Focus Interview: How did the "Chinese the 1.4 billion-dollar international economy work?

Medicine Network December 29 - Health insurance drug catalog access negotiations and each of us related, because it is related to what drugs can be health insurance, drug prices are what.
We know that the high cost of seeing a doctor and the inflated price of drugs have a lot to do with squeezing out the water of the drug price and letting the price of the drug come down to reduce the burden on patients, and at the same time, for the health insurance fund this big plate, also need to negotiate, with limited funds to absorb more good medicine, new drugs.
2020 is the first comprehensive adjustment of the national medical insurance drug catalogue after the implementation of the enterprise declaration system, and the fourth consecutive year of health insurance catalog negotiations.
more drugs than in previous negotiations, with 162, with a higher success rate of 73.46 per cent and an average price reduction of 50.64 per cent for the 119 successfully negotiated drugs.
is the negotiation going on? Focus interview reporters followed.
December 16th, the 2020 National Health Care Drug Catalog Adjustment Negotiating Group held a negotiation on the prices of PD-1 and PD-L1 monoanto-drugs.
as a new drug for anti-tumor therapy, PD-1 and PD-L1 monoantial drugs, is one of the most closely watched varieties in this price negotiation.
Wang Mengzhao, director of respiratory and critical care medicine at Beijing Concord Hospital, said: "PD-1 and PD-L1 monoantigens are emerging immunotherapy that last longer than previous drugs and can significantly extend the patient's survival, so the drug plays a very important role in treating tumors.
"For many cancer patients, PD-1 and PD-L1 monoantial drugs are new and life-saving drugs.
the clinical urgent need, safe and effective good medicine into health insurance, is the National Health Insurance Administration of the national health insurance drug catalog adjustment work of the main principle, but to enter the health insurance there is an important consideration - price.
To carelli pearl monoantigen, for example, the main range of adaptation covers specific Hodgkin's lymphoma, hepatocellular carcinoma, non-small cell lung cancer, esophageal squamous cancer, before the negotiations, the price of a single unit 19800 yuan.
Xiong Xianjun, director of the medical services management department of the State Administration of Health Care, said: "China is a developing country after all, taking into account the affordability of ordinary people for price and after the inclusion of health insurance."
", but high prices are a common feature of the 162 drugs involved in the negotiations.
the rules, the final offer must not exceed the standard floor price for health insurance payments calculated in advance by the health care industry.
, deputy director of the National Health Insurance Administration's Center for Medical Security Management, said: "It is when the experts negotiate, the experts in the negotiation team hand sealed envelope, at the last moment in front of the enterprise opened the paper."
", the floor price that can only be opened during the negotiations, is the underlying card of the negotiations between the health care industry and the "bull's-eye" of the pharmaceutical company's offer.
, how did this decision come about at the key price that the negotiations made? After determining the drug to be negotiated, the first step is to determine the price of the main reference basic information, mainly from two aspects.
On the one hand, the State Administration of Medical Security, from the point of view of clinical treatment, invited 122 clinical experts to evaluate and rate 162 drugs one by one, and determine the reference drugs;
the second step: the professional price measurement stage, but also the final health care fund to pay the floor price formation of the most critical stage.
Hu Jinglin, secretary of the party group of the State Health Security Administration, said: "Negotiating drug measurement work is directly linked to access to the medical catalogue, which can be said to involve the basic drug rights and interests of the vast number of insured persons, but also related to the long-term stable operation of the medical insurance system, but also related to the vital interests of pharmaceutical manufacturers."
" is related to the interests of the people, fund security, enterprise development, reasonable price determination is very important.
The National Health Insurance Administration randomly selected 40 drug economics experts and 12 fund measurement experts from a pool of experts for more than ten days of professional calculations.
The Pharmaceutical Economics Group calculates the price of a drug based on the degree of benefit to the drug patient, and the fund's measurement team calculates the price based on how much impact the drug will have on the fund when it is included in the catalog, " said Xiong Xianjun.
" patient benefits, fund safety, drug economics and fund measurement two groups of experts, divided into two angles, each closed, back-to-back parallel measurement, mutual non-interference.
fund is limited, but measurement experts pointed out that the whole calculation is not the pursuit of low prices, but highlights the value of drugs and cost-effective principles.
Liu Guoen, head of the 2020 National Health Insurance Drug Catalog Adjustment Drug Economics Measurement Expert Group, said: "It has good efficacy, low side effects, whether this value can be enough in exchange for higher prices, which is called cost-effective, and this requires drug economics to calculate."
health insurance agency has given drug economics experts a very important role in taking into account drug-to-drug comparisons, not simple price comparisons.
"2020 National Health Insurance Drug Catalog Adjustment Fund measurement expert group leader Zheng Jie said: "Our country does now exist the phenomenon of inflated drug prices, China has an old saying that 'money is going to be spent on the knife edge', to be able to ensure the safety of the fund, the so-called fund security, is not to wear the bottom, not waste."
"in order to ensure objective fairness and integrity, measurement experts strictly prohibit direct contact with pharmaceutical enterprises, then, in this link, the legitimate interests and claims of enterprises how to protect? After a week or so of closed work, measurement experts on the drug prices responsible for the formation of measurement points and preliminary conclusions.
time, the team leader and the staff of the National Health Insurance Administration were divided into three groups, and over a three-day period, they met one-on-one with 162 companies that were going to negotiate drugs to communicate in detail about the price estimates of the drugs.
based on enterprise feedback information, the measurement experts on the floor price further correction adjustment.
, the Drug Economics and Fund Measurement Group, each independently, gave the final estimate of the price of 162 drugs.
the bottom price that the health insurance fund can afford to pay, we move on to the third step: the negotiation phase of drug access.
negotiators draw from local health-care departments, and are also randomly selected for the drugs they are responsible for negotiating, and only at the negotiating table can they open the previously calculated floor price.
summarize the entire process after determining the drug to be negotiated, the first step: the main reference to the price base information;
, the National Health Service is responsible for setting the rules, and each stage of implementation is carried out by experts in the appropriate field, who can be said to play a crucial role.
, how is the authority of the expert constrained? Xiong Xianjun said: "Experts in each procedure will not cross, can not participate in the review team, but also participate in the negotiating team, which is not allowed, this is also to avoid experts to dominate the entire negotiation content."
" according to the rules, each expert and drugs one-to-one correspondence, three stages, no one cross experts, from the system design to achieve the whole process of the center, at the same time, each stage is also specially set up with pharmaceutical enterprises to communicate and interact, in order to achieve as much as possible price objectivity.
December 16th, seven varieties of PD-1 and PD-L1 mono-anti-drugs, a new drug for anti-tumor therapy, were involved in negotiations and competition was fierce.
the rules, companies have only two offers, and the second offer is no more than 15% from the Medicare floor price.
AstraZeneta, which last year negotiated several products to be included in Medicare, also won several bids, facing a second offer for the PD-1 and PD-L1 monoantigens.
several phone calls between the company and its headquarters, the company finally made a crucial second round offer.
Although the second round of quotations targeted, but in the fierce price competition, after an hour of arduous negotiations, several times asked headquarters, the company's offer still can not reach the floor price, the negotiations had to be terminated.
The negotiations, PD-1 and PD-L1 monoantigen drugs, including carelli pearl monoantigen, including three drugs were shortlisted, involving a variety of diseases including lung cancer, liver cancer, melanoma, lymphoma and other malignancies, the average price drop of about 78%.
According to figures released by the Health Insurance Bureau, the price of 162 varieties, 119 of which involved 31 clinical treatment areas such as cancer, rare diseases, hepatitis, diabetes, rheumatoid immunity, cardiovascular, digestion, etc., fell by an average of 50.64 percent.
Three must talk about, is now the new drug into the health insurance catalog principle, but the new drug to come in, the total plate of the health insurance fund is limited, and because our country is still in the stage of development, the total plate of the fund does not have too many increments, then, how to give the new drug more fund space? There needs to be an article on the stock.
This adjustment of the medical insurance drug catalog directly called out the previous catalog of clinical value is not high and the Drug Administration approved the cancellation of 29 drugs, but also in 2018, including the expiration of special tumor negotiations to renew the 24 drugs already in the catalog, renegotiation and price reduction.
recent years, the list of Medicare drugs has been adjusted every year to include new drugs, good drugs and special effects drugs that patients originally needed to pay for at their own expense.
this adjustment, the total number of drugs in the health insurance list has reached 2,800.
In addition, in addition to the health care catalog access negotiations described in the program, the state will also organize a centralized volume of procurement each year, procurement of both drugs, but also such consumables as crown stents, both in the health insurance catalog, but also in the catalog.
the purpose of both approaches is to guide the price of drugs and consumables back to reasonable prices through the market mechanism of volume-for-price, to improve the efficiency of the use of health insurance funds, and ultimately to make patients' medical medications more affordable.
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