Health insurance payment standards to change, all fixed-point pharmaceutical institutions!

Pharmaceutical Network February 3, February 1, Chongqing Health Insurance Bureau issued on the public soliciting of "Chongqing City drug transaction procurement network work rules (trial) (draft for comments)" and "promoting drug medical insurance payment standards and the price synergy of the notice (draft for comments), " the deadline for comments is February 6, 2021.
for the industry's highly concerned drug medical insurance payment standards, Chongqing proposed that the online purchase of drugs will be the online price of drugs as the payment standard, that is, the payment ceiling.
other provinces without provincial platforms to hang up the price and do not apply the differential price rule of drugs, temporarily not included in the medical insurance payment.
will be implemented by all health insurance targeted pharmaceutical institutions.
The national minimum list price as the standard of payment of medical insurance drugs in accordance with Chongqing's opinion draft, into the scope of medical insurance payment of drugs, through bidding, bargaining, linkage of the national minimum price, etc., to form a reasonable drug price, to achieve the standard of medical insurance payment and drug network price synergy.
For the list price, Chongqing has also put forward new requirements: for the bargaining procurement of drugs online prices, the city's medical insurance departments to organize the bargaining procurement of medical insurance drugs, the successful enterprises in accordance with the results of the bargaining directly on the internet, medical institutions at all levels may not re-bargain.
medical institutions themselves or jointly with other medical institutions to carry out bargaining non-medical insurance catalog drugs, the transaction price is not higher than the platform online price.
and limit the price of the drug, the price of the network is not higher than the product in other provincial procurement platforms in the country is now implemented the lowest hanging network price.
In which, the production enterprises with the generic name dosage form packaging specifications in other provinces in the country without price, select the same production enterprises with the generic name dosage form other products after the difference between the price to take the lowest price hanging network;
With the generic name dosage-type hanging network group drugs in other provincial platforms in the country no price and does not apply to the difference between the price, product information hanging network, production enterprises independently quoted and medical institutions bargaining transactions, production enterprises should be in other provincial procurement platforms in the country to produce the lowest hanging network price within 1 month, to the platform to declare price information and included in the limit price hanging network.
addition, the same production enterprises with the generic name of the same dosage form hanging net drug preparation specifications shall not exceed 3 (except for basic infusions or different adaptation drugs due to differences in content).
other words, Chongqing's medical insurance drug payment standards will be the lowest online price in the country.
In addition to the medical insurance payment standards for the purchase of drugs on the Internet, Chongqing requires: shortage of drugs, first according to the actual price of medical institutions self-negotiated procurement formed;
is also worth noting that the implementation of the new chongqing drug medical insurance payment standards will involve all medical insurance fixed-point pharmaceutical institutions.
, Chongqing also encourages non-public medical institutions and pharmacies to purchase through the platform, and gradually promote the non-public medical institutions and pharmacies and other medical insurance funds to pay for all drugs purchased through the platform.
hospitals and pharmacies unified medical insurance payment standards will become a trend since the establishment of the National Health Insurance Bureau, the development of medical insurance drug payment standards is one of the important work.
the industry, the formulation of medical insurance drug payment standards as an important cornerstone of medical insurance payment methods, will become an important task of medical insurance reform and even medical and health system reform.
, at the national level, has not yet implemented a unified standard of medical insurance payment, only with the purchase of varieties, national medicine to achieve a unified standard of medical insurance payment.
stage, the standard of payment for medical insurance is mainly formulated by the provinces and municipalities.
some provinces combined with local reality, formulated and issued drug payment standards related policies, Fujian, Anhui, Zhejiang, Hainan and other places have issued local health insurance payment standards.
how to set standards for the payment of medical insurance drugs will have a profound impact on the pharmaceutical market.
industry believes that the large-scale price reduction of generic drugs is to develop and implement health insurance payment standards, health care payment reform is also the key to push for further drug price reduction.
addition, for retail pharmacies, most medicare drugs may be priced upside down, such as the uniform implementation of the medicare payment standard based on the lowest purchase price.
, there have also been calls in the industry that medicare-targeted pharmacies should not enforce the same payment standards as public hospitals.
in accordance with Zhejiang's new regulations: all online transactions of health insurance catalog products (excluding self-purchased products), are included in the scope of medical insurance drug payment.
public hospitals and private hospitals enforce the same payment standards.
standards for the payment of medical insurance drugs in fixed-point retail pharmacies shall be uniformly implemented according to 15% of the payment standards of medical institutions (excluding national and provincial negotiated medicines).
, however, some in the industry believe that in the long run, hospital and retail markets to achieve a unified standard of payment for health care will become an unstoppable trend.