Innovative medicine into health insurance, pharmaceutical circulation rebates... These questions were officially answered

Negotiations on the national health insurance access catalogue have come to an end, and the fourth batch of centralized procurement of medicines organized by the state is also about to start.
the past year, through measures such as volume procurement and medical insurance negotiations, the prices of medicines and high-consumption medicinal herbs have dropped significantly, the burden on patients has decreased significantly, and the accessability of patients has increased significantly.
with the deepening of these work, pharmaceutical enterprises for innovative drugs market access, pharmaceutical circulation enterprises to pay back and other issues have become the focus of attention in the near future.
recently, the National Health Insurance Administration on the official website published a number of two-session representative proposal responses, including responses to these two questions.
the approval of innovative drugs to seamlessly dock into health insurance? In the proposal, it was suggested that the National Health Insurance Administration should establish a policy pilot mechanism of "seamless interface between drug approval and medical insurance access, market access", optimize the access mechanism for medical insurance, and promote the rapid access of innovative drugs and other innovative drugs into health insurance.
the National Health Insurance Administration replied that the health care sector has always attached great importance to the access of innovative drugs to health insurance.
The Opinions of the State Council of the CPC Central Committee on Deepening the Reform of the Medical Security System put forward that we should base ourselves on the orientation of "safeguarding the basic", adapt to the basic medical needs of the masses, advance clinical technology, adjust and optimize the catalogue of medical insurance, and include drugs with high clinical value and excellent economic evaluation in the scope of medical insurance payment.
In order to adapt to the progress of clinical medicine science and technology and the changes in the drug demand of insured personnel, in July 2020 the State Health Insurance Administration issued the Interim Measures for the Administration of Drug Use for Basic Medical Insurance, which clearly stipulates the formulation, adjustment, use and payment of the list of essential medical insurance drugs, and the National Medical Insurance Drug Catalog is adjusted annually in principle.
the national level has issued five editions of the medical insurance drug catalog, the number of drugs in the list increased from 1535 to 2709, and through negotiations to some of the clinically necessary drugs listed in recent years to reduce prices into the catalog.
, the vast majority of drugs supported by "major new drug creation" science and technology have been included in the national drug catalogue.
the decision-making and deployment of the CPC Central Committee and the State Council, the State Health Insurance Administration recently launched a new round of adjustment of the medical insurance catalogue.
According to the 2020 National Health Insurance Drug Catalog Adjustment Work Programme (hereinafter referred to as the Work Programme), the scope of this year's drug catalog adjustment is august 17, 2020 (inclusive) before the approval of drugs, significantly shorten the waiting period for innovative drugs into the health insurance catalog, but also to enable insured people to use innovative drugs with better clinical value as soon as possible, as soon as possible to benefit.
In addition, the state supports the insurance industry to vigorously develop commercial health insurance, most groups of supplementary medical insurance, millions of medical insurance and anti-cancer insurance products have some basic medical insurance list outside the scope of innovative drug costs, and some insurance companies in the research and development of specific innovative drug-specific insurance products, to facilitate the people's use of innovative drugs.
Next, the National Health Insurance Administration will take into account the needs of insured persons, affordability, health insurance financing capacity and other factors, through strict expert review, and gradually the efficacy of accurate, health insurance funds can afford innovative drugs into the scope of health insurance payments.
basis, we will further improve the multi-level medical insurance system, vigorously promote the development of commercial health insurance, give full play to the role of commercial insurance risk management and protection functions, and improve the level of medical security for insured patients.
Resoling the old problem of pharmaceutical circulation enterprises to pay back the old difficulties in response to the representative's "proposal on solving the old problems of pharmaceutical circulation enterprises to pay back money", the State Health Insurance Administration replied to continue to promote the reduction of comprehensive procurement costs of drugs and medical devices as the goal of the national negotiations to reduce price reductions and GPO model;
provinces have also issued the implementation of the policy of the relevant detailed provisions, and constantly increase the supervision of the settlement of medical institutions, effectively ensure the speed of repayment.
, on the one hand, it is clear that the medical insurance department advances the drug payments to medical institutions.
Opinions of the State Administration of Medical Security on the Central Procurement and Use of Pilot Health Insurance Companion Measures by The State Organization (Medical Insurance Issue (2019) No. 18) explicitly requires "the implementation of the policy of advance payment of medical insurance funds."
Before the pilot work is officially launched, medical institutions shall be prepaid in advance in accordance with not less than 30% of the special procurement budget, and medical institutions shall be required to settle with enterprises in a timely manner in accordance with the provisions of the contract and reduce the financial costs of enterprises."
, on the other hand, to encourage health insurance agencies or procurement agencies to settle or advance drug payments directly with enterprises.
from the actual operation of the "4 plus 7" pilot, the 30-day clearance rate of the selected products in the "4 plus 7" pilot reached more than 90%, and the problem of medical institutions defaulting on drug payments was effectively alleviated.
Among them, Shanghai, Shenyang, Dalian and Chengdu shall be prepaid by the medical insurance department to the production or distribution enterprises, Xiamen shall be settled directly by the medical insurance department and the distribution enterprises, and the remaining six pilot city medical insurance funds shall pay the medical institutions in advance.
of the pilot cities in the united States reached 50 per cent in advance and 60 per cent in individual cases.
next step, the State Health Insurance Administration will, in accordance with the recommendations of its members, further attach great importance to the issue of rebates for pharmaceutical circulation enterprises, and constantly improve the supporting policy measures for drug procurement management, so as to effectively reduce the pressure on enterprise funds.
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