China News Agency, Beijing, June 29. China's National Medical Insurance Bureau officially announced the "2022 National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog Adjustment Work Plan" and related documents on the 29th, marking the establishment of the National Medical Insurance Bureau since the establishment of The fifth round of China's medical insurance drug catalog adjustment work was officially launched.
Compared with the previous rounds of catalog adjustment, this adjustment optimizes the scope of application, and appropriately favors special groups such as rare disease patients and children.
Implementing the requirements of the "Government Work Report" to "strengthen the protection of drugs for rare diseases", there is no time limit for "approval for marketing after January 1, 2017" for the application conditions of drugs for rare diseases, and at the same time, it has been added to the National Encouraged Generic Drug List and encouraged Drugs that are developed and declared on the Children's Drug List can be declared in this year's medical insurance list.
The adjustment of the medical insurance drug catalog has improved the access method, and the payment standard is determined simultaneously when the non-exclusive drug is admitted.
Solve the problem that non-exclusive drugs cannot be included in the catalog due to the high price of individual companies.
Drawing on the principle of negotiation, experts calculate and determine the willingness to pay for medical insurance, and then the company makes an independent quotation. As long as one company participates and the quotation is lower than the willingness to pay for medical insurance, the generic name can be included in the catalog, and the lowest quotation is used as the payment standard for the generic name ( If the minimum offer is lower than 70% of the willingness to pay for medical insurance, 70% of the willingness to pay for medical insurance is used as the payment standard).
The National Medical Insurance Bureau stated that it will guide local governments to explore and improve management measures, and support the priority use of varieties under the same generic name whose price is not higher than the payment standard, effectively reducing the burden on patients and better exerting their security functions.
At the same time, this catalog adjustment has improved the renewal rules, which is more conducive to stabilizing expectations.
Include non-exclusive drugs (regardless of whether the agreement expires or not), and exclusive drugs that have gone through two agreement periods (4 years) but with no change in payment standard and payment scope into the regular catalog management; adjust the scope of medical insurance payment this year but the fund Drugs with little impact on the budget (not exceeding 1 times) can also be easily renewed.
The above approach is conducive to stabilizing the expectations of enterprises and all aspects of society.
In addition, this adjustment also optimizes the workflow, making the review more scientific and efficient.
Based on the fact that the work of the expert review link is becoming more and more mature, the data of the drug application is more comprehensive, and the review link is optimized and integrated into a joint review by experts from the comprehensive group and the professional group.
The National Medical Insurance Administration also stated that according to the current arrangement, this year's adjustment process is still divided into five stages: preparation, declaration, expert review, negotiation/bidding, and announcement of results.
If it goes well, the application will be officially launched on July 1, the results will be announced in November, and the implementation will be implemented on January 1 next year.
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