2020 health insurance directory adjustment order how to view will change, change and unchanged.

Author . . . On August 3rd, the State Health Insurance Administration issued the Work Programme for the Adjustment of the National Health Insurance Drug Catalog 2020 (Draft for Comments) for public comments.
highlight of the draft is the inclusion of more innovative drugs, including domestically produced and imported.
3, 5 and 7 of the seven new drugs to be added, can be targeted at new drugs.
some of the new drugs to be added are: Article 3, included in the list of new drugs in urgent clinical need abroad, encouraging the catalog of generic drugs, or encouraging research and development to declare the list of children's drugs, and by December 31, 2019 by the State Drug Administration approved the listing of drugs.
Article 5. Between 1 January 2015 and 31 December 2019, drugs (including new active ingredients, new dosage forms) approved for market by the State Drug Administration in accordance with the application procedure for the registration of new drugs.
6. Between 1 January 2015 and 31 December 2019, supplementary applications and approvals are made to the State Drug Administration based on the results of clinical trials for drugs with significant changes in adaptive disorders, functional treatment, etc.
7. By December 31, 2019, drugs entering the latest provincial medical insurance drug catalogues at or above the provincial level.
, the main active ingredients were included in the "first batch of national key monitoring rational drug catalogue" except.
by the health insurance directory adjustment widely solicited views of the east wind, the author on the scope of the adjustment of the health insurance directory to make some constructive comments.
One, new not new enough, old enough old this catalog adjustment, the domestic biological similar drugs is a dose of support, the new drugs approved by the State Drug Administration to market the latest date set for December 31, 2019, there will be a part of the pharmaceutical companies, products affected by this, which reflects the health insurance sector on drug safety, efficacy need to do observation of caution, revealed the health insurance sector on drug price reduction, price need to be careful.
so-called "new is not new enough", but the reality is that there is a need.
this catalog adjustment, for traditional Chinese medicine, some old medicine did not see obvious benefits.
the same time, the last catalog adjustment of 148 new drugs, the proportion of traditional Chinese medicine is not small.
Every catalog adjustment to straighten out the budget, cage for birds, this time can include how many traditional Chinese medicine, but also look at the medical insurance drug cost expenditure pressure, traditional Chinese medicine not included in the catalog price reduction performance and how many drugs were cleared out of the catalog and other factors.
the author believes that catalog adjustment should also pay attention to the old drugs in and out.
, should keep the old, should seek change immediately after the previous continue, why say catalog adjustment should also pay attention to include old drugs? First, from the sample economic comparison, no new drug is easier to see than the old drug, reliable evaluation.
say that we didn't pay much attention to the economics of medicine in the past, and we didn't know much about old drugs.
's an excuse.
, from the point of view of inventory change and incremental change, the efficiency potential of stock change must be greater than the increment.
our catalogue is not eleven or twenty-two years old, is suitable for looking back, often look back.
, in a sense, it's more exciting to call up a catalog than to move it into a catalog (we're not a drug company, of course).
some pharmaceutical companies look lively is also dark), this is a detox, metabolic process.
health insurance catalog is a very realistic platform, than the number of drugs in the base drug catalog out of several times, is normal.
but the health-care directory is now so big, it may be bigger after the 2020 adjustment, is there any water in it? The so-called water cargo, in fact, is that the evaluation of pharmaceutical economics is lower than similar drugs, or belong to the clinically not recognized and not used drugs (technology is really not good), or clinically not recognized but a large number of drugs used (technology is OK, drug economy is very poor).
believe that can pass the five-pass, into the three expert team of the eye of the directory of new drugs, the chances of shipping water is small, even out, but also tend to be "technology seems to be very good, in fact, not necessarily" this situation.
Three, aim fine, embrace innovation in the sixth case, specifically referred to "according to the results of clinical trials to the State Drug Administration to supplement the application and approval, adaptation, functional treatment and other major changes in the drug", according to the degree of far-fetched from low to high, can be understood as: First, reflect the convenience of the adjustment of the scope of medical insurance payments, encourage enterprises to develop adaptation, encourage old drug innovation, drug research and development;
the international comparison of Professor Ding Jinxi's research at the Chinese Pharmaceutical University, the paper introduces IBP based on adaptive disorders.
that the same drug has multiple adaptations into medicare reimbursement, corresponding to different payment criteria (and sales price).
this approach has some reference significance.
the initial phase of the trial, in order to simplify logic, it is recommended that post-entry adaptations be eligible for the same or lower payment standards, unless the enterprise can provide reasonable advice on pharmaceutical economics.
However, due to the current medical insurance, health administrative departments on clinical false prescriptions, fabricated adaptation control still have a certain risk of leakage, it is recommended that enterprises can provide reasonable advice on pharmacoe economics and achieve higher payment standards in post-consequenation, enterprises should also be required to provide serious clinical treatment path guide program, pending approval or filing of health administrative departments to enjoy the claim of payment standards, and abuse of liability.
fourth and third medical linkage, the market linkage above a specific analysis of the application of IBP model, has been the drug supervision, medical insurance, medical departments linked together.
from this catalog adjustment of many provisions, but also closely in line with drug regulatory approval, medical clinical needs.
ultimate goal is to put more good medicines, new ones on the health insurance market, hospital stocks, doctor's prescriptions and patient use, with a people-centric focus.
, is there any linkage between market subjects? In fact, there are, enterprises, products between both competition contradictions and price dependence.
example: catalog of new drugs this time to be "soul cut prices", so that drug prices than the stock of some drugs have not been cleared, not good evaluation of the evil, is a contradiction.
old medicine expensive, the new medicine must want to be more expensive, but also contradictory.
Fifth, recruitment and integration, dynamic adjustment in the past, we have been moving towards the "recruitment of one, volume price linkage" with the direction of volume procurement, also did not stop to rest, this time clearly will be "the second batch of national organizations in the centralized procurement of drugs selected drugs" into the health insurance catalog, is a matter of good name.
, it is inevitable that the centralized procurement of drugs will be further expanded to the scope of all drugs, but it may not be directly related to entering the medical insurance catalogue.
the current health insurance directory adjustment on time, is to promote the dynamic adjustment of the directory the best practice statement.
directory dynamic adjustment, is good at sports warfare enterprises is a long-term good.
First, into the new health insurance catalog, is the product's goodwill endorsement;
long-term mechanism, the wide-angle lens first talks about the directory adjustment and the mutual promotion of medical insurance and relief mechanism for serious and serious diseases.
example, Professor Hua Shucheng, a representative of the National People's Congress and president of Bethune First Hospital at Jilin University, suggested that the health care department include painkillers for terminal cancer patients in health insurance and fully reimburse them to reduce their financial burden.
this example is very attractive at first look.
after several national organizations of anti-cancer drug health insurance negotiations into the catalog, some people suffering from serious and serious diseases only use the previous one-fifth of the out-of-own, out-of-own costs, can eat "life-saving drugs."
people's interests as the center, around the terminally ill, the price of painkillers should be concerned.
but these painkillers are not all new drugs, there are many even in the specific medical institutions of the drug catalog is the only, only two drugs, then it is difficult to enter the timely purchase of the pilot.
but these painkillers are the core medicine in the medical insurance and relief mechanism for serious and serious diseases, the just-needed medicine, and the window paper for the reform to have a total effect.
talk about catalog adjustment and exclusive enterprises, products is not to reduce the price of the confrontation and find another way.
If there are some drugs, such as the above-mentioned advanced malignancies used painkillers, for many years to maintain a high price, is not willing to negotiate, bargain, is not to reduce prices, keep gold.
then, it or they must have a drug economics evaluation loophole.
under the laser of the three doctors, there is no escape.
, on the one hand, strictly restrict prescriptions, ensure reasonable medication, first cut back, on the one hand, do not reduce prices on the world to find, find reliable competition, and then open source.
it is worth emphasizing that, in addition to medical insurance and assistance for major diseases, in the era of medical humanities in great health, we also have to be in awe of hospice care, painkillers in this segment more just needed, real.
Continue to take such adaptation scenarios as examples of drugs, if some applicable chemicals in China have not been consistent evaluation, in the real world should also consider breaking into the basis;
, we see that this directory adjustment program remains unchanged, continuing to rely on five stages, three categories of experts.
although the previous catalog adjustment is dependent on expert strength, this is not a time, today's directory adjustment has been deeply aware of the "merit and discipline", vowed to do "flat-headed brother."
01 "Pingtou brother" time: "expert review stage (September-October 2020): combined with the enterprise declaration, the establishment of a review drug database."
demonstrate to determine the technical points of the review.
organization review experts to review, forming a new transfer, direct transfer out, can be transferred out, adjust the scope of payment and other 4 aspects of the drug recommendation list.
negotiation and bidding phase (October-November 2020): 1. Soliciting the intention of the relevant enterprises regarding medicines to be included in the negotiations and bidding.
organization to submit negotiation (bid) materials as required, in accordance with the intention of the enterprise.
2. Organization of measurement experts through fund measurement, pharmaceutical economics and other methods to carry out assessments, and put forward assessments.
3. Negotiators negotiate or bid with enterprises on the basis of their assessment opinions, determine a unified national standard for the payment of health insurance, and simultaneously clarify management policies.
"02" line-up: "(i) review experts: evaluation experts are divided into integrated groups and clinical groups."
The comprehensive group of evaluation experts by the style, strong business, familiar with and enthusiastic medical security business, voluntary participation in the catalog review of pharmacy, pharmaceutical economics, medical insurance management experts, mainly responsible for proving the identification of technical points of drug evaluation, all drugs included in the scope of the review to provide evaluation advice.
clinical group evaluation experts are recommended by relevant academic groups and industry (associations) and are mainly responsible for ingicing on drugs in their area of expertise.
(2) Experts: Experts in health insurance management, pharmaceutical economics, etc. recommended by local health insurance departments and relevant academic groups.
is divided into fund measurement group and drug economics group, respectively, from the impact of health insurance fund and drug economics evaluation of the two aspects of the negotiation of drugs and competitive drugs to put forward assessments.
(iii) negotiation (bidding) experts: composed of representatives of the health insurance department and relevant experts, responsible for negotiations and bidding drug companies on-site negotiations and bidding.
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