Can you increase the amount with medical insurance? The Difficult Difficulty of Entering Hospitals in Medical Insurance Negotiations Needs to be Solved

If you count the medical insurance negotiation products released by the Health and Family Planning Commission in 2016, my country has launched 5 medical insurance negotiations, and more and more products have entered the medical insurance catalog through negotiations.

• In 2016, a total of 3 products were successfully negotiated by the Health and Family Planning Commission, and successively added to the medical insurance in various places, and only officially entered the medical insurance catalog in 2017;
• 36 products were successfully negotiated for medical insurance in 2017;
• In 2018, a total of 17 oncology drug medical insurance negotiations were successful;
• In 2019, the medical insurance drug catalogue has successfully added 70 new medical insurance negotiations.
  
  

  Products that enter medical insurance negotiations are generally renewed once every two years, which means that the price will be reduced once every two years.

  
  

  From the perspective of the three batches of medical insurance negotiation products from 2016 to 2018, the first three batches of medical insurance catalogues that were successfully negotiated had 2 products with a scale of more than 2 billion.

  
  

  The market size of these three batches of products in 2017 was 28.

  
  

  Note: "Year" refers to the year in which the medical insurance negotiations are announced

  Data source: Mi Nei.

  
  

  Of course, it is not that the 2017 medical insurance catalog has three products with sales of less than 100 million yuan in 2019.

  
  

  In 2019, there were 70 new products that entered the medical insurance negotiation catalogue.

  
  

  Products that are likely to grow substantially in 2020 include Sintilizumab Injection, Pertuzumab Injection, Alectinib Hydrochloride Capsules and Thiopefilgrastim Injection, and the market size is expected to reach one billion yuan.

  
  

  Among the newly-added medical insurance negotiation catalog products in 2020, a total of 50 products have a market size of less than one million in 2019, and 12 products are between one million and ten million.

  
  

  For the existing hospitals, the catalog of their own hospitals is basically fixed, with 1,500 product catalogs for the third-class hospitals and 1,200 product-regulation catalogs for the second-class hospitals.

  
  

  The products in the 2019 and 2020 medical insurance negotiation catalogs are basically not in the 2018 essential medicines catalog, which means that if the medical insurance negotiation catalogs want to enter the hospital terminal, they must first enter the essential medicines catalog.

  
  

  In addition, if an average of 1 billion yuan per product is calculated like the first three batches of drugs, the drugs listed in the medical insurance negotiation catalog in 2019 and 2020 can theoretically exceed 189 billion yuan.

  
  

  It is worth noting that in 2019 and 2020, domestic PD-1 products have basically entered the medical insurance negotiation catalog.

  
  

  After the implementation of the medical insurance negotiation catalogue, the market size of the medical insurance negotiation catalogue products has grown too fast.

  
  

  The overall market size of the products in the medical insurance negotiation catalogue is currently being exchanged for the market size of generic drugs after the price of generic drugs has been reduced by centralized procurement.

  
  

  The policy of the DRG/DIP system will be piloted in 2021.
  If the new drugs listed in the medical insurance negotiation list cannot enter the guidelines/clinical pathways for the corresponding indications, it will basically be difficult to grab the market.
  This means that domestic new drug companies must consider how to win medical insurance reimbursement in the clinical research and development stage-how to get a position in the guideline/clinical path-how to obtain pharmacoeconomic support in the comprehensive treatment of indications, and actively participate in the city Only by calculating the risk, it is possible that the drug will not be on the market but the market profit will be indefinitely, and eventually the high R&D expenses and clinical research investment will be lost.