Exclusive quick review: the suspense caused by the three-year transition period of provincial increased medical insurance!

On the evening of July 22, the official website of the State Medical Insurance Bureau posted the opinions on the establishment of the management system of the medical insurance treatment list (Draft for comments) (i.e opinions) After reading the opinions, it was nearly 10 o'clock late at night During this time, the author successively communicated with the relevant practitioners in the industry and the leaders of the drug policy research in a province, but the result was the opposite conclusion On: that is to say, "the three-year transition period will be set up for provincial increased medical insurance" and "the national unified medical insurance catalog will not leave any more room for local people" Inadvertently, whether the transition period will be set up for provincial increased medical insurance has become a pending case of concern in the industry I believe that in this week and in the future, the market access personnel of pharmaceutical enterprises will run around to consult the medical insurance personnel everywhere, and strive to Ask for clarity From the perspective of speculation, the author argues that "the national unified medical insurance catalogue and the original local supplementary medical insurance catalogue cannot have another three-year transition period" 1、 This time, the national medical insurance catalogue is strictly required, and local governments are not allowed to supplement the scope of drugs paid by basic medical insurance in the "drug catalogue" part of the opinions The State formulates the directory of national basic medical insurance drugs in a unified way All localities shall strictly follow the directory of national basic medical insurance drugs In principle, they shall not make their own directory or use alternative methods to add drugs in the directory In the 2017 version of the medical insurance catalog, it is required to "regulate the adjustment of drug catalog in each province", that is, the provincial (District, city) social insurance authorities shall not adjust the class a drugs in the drug catalog, and shall adjust the class B drugs in strict accordance with the current laws, regulations and documents According to the author's incomplete statistics, at present, the list of medical insurance drugs in use in all provinces in China is the 2017 version of the national medical insurance drug list, plus 36 negotiation drugs of the Ministry of human resources and social security in 2017, 17 anti-cancer drugs of the National Medical Insurance Bureau in 2018 and related preparations commonly used in hospitals If the national medical insurance catalog is standardized, from the perspective of basic insurance, as a unified catalog, the national medical insurance catalog can basically reflect the fairness and universality of medical insurance drugs from the perspective of positive understanding Therefore, the new version of national medical insurance catalog has been basically "enough", and no need for additional "supplement" from the local has become the setting 2、 There is little chance for the original local government to set up a three-year transitional period to supplement the medical insurance catalogue The opinion points out that the Provincial People ' Perhaps this passage is the most imaginative one After reading this passage, the first feeling of the author is that the local supplementary medical insurance products will give a period of adjustment time limit, that is, they are allowed to "slow out" while "forbidden in" But in fact, after a comprehensive review of the whole opinions, it is found that this "three-year" is more of an overall upper limit for the whole list system When it comes to the supplement of the local medical insurance catalogue, the opinions has already made it clear that only the national ones can be used, and the local ones cannot be used in disguise Of course, from the perspective of full consideration of the actual situation of each province, local ethnic medicine can make an exception The opinions put forward that: local disease security and Tibetan medicine, Mongolian medicine, Uyghur medicine and other ethnic medicine are included in the list of Medicare drugs and other special policy measures, as well as major policy adjustments such as provincial overall planning of basic medical insurance After reporting to the administrative department of medical security under the State Council and the Ministry of finance, each province should follow the Regulations are advanced Besides, there is no other example 3、 Local medical insurance supplement is blocked How to enter medical insurance again? At present, the first innovative medicine that can enter medical insurance through negotiation path is innovative medicine Opinions of the State Council on the reform of the review and approval system for medical devices (GF [2015] No 44) clearly states that it is required to encourage drug innovation oriented by clinical value and accelerate the review of innovative drugs urgently needed in clinical practice The guiding opinions of the State Council on promoting the healthy development of the pharmaceutical industry also clearly put forward the establishment of a fast channel for the review, approval and market access of drugs in short supply and innovative drugs What is the definition of innovative drugs? According to the interpretation of CFDA's work plan for the reform of chemical drug registration and classification, innovative drugs are "new compounds with clear structure, pharmacological effect and clinical value" (Class 1 drugs in the new chemical registration and classification, i.e innovative drugs not listed at home and abroad) As most of the domestic innovative drugs are newly put into use, the original price is relatively high Therefore, it's a good choice to determine the price to enter the medical insurance catalog through the centralized negotiation and negotiation of the state The former 4 + 7 has become popular, and the latter has been linked with the national procurement Therefore, this bus of the medical insurance catalog has not been boarded or left behind, which means it will be more difficult to enter the medical insurance catalog in the future, because the dynamic adjustment of the scope of the medical insurance catalog will be more difficult It's really limited 4、 Bidding for procurement in various provinces is waiting for the introduction of the new medical insurance catalogue From the second half of last year to now, one of the important reasons for the slow pace of drug bidding and purchase in all provinces is that they are looking forward to the introduction of the new version of the medical insurance catalog Only after the new version of the medical insurance catalog is introduced, can drug procurement catalogs in all regions be formulated, selected and screened on this basis From the perspective of correct policies, they are too radical and innovative A bidding project, at least in this period of time, is not a wise choice This is the reason why some provinces in the south prefer to choose inter provincial price linkage rather than recruit again, even though they are very good in the industry, but they have been put on hold temporarily The reason is simple: the time is not right At the same time, the main focus of the provinces is still on the 4 + 7 national linkage For the introduction of the new version of the national health insurance catalog, many enterprises have used the resolute courage to fight back and forth, that is, they must not enter! Under the pressure of the boss, many pharmaceutical companies' market access is full of laughter, beautiful eyes and expectation They are going to carry out policy exploration and emotional marketing If some pharmaceutical companies still equate market access with government affairs, it is undoubtedly a miscalculation and disorder In the context of medical drive, the only factor that determines whether the product can stay in the medical insurance catalog or enter the medical insurance catalog is very complex Miscellaneous is also very simple, just four words: product value! Statement: this opinion only represents the author, not the position of yaozhi.com, welcome to exchange and supplement in the message area; if you need to reprint, please be sure to indicate the author and source of the article.