In 2020, the drug adjustment of the medical insurance catalogue will be launched, with seven new types of drugs proposed.

Introduction: On August 3, the State Health Insurance Administration released the Work Programme for the Adjustment of the National Medical Insurance Drug Catalog for 2020 (draft for comments) (hereinafter referred to as the "Opinion Draft"), which will be available for comments by August 10, 2020.
August 3, the National Health Insurance Administration issued the 2020 National Health Insurance Drug Catalog Adjustment Work Programme (draft for comments) (hereinafter referred to as the "Opinion Draft"), the consultation deadline of August 10, 2020.
the 2020 National Medical Insurance Drug Catalog Adjustment Work Programme (Draft for Comments) In order to implement the decision-making and deployment of the CPC Central Committee and the State Council, further improve the level of drug security for insured personnel, standardize the management of medical insurance and drug use, according to the Social Insurance Law of the People's Republic of China, the Opinions of the State Council of the CPC Central Committee on Deepening the Reform of the Medical Security System, the Interim Measures for the Administration of Basic Medical Insurance Drugs and related documents, the 2020 National Basic Medical Insurance Drug Catalog (hereinafter referred to as Drugs) adjustment work programme is formulated as follows.
. The target task is guided by Xi Jinping's new era of socialist ideology with Chinese characteristics, comprehensively implements the spirit of the 19th National Congress and the 19th Central Committee of the Second, Third and Fourth Plenary Sessions of the 19th National Congress, adheres to the people's health as the center, continuously deepens the reform of the medical security system, establishes a dynamic adjustment mechanism for the drug catalogue, dynamically adjusts the scope of the drug catalogue according to the fund's ability to pay, provides support for the normalization of the new crown epidemic prevention and control, and strives to achieve a more optimized structure of the drug catalogue, more scientific norms, more scientific management and more efficient payment, and more efficient
. The scope of adjustment takes into account the functional positioning of basic medical insurance, the clinical needs of drugs and the affordability of funds, and the scope of the adjustment of the drug catalogue in 2020 is as follows: (1) The scope of adjustment of the list of western and traditional Chinese medicines conforms to the provisions of Article7 and Article 8 of the Interim Measures for the Administration of Drug Use in Basic Medical Insurance, and drugs outside the drug catalogue with one of the following circumstances may be included in the new scope of the drug catalogue in 2020.
1. Medication for the treatment of respiratory diseases associated with xinguan pneumonia.
2. Drugs included in the National Essential Medicines List (2018 edition).
3. Include in the list of new drugs abroad that are urgently needed in clinical areas, encourage the list of generic drugs, or encourage research and development to declare the list of children's medicines, and approve the listing of drugs by the State Drug Administration by 31 December 2019.
4. The second batch of state-organized drugs are centrally procured.
5. Between 1 January 2015 and 31 December 2019, drugs (including new active ingredients, new dosage forms) were approved for listing by the State Drug Administration in accordance with the application process for registration of new drugs.
6. Between 1 January 2015 and 31 December 2019, supplementary applications and approvals were made to the State Drug Administration based on clinical trial results, and drugs such as indications and functional treatment were subject to significant changes.
7. By December 31, 2019, drugs will be included in the latest edition of the provincial medical insurance drug catalogue.
, the main active ingredients are included in the "first batch of state key state key monitoring of rational drug use of drugs catalog" except.
eligible drug catalogues of Western and traditional Chinese medicine, all by the enterprise in accordance with the procedures to file a declaration, after examination and approval into the proposed new scope.
(2) Drugs in the list of Western and Traditional Chinese medicines that meet the requirements of Article 9 and Article 10 of the Interim Measures for the Administration of Drug Use in Basic Medical Insurance, and those in the list of drugs with one of the following circumstances may be included in the scope of drug catalog adjustment in 2020.
1. The range of catalogued drugs.
(1) Drugs that have been revoked, revoked or cancelled by the State Drug Administration.
(2) taking into account clinical value, adverse reactions, drug economy and other factors, the assessment of the risk is greater than the benefits of the drug.
2. Adjust the scope of standard drugs to be paid.
(1) is within the validity period of the agreement and the negotiating drugs to which the payment criteria are redefined in accordance with the agreement.
(2) It is necessary to adjust negotiated drugs that limit the scope of payment, based on the enterprise application or expert assessment.
(3) The price/cost is significantly higher than other drugs in the same field of treatment, and in recent years it has taken up a larger amount of funds.
(iii) Other 1. The eligible Chinese medicine tablets shall be included in the scope of adjustment as required.
. Improve the drug catalogue, standardize the drug name dosage form, and appropriately adjust the drug A-B category, catalog classification structure, notes and other content.
. The adjustment of the pharmaceutical catalogue in 2020 is divided into five stages: (1) Preparation phase (July-August 2020) 1. Lead by the State Health Insurance Administration, and work with the Ministry of Industry and Information Technology, the Ministry of Finance, the National Health and Health Administration, the State Drug Administration, the National Administration of Chinese Medicine to study and formulate a work programme to determine the principles and procedures for catalog adjustment.
, after soliciting public opinion, publish the programme.
. The establishment of working institutions, the establishment of working mechanisms, the establishment of expert banks, the formulation of working rules and integrity of confidentiality, interest avoidance and other provisions.
(ii) issue s/enterprise declaration guidelines during the enterprise declaration phase (August-September 2020).
accepte eligible enterprises to submit the necessary information to the National Health Insurance Center in accordance with the scope of the 2020 drug catalog adjustment.
a formal review of the information and the publicity of medicines that have been formally reviewed.
(iii) Expert review stage (September-October 2020) in conjunction with the enterprise declaration, the establishment of the evaluation of drugs database.
the argument determines the technical points of the review.
to organize the evaluation experts to review, forming a new transfer, direct transfer out, can be transferred out, adjust the limited payment scope and other four aspects of the drug recommendations list.
(iv) Negotiation and Bidding Phase (October-November 2020) 1. Solicit the relevant enterprises' intention seeking the intention of the drug to be included in the negotiation and bidding.
organize the requested submission of negotiation (bid) materials according to the intention of the enterprise.
. Organizational measurement experts conduct assessments and make assessments through fund measurements, pharmacoeconomics and other methods.
. Negotiators shall negotiate or bid with enterprises on the basis of assessment opinions to determine the uniform standard of payment of health insurance throughout the country and to clarify the management policy simultaneously.
(v) announce the results of the results phase (November-December 2020) to publish the results of drug catalogue adjustment, release a new version of the drug catalog, synchronous and clear management and implementation requirements.
fourth, expert composition and responsibilities (i) evaluation experts are divided into integrated groups and clinical groups.
comprehensive group of experts by the style, strong business, familiar with and enthusiastic medical security cause, voluntary participation in the catalog review of pharmaceutical, pharmaceutical economics, medical insurance management experts, mainly responsible for the demonstration and determination of the technical points of drug evaluation, all drugs included in the scope of the review to provide evaluation opinions.
clinical group review experts by the relevant academic groups and industry (association) recommendations, is mainly responsible for the field of medicine advice.
(ii) The measurement experts are composed of experts in the areas of health insurance management and drug economics recommended by local medical insurance departments and relevant academic groups. the
is divided into the fund measurement group and the drug economics group, respectively, from the impact of the medical insurance fund and the evaluation of drug economics for the negotiation of drugs and the evaluation of the drug economy.
(3) The negotiation (bid) experts shall be composed of representatives of the medical insurance department and relevant experts, who are responsible for on-site negotiations and bidding with the negotiating and bidding pharmaceutical enterprises.
V. Supervision Mechanism (1) take the initiative to accept the supervision of all parties and accept the supervision of the public, the news media and pharmaceutical enterprises.
publicly publish the work programme and make public the list of eligible drugs for declaration.
set up a reporting telephone and mailbox, to accept complaints from all walks of life.
(2) improve the internal control mechanism to clarify the responsibilities of jobs and personnel, improve the information confidentiality, interest avoidance, accountability and other disciplinary norms, to ensure that the directory adjustment work is fair, safe and orderly.
(3) Strengthen expert supervision and establish a system of expert responsibility, benefit avoidance and accountability, and all evaluation and measurement work will remain in the way, so as to ensure that experts give their opinions independently and impartially. Annex of the
: The scope of the drugs declared by the National Medical Insurance Drug Catalog in 2020, and the drugs outside the list meet the conditions listed in the second part of this Programme (i) of Western medicines and Traditional Chinese medicines" listed in the catalogue.
2. The listed drug (1) is within the validity period of the agreement and the negotiating drug must be redefined in accordance with the agreement. During the validity period of the
(2) agreement, with the approval of the State Drug Administration, the indications or functional treatment have changed significantly and the enterprise has voluntarily applied for the adjustment of the negotiating drugs that limit the payment scope.
.