Which drugs are expected to be covered by medical insurance?
How to negotiate drug contract renewal?
Xinhua News Agency, Beijing, June 16 (Reporter Peng Yunjia) The adjustment of the medical insurance catalog is related to every insured person.
The National Medical Insurance Administration recently issued the "2022 National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog Adjustment Work Plan" and related documents for comments, which means that this year's medical insurance catalog adjustment will be officially launched.
Which drugs are expected to be covered by medical insurance?
How to renew a negotiated drug agreement after it expires?
These can be found in the work plan "answers".
More rare disease drugs, children's drugs, etc. are expected to enter medical insurance
According to the work plan, six categories of drugs outside the list can be declared for the adjustment of the 2022 medical insurance list, including new generic drugs, indications or functions approved by the State Food and Drug Administration during the period from January 1, 2017 to June 30, 2022 Medicines that have undergone major changes in attending; medicines related to the treatment of new coronary pneumonia, etc.
Compared with last year, the adjustment of the 2022 medical insurance catalogue will add children's medicines and generic medicines.
Among them, the scope of children's medicines should be in the three batches of the list of children's medicines that are encouraged to be applied for research and development issued by the National Health Commission and other departments, and the generic medicines should be in the two batches of encouraged generic medicines lists.
"More children's medicines are included in the medical insurance, which can reduce the patient's drug burden." Zou Liping, member of the Standing Committee of the Pediatric Branch of the Chinese Medical Association, believes that this will also play a guiding role in the pharmaceutical market, and encourage more companies to focus on the research and development of children's medicines, bringing good news to patients.
In the adjustment of the National Medical Insurance Catalogue in 2021, Nosinagen Sodium Injection, which was once used for the treatment of spinal muscular atrophy with 700,000 yuan per injection, was included in the medical insurance for more than 30,000 yuan after medical insurance negotiation. Pay attention.
Up to now, more than 60 drugs for rare diseases have been approved for marketing in China, of which more than 40 have entered the national medical insurance list, involving 25 diseases.
The work plan makes it clear that the rare disease treatment drugs approved by the State Drug Administration before June 30, 2022 can apply for this year's medical insurance negotiation. sick.
Categorize the renewal of the negotiated agreement for expired drugs
In the process of dynamic adjustment of the medical insurance catalog, the "soul bargaining" of drug negotiation has attracted much attention.
The medical insurance department negotiates with the pharmaceutical companies on the payment standard of the drug, and directly decides whether the drug can be included in the medical insurance and at what price according to the result.
In 2021, there will be 67 exclusive drugs outside the catalog that have been negotiated into medical insurance, with an average price reduction of 61.71%.
According to the "Interim Measures for Medication Administration of Basic Medical Insurance", the negotiated drug agreement is valid for 2 years in principle.
After the expiration of the agreement, analyze and compare the actual expenditure of the medical insurance fund during the agreement period with the impact of the budget submitted by the enterprise before the negotiation, reduce the price according to the degree of difference, and renew the agreement.
The "Rules for Negotiated Drug Renewal (Draft for Comment)" proposes three types of negotiated drug renewal rules, including routine catalog management, simple renewal and renegotiation, and provides detailed provisions for the three renewal methods.
According to the results of contract renewals in previous years, it can be found that drugs that have been successfully renewed through negotiation often have more advantages in price.
For example, in 2019, 27 drugs whose contracts were successfully renewed through negotiation saw an average price drop of 26.4%; in 2020, 14 exclusive drugs were renewed or renegotiated according to the rules, with an average price reduction of 14.95%.
Give full play to the leverage of medical insurance funds
Since the establishment of the National Medical Insurance Administration, it has carried out four consecutive negotiations on the access to the medical insurance catalogue, and a total of 250 drugs have been added to the catalogue through negotiation, with an average price drop of more than 50%.
Through negotiated price reduction and medical insurance reimbursement, the cumulative burden on patients will be reduced by about 150 billion yuan in 2021.
On the basis of adhering to the dynamic adjustment of the medical insurance catalogue, more attempts and explorations are being made to adjust the medical insurance catalogue.
The work plan proposed for the first time that the non-exclusive drugs to be included in the medical insurance catalogue should be simultaneously determined by bidding and other methods to determine the medical insurance payment standard.
The "Non-exclusive Drug Bidding Rules (Draft for Comment)" states that an enterprise's quotation cannot be higher than the provincial minimum winning bid price valid within 2 years before the application deadline and the market retail price submitted at the time of application, and the quotation should be compared with the willingness to pay for medical insurance; For non-exclusive drugs included in the medical insurance through bidding, the lowest price quoted by each company shall be taken as the payment standard for the drug.
Some experts said that this will give full play to the leverage of medical insurance funds, have a positive impact on the structure of drug use and the market price mechanism, and further reduce the burden of medication for patients.
In addition, this year's work plan clearly sets the time for the identification of exclusive drugs to be June 30, 2022, which will better achieve the "seamless connection" between new drug approval and medical insurance, and encourage new drug research and development.