Improve the dynamic adjustment of the drug catalogue and standardize the whole process management of medical insurance drug use.

Wen . . . On the last day of July, Chen Wen's long-awaited Interim Measures for the Administration of Drug Use in Basic Medical Insurance (hereinafter referred to as the Measures for the Administration of Drug Use) was officially announced on the official website of the State Administration of Medical Security and will come into effect on September 1, 2020.
This management approach responds to the reform requirements of the Opinions of the State Council of the CPC Central Committee on Deepening the Reform of the Medical Security System to improve the dynamic adjustment mechanism of the medical insurance catalogue and implement the list system of medical security treatment, which will become the main policy basis for the management of drug use in basic medical insurance.
. Point 1 of the Measures for the Administration of Drug Use 1. It is clear that the basic principles of drug administration of basic medical insurance are people-centered, which is embodied in the practical protection of the reasonable drug use needs of the insured persons and reflects the fundamental purpose of the management of medical insurance drug use.
basic principles of drug insurance reflect the pragmatic attitude of basic medical insurance to do its best and do its best to achieve the level of drug insurance coverage in line with the health insurance fund and the affordability of the insured.
the principle of graded management, reflecting the unity of points, each do its part.
adhere to the principle of expert evaluation, and continuously improve evidence-based decision-making, improve the ability of health insurance governance.
the principle of both Chinese and Western medicine, give full play to their respective advantages and promote the development of traditional medicine.
2. The responsibilities of medical security departments at all levels are defined according to the principle of graded management, the division of responsibilities between the administrative departments of medical security under the State Council, the administrative departments of medical security at the provincial level and the medical security departments in the co-ordination areas has been determined, and the spirit of the list system on the implementation of medical security treatment in the Opinions of the State Council of the CPC Central Committee on deepening the reform of the medical security system has been implemented, and the local medical security departments have been given responsibilities for the payment, management and supervision of medical insurance drugs.
3. The conditions and procedures for the adjustment of the National Drug Catalog are defined, the basic conditions for inclusion in the Drug Catalog, the scope of non-inclusion in the Drug Catalog, the conditions for the direct transfer of the Drug Catalog and the conditions under which the Drug Catalog can be transferred, and the mechanisms and procedures for the dynamic adjustment of the Drug Catalog are clarified, on the basis of early exploration of practice Not only perfected the expert evaluation, access negotiation, publication of the results of the directory adjustment links, but also innovatively put forward the enterprise declaration, access bidding mechanism, established in addition to chinese medicine tablets using expert evaluation methods, other drugs using enterprise declaration, expert review, negotiation or access bidding, publication of the results of the adjustment procedures, and the negotiation of renewal made more clear provisions.
4. The use of the Drug Catalog, the payment, management and supervision of medical insurance drugs from recruitment and hanging network, medical institutions, medical insurance payment conditions and classification payment, fixed-point pharmaceutical institutions, enterprises, medical insurance departments, such as the internal management and supervision has been clearly defined, enriched the connotation and means of medical insurance drug management.
. The role of the Measures for the Administration of Drug Use 1. Is conducive to improving the management level of medical insurance drugs The Drug Catalog not only determines the level of treatment of insured persons, but also is a concrete embodiment of the level of medical technology, which will have a direct impact on the development of new drug research and development and biopharmaceutical industry.
The original medical insurance drug management method has not adapted to the development of medical security and the modernization of medical insurance management ability, absorbing new management concepts and methods, regulating the determination and adjustment of the scope of medical insurance drug use, and on this basis, strengthening the payment, management and supervision of medical insurance drug use is an inevitable way to improve the level of medical insurance drug management.
2. The adjustment of the original Drug Catalog, which is conducive to the simultaneous determination of the standard of payment for health insurance, and the determination of the standard of payment for medical insurance are independent of each other, and the division of access to health insurance and the mechanism of price formation is becoming more and more harmful.
recent years, in the process of adjustment of the Drug Catalog, the access negotiations for some high-priced exclusive drugs have achieved good results, and the industry has become an important component of the drug price formation mechanism.
On this basis, the medical insurance access and through negotiation or centralized procurement or access bidding methods to determine the payment standards, is conducive to the health insurance access leverage reasonable determination of payment standards, will become China's drug health insurance access and payment of a new model.
3. Conducive to guiding drug value innovation and pharmaceutical enterprises expected to be reviewed by experts, in addition to qualified centralized procurement of selected drugs or government-priced drugs can be directly included in the "Drug Catalog", other drugs in accordance with the provisions of the drug economics and other information, after expert review of the original "Drug Catalog" recommendations can be transferred drugs also in accordance with the provisions of drug economics and other information, negotiations or access to bidding, which will create a clear value-oriented drug research and development and enterprise expectations to promote the long-term healthy development of the biopharmaceutical industry.
4. It is conducive to ensuring the basic drug demand and fair access of insured persons and the Measures for the Administration of Drug Use determines the dynamic adjustment mechanism of the Drug Catalog, which is adjusted once a year in principle, and the administrative department of medical security under the State Council organizes the formulation, adjustment and publication of the National Drug Catalog.
3. As an interim approach, the Measures for the Administration of Drugs retain the scope for the development of specific rules and methods, including specific requirements and methods for qualified enterprises to submit the necessary information in accordance with the provisions, specific rules for negotiating renewals, rules for the formulation and adjustment of payment standards, etc., to be further clarified in the relevant rules in the future.
In addition, the Drug Catalog does not meet the conditions of safety, effectiveness, economy and other conditions of the drug, access to bidding methods, the scope and specific conditions of the adjustment of the Drug Catalog in that year also need to be further clarified and perfected in practice.
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