of guiding drug price reductions, through measures such as guiding drugs to moderate competition and price-for-quantity, the prices of 67 new exclusive drugs outside the catalogue were reduced after negotiations, a reduction of 61.71%; there were also 27 drugs in the catalogue that were successfully negotiated to reduce drug prices. .
"Some people think that negotiation is bargaining, and the lower the better. This is a misunderstanding. Fund calculations are not seeking the lowest price, but a reasonable price." Zheng Jie said that to measure specific drug prices, it is necessary to comprehensively consider reasonable drug demand and drugs. Clinical value, degree of innovation, market competition and other factors, based on evidence-based evidence, conduct a comprehensive and multi-angle scientific evaluation of drugs.
According to reports, since the establishment of the National Medical Insurance Administration, 4 national medical insurance drug negotiations have been carried out, and a set of standardized and standardized models has also been established for fund estimation.
In order to achieve continuous improvement of the medical security level of the common people on the basis of the sustainable foundation of the fund, the National Medical Insurance Administration has adopted measures such as volume procurement and catalog access negotiations to reduce the burden of drug costs.
Free cages and change birds, and timely include new and good medicines in the catalog
According to reports, in the four years since the adjustment of the national medical insurance drug catalogue, a total of 507 new drugs have been added to the scope of national medical insurance payment, and a batch of "magic drugs" and "zombie drugs" have been removed from the catalog.
In this year's catalog adjustment, there are 11 drugs in the original catalog that have low clinical value, strong substitutability, and small purchases on the national recruitment platform in recent years have been transferred out of the catalog.
Through measures such as guiding the moderate competition of drugs and changing prices by quantity, the prices of some drugs in the catalogue have been lowered again to make room for the purchase of more cost-effective drugs and successfully upgrade the drug security.
The 74 new varieties this time accurately complement the drug needs of tumors, chronic diseases, anti-infectives, rare diseases, women and children, and a total of 21 clinical groups are involved.
"A large number of newly marketed drugs are included in medical insurance. For example, many of the 18 types of oncology drugs are drugs with new targets and new mechanisms. The previous high prices were beyond the reach of many patients." Shi Yuankai explained.
For example, vomitinib, a new domestic drug for the treatment of lung cancer, was approved for marketing in March this year. It belongs to the three-representative skin growth factor receptor tyrosine kinase inhibitor drug. It is used for patients with genetically sensitive mutations caused by first-generation drugs, and it enters the medical insurance list. Allow lung cancer patients to have more choices while reducing the burden.
Abecilil tablets are the first cyclin-dependent kinase 4/6 inhibitor drugs included in the National Medical Insurance List.
By evaluating the clinical value, patient benefits, and degree of innovation of this new mechanism drug, it is included in medical insurance, so that more breast cancer patients can afford good drugs and new drugs, and through adherence to treatment, they can obtain a higher quality of life.
Say no to "expensive drugs"
According to statistics, since 2018, the Beijing Medical Insurance Fund has paid about 4 billion yuan for the National Talks, which has brought huge benefits to the people.
"But because we are still a developing country, the funding level and protection capabilities of the medical insurance fund are still very limited. As far as I know, according to the limited payment scope, the current annual treatment cost of all drugs in the national medical insurance catalog does not exceed 300,000 yuan." Zheng Jie said that in the future catalogue adjustment work, the National Medical Insurance Bureau will continue to eliminate the high-priced drugs into medical insurance.
For example, a certain anti-cancer drug of 1.2 million yuan per shot that was hotly discussed in the media some time ago was not eligible for negotiation because it was far beyond the fund's affordability and the burden level of the common people.
"The primary working principle of the catalogue adjustment work is'guarantee basic'," Zheng Jie emphasized, making full use of the limited funds to better meet the increasing medical and health needs of the people, and putting forward higher requirements for medical insurance.