Annual fee fell below 10,000 yuan, domestically produced PD-1 announced the medical insurance price, Hengrui has the most indications

On March 1, the new version of the National Medical Insurance Catalogue was officially launched today.

Compared with previous years, in 2020, the medical insurance catalogue has the largest number of drugs transferred, and the scope of benefits is the widest.

In this medical insurance catalogue, Western medicine covers 52 treatment areas and Chinese medicine 31 treatment areas, which basically achieves full coverage of treatment areas, especially in the fields of tumors, cardiovascular and cerebrovascular diseases, and immune system diseases, filling many drug gaps.

01 PD-1 with a decrease of 85%

The previously secret payment price of PD-1 medical insurance has gradually surfaced with the formal implementation of the new version of the medical insurance catalog on March 1.

The latest medical insurance catalog payment price shows that the price of Hengrui Pharmaceuticals Carrelizumab is 2928 yuan/200mg, a drop of 85%, and the four major indications of liver cancer, esophageal cancer, lung cancer, and lymphoma are all included in the medical insurance payment.

BeiGene also announced the price of tislelizumab: 2180 yuan/100mg, and the price has fallen by 80%.

The quotations of the three specifications of Junshi Bio-Treprizumab are: 80mg (2ml) 906.

Prior to the above three PD-1s, Sintilimab's Sintilimab has entered the medical insurance catalog in 2019.

Obviously, with the help of medical insurance negotiations, it has become a fact that PD-1 has entered the 10,000 yuan era.

02 Innovative drugs are cost-effective first

Not only are prices falling, but for many innovative drugs like PD-1, the time from listing to being included in medical insurance has also been drastically shortened.

According to data from the National Medical Insurance Administration, the median time from listing to medical insurance for drugs negotiated in 2020 is 1.

This year, a major focus of the dynamic adjustment mechanism of the medical insurance catalog established by the National Medical Insurance Administration is to include more innovative drugs in the scope of reimbursement.

When the National Medical Insurance Catalogue begins to include more innovative drugs, how to find a balance between the price of drugs and the innovation capabilities of pharmaceutical companies may be one of the focuses of the industry in the future.

A number of local innovative pharmaceutical companies suggested that, on the one hand, they should consider following market rules and formulate reasonable drug pricing mechanisms during national drug negotiations and centralized procurement bidding; on the other hand, they should protect the innovation capabilities of companies and introduce policies to encourage corporate innovation to protect Encourage the enthusiasm of enterprises to innovate.

Obviously, the future pricing of innovative drugs will take into account multiple core factors such as product value, patient benefits, and medical insurance expenditures.

03 In August, it entered the centralized procurement, and in December it entered the regular catalog.

It is worth noting that in the new version of the medical insurance catalog, there are also three varieties selected in the 2018 medical insurance negotiations to be transferred to the conventional medical insurance catalog, and one variety has not been reduced in price after renewal.

The three varieties included in the routine medical insurance list are azacitidine, afatinib and sunitinib.
It is worth noting that data from Meinenet showed that these three varieties entered the medical insurance during the negotiation in 2018, and achieved a substantial increase in 2019.
Among them, Pfizer (Xinji)'s azacitidine entered the medical insurance with a 60% decrease.
Sales in the middle of the year increased by 24 times; BI's afatinib entered the medical insurance with a 40% decrease, and its sales increased 20 times in one year; Pfizer's sunitinib entered the medical insurance with a 67% decrease, and its sales increased by one in a year.
Times.
It can be seen that varieties with strong clinical demand may "bypass" negotiations and be included in the routine medical insurance catalogue.

In fact, azacitidine is also the species involved in the third batch of centralized procurement in August 2020.
At that time, Pfizer’s original research price was 736.
5 yuan/piece, Chia Tai Tianqing’s price was 346 yuan/piece, and Sichuan Huiyu’s price was 260 yuan.
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In the end, CP Tianqing and Sichuan Huiyu won the bid.
In this negotiation, azacitidine did not appear in the negotiation catalog, but was directly included in the regular catalog.

However, even though azacitidine is included in the conventional medical insurance list, the original drug is actually double squeezed by medical insurance negotiations and centralized procurement.

In the "Opinions on Promoting the Normalized and Institutionalized Development of the Centralized and Volume Procurement of Drugs" issued by the State Council at the end of January: The selected price is the benchmark to determine the medical insurance payment standard.
"

That is to say, the previous "three-year transition period" for medical insurance payment products will soon be cancelled.
If the centralized procurement of products paid by medical insurance fails to win the bid, it will be directly reimbursed at the winning bid price when the results of the centralized procurement are implemented.

In this medical insurance catalogue, there is also Hengrui's pegaspargase injection, although the contract has been successfully renewed but the price has not been reduced, and it still maintains the negotiated price of 2,980 yuan per bottle in 2018.
It is reported that pegaspargase is used in the first-line treatment of children with acute lymphoblastic leukemia.
In 2018, Hengrui entered the medical insurance with a 40% decrease, and sales increased by 12% in 2019.

Xiong Xianjun, director of the Medical Service Management Department of the Medical Insurance Bureau, once stated at a press conference that the strategy of medical insurance negotiations is to "through strategic purchases, make full use of the market mechanism of drug access'price for volume'", however, "price reduction is not negotiation.
What they are pursuing is that the retail price of the enterprise was relatively reasonable before, and the price reduction of the medical insurance negotiation will naturally be small.
"

04 Most patients concerned about the variety successfully entered the medical insurance catalog

After the medical insurance negotiations in December 2020, the E-medicine manager's official account received hundreds of messages in the backstage, among which there are many varieties that patients want to pay attention to.
The E-medicine manager sorted out the 9 most mentioned varieties, which are Syini.
Modder, fingolimod, carrelizumab, osimertinib, pambocinib, skuccinib, eimexizumab, rituximab, and niraparib.

Among the 9 varieties, the two varieties used to treat multiple sclerosis, Fingolimod and Sinimod, have successfully entered the 2020 medical insurance list through negotiations.
Among them, the payment price of Fingolimod medical insurance is 228 yuan/cap, and the payment price of Sinimod medical insurance is 49.
26 yuan/cap.

It is reported that Fingolimod was approved for marketing in China in July 2019 for the treatment of relapsing multiple sclerosis (RMS) in patients aged 10 years or older.
According to Novartis’s announcement, this is the only domestic product with children.
Indications of multiple sclerosis corrective treatment drugs.

Sinimod passed the priority review in May 2020 for the treatment of relapsing multiple sclerosis in adults.

In addition to these two varieties for the treatment of multiple sclerosis, carrelizumab has received the most attention.
According to public information in the industry, the price of carrelizumab medical insurance was 2,928 yuan/branch, and the price before medical insurance negotiations was 19,800 yuan/branch, a drop of more than 80%.
At the same time, according to the public information of the medical insurance catalog, all four indications of carrelizumab have been included in the medical insurance catalog, namely:

Treatment of patients with relapsed or refractory classic Hodgkin's lymphoma who have undergone at least second-line chemotherapy;

Treatment of advanced hepatocellular carcinoma patients who have previously received sorafenib treatment and/or oxaliplatin-containing system chemotherapy;

The combination of pemetrexed and carboplatin is suitable for unresectable locally advanced or metastatic non-squamous non-small cell lung cancer with negative epidermal growth factor receptor (EGFR) gene mutation and anaplastic lymphoma kinase (ALK) negative ( NSCLC) first-line treatment;

Previously received treatment for patients with locally advanced or metastatic esophageal squamous cell carcinoma who had disease progression or intolerance after first-line chemotherapy.

The third patient concerned is osimertinib, which has been included in medical insurance during medical insurance negotiations in 2018.
At that time, the price of medical insurance was 510 yuan/tablet.
At the end of 2020, the negotiation of medical insurance was successful, and the indications for inclusion are: locally advanced or metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 19 deletion or exon 21 (L858R) substitution mutation First-line treatment for adult patients; disease progression during or after treatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) in the past, and the presence of locally advanced or metastatic non-positive EGFR T790M mutations has been confirmed by testing Treatment of adult patients with small cell lung cancer.

The fourth patient's concern is pibacillil, which is used in the combination of first-line medication and trazole for the treatment of postmenopausal women who have not received systemic treatment to control their advanced disease, estrogen receptor positive (ER+), human epidermal growth factor receptor 2 (HER2-) Patients with advanced or metastatic breast cancer.
It is a pity that piperacillil is not included in the medical insurance catalogue, but it is worth noting that on January 18, Pfizer announced that it would take the initiative to reduce the price of piperacillil.
The price will be reduced from 29799 yuan/bottle to 13,667 yuan/bottle, a decrease of 54%.
This is the first time the product has experienced a major price cut after nearly two and a half years after entering the Chinese market.

In addition, Immerizumab, which was approved in 2018 for the treatment of hemophilia A patients with coagulation factor VIII inhibitors, is also not included in the medical insurance list, and its price exceeds 400,000 US dollars per year.