Insincere Don't Disturb - 2020 National Health Care Directory Adjustment Outlook.

Recently, the State Health Insurance Administration announced the 2020 National Health Insurance Drug Catalog Adjustment Work Programme.
the deadline for declaring the scope of the new drug was delayed from December 31 last year to the date of writing, august 17, compared with the draft.
a small change could affect billions of dollars in business.
rumors, what change date is because of an enterprise, so a certain enterprise's product this time must be high price negotiations successful.
all kinds of black box talk, people laugh.
in the author's opinion, if they have a disharmonious vision to interpret the policy, then naturally look at what policy is crooked.
Take this date adjustment, December 31st and August 17th itself have their own pros and cons, for enterprises, the same is true, some enterprises are now grumbling, until their own product negotiations are successful, certainly is also to bring up a rice bowl to a "true fragrance!" "。
send you a line here, with the enterprises to encourage: - - what is the most expensive in the 21st century? Harmonious! About the rules - my dream is once a year! Before the introduction of this program, a more important policy is the introduction of the "Interim Measures for the Administration of Basic Medical Insurance Drug Use", which is also Hu Jinglin signed the National Health Insurance Bureau Order No. 1, the importance can be imagined.
the last time the management of the medical insurance drug catalogue was introduced in 1999 under the leadership of the Ministry of Labour.
at that time, the whole social health insurance system has just been established, along with the introduction of management methods, in 2000 issued the first edition of the National Health Insurance Drug Catalog.
At that time, the approach proposed a catalog of 2 years an adjustment, and the new drug is updated once a year, although the health insurance directory from the Ministry of Labor to the Ministry of Human and Social Affairs, and from the Ministry of Human and Social Affairs into the Health Insurance Bureau, but as if in the dark, after 21 years, the new method has re-realized the annual supplement of the new drug.
large-scale catalog adjustment, history should be 2000, 2004, 2009, 2017 and 2019, although theoretically a two-year adjustment, but the actual average down to 4-5 years, of course, there are many reasons, but I think one of the most important reasons is the balance between efficiency and equity.
take the 2019 adjustment, after nearly half a year, organized more than 10,000 experts across the country repeatedly argued, which is undoubtedly the greatest degree of fairness and justice.
but from a different perspective, such a large-scale adjustment to some extent at the expense of efficiency, in terms of time and cost every year such adjustment is really a bit of a toss-up.
new management approach is to maximize efficiency, or achieve harmony, on the premise of fairness.
look back at the 2019 adjustments, no doubt laying the groundwork for future adjustments, especially the fine combing of the regular catalogue.
this year, the reason can be from the Health Insurance Bureau invited enterprises to negotiate into enterprises to declare their own, in line with the international mainstream rules, but also because the scope of 2019 is large enough, enough experts, lay a good enough foundation.
if the new management methods, at least in the next few years, should not be a large-scale adjustment of the regular catalog, and new products, is all with the payment standards into the catalog.
That is, the future catalogue will become two parts, partly based on the deletion of the old regular catalogue, this part is without payment standards, and the payment standards should be referred to the provincial health insurance bureau to complete;
This catalog adjustment through the volume of procurement to enter the variety should be at least 2, are the second batch of procurement of products, albumin yew alcohol and Anli shengtan, the efficacy and safety of these two products in the 2019 adjustment or by experts recognized, when the reason can not be included, or because the price is high, not good enough in economy, and now through the volume of procurement, the price has been greatly reduced, so the possibility of inclusion in the catalog is great.
The second batch of volume procurement also has a non-medical insurance product is his Darafe, this product to treat erectile dysfunction of the adaptive disease is clearly not in line with the new management methods, and pulmonary hypertension adaptation seems to have not been approved in the country, so the possibility of inclusion is very small.
The third batch of non-medical insurance products purchased in the volume can theoretically catch up with this catalog adjustment, in which Dapositin and his Darafei, the adaptation does not meet the conditions, and Xidina is not due to domestic pulmonary hypertension adaptation has been approved, so it is still possible to include, of course, adaptation will certainly be limited to idioid pulmonary hypertension.
left ethyl laxitan injection with a thick solution is also in 2019 because the price did not enter, this collection into the catalog should not be a problem.
The details of the rules of access bidding have not yet been made public, but Wang Wenshengyi seems to be able to speculate that it should be similar to the national procurement model, by the manufacturers to bid for an access price, and then the Health Insurance Bureau to take one of the lowest value as the payment standard, the winning manufacturers should be able to obtain a certain period of time of exclusive right to reimbursement of health insurance, until the state with volume procurement or exclusive rights expire.
this approach should be said to be on the landing of the co-ordination of regional health insurance operations will be a little difficult, but with the standardization of medical insurance drug codes, should not cause any particularly difficult.
rules for negotiations should not be much different from last year, including data preparation and processes, and at best a little fine-tuning, with no qualitative changes.
One of several possible variables is whether competitive negotiations will be expanded, on this issue, my personal view is last year's hepatitis C single genotype or a relatively special category, for a curable infectious disease, the future market size is relatively fixed, from time to time is also relatively short-term, relatively speaking, the expenditure of the health insurance fund is similar to a one-time, so competitive negotiations, there are some with the meaning of procurement.
And this year there is no similar to last year's hepatitis C disease field products, so it is not suitable for competitive negotiations, you know, even if the same xx level, xx puli, xx statin, due to efficacy, safety, drug interaction some differences, specific to the patient is likely to be unable to replace each other, and most chronic patients are life-long medication, once the treatment plan is determined, drug replacement will involve drug wash period and other complex problems.
Sceressily, competitive negotiations can maximize price reductions, which is most beneficial from the point of view of medicare purchases, but I personally believe that the expansion of this rule must be treated with caution and must be widely recognized by relevant clinical and pharmacological experts before selective use can be made."
another possible variable is the innovative access model, the risk-sharing mechanism proposed in last year's programme.
Although from last year's actual situation, the proposal put forward by enterprises were ultimately not adopted, this year's program did not mention the relevant content, but with the current health insurance bureau with the times, and strive to innovate the work ideas, this year is likely to be able to put forward innovative access programs by enterprises, whether it is price agreements or pay according to efficacy, as long as the enterprise's data and logic is impeccable, health care should be willing to try the relevant pilot programs under the premise of expert resources.
the product in the negotiation and entry auction section, some predictions will be made below.
a few words to explain before you make a prediction.
Readers who pay attention to my catalog adjustment forecast every year may find that there are always some varieties I am not sure about, especially the negotiation part, there are always some good varieties I see inexhakable, here is actually a question: from an enterprise point of view, whether the successful negotiations must be the right choice? The success of the negotiation means that more products are included, the patient is certainly the beneficiary party, and from the point of view of the health insurance bureau, the right price to buy is the most advantageous, and here also leads to a rule that the current negotiating standard is actually more similar to the price, rather than the amount paid by the health care side, if it is talking about the amount of health insurance bill, and the difference between the price set by the enterprise by the patient, then from the point of view of the enterprise is certainly beneficial, the enterprise will be as successful as possible.
the current rules, companies are undoubtedly pursuing profits or maximizing profits.
For example, there are some products added more provincial level, and provincial supplements gave a three-year transition period, if the negotiation of price reduction, the increase in sales profits than the loss of profits, then there is no doubt that the choice to fail or not to talk about will be more favorable.
extreme cases, there has been a product 17, 18, 19 for three consecutive years of failed negotiations.
Objectively speaking, this knowingly can not talk about the idea of trying again, to a certain extent, caused the waste of administrative and expert resources, set a negotiating failure the next year can be renegotiation of the rules will reduce this phenomenon, but from this year's rules, more than 5 provinces to add the proposal does not seem to negate the enterprise to take deliberate failure or abandon the strategy.
, of course, from a different point of view, the five-province or more additions to the rules in theory can better continue the continuity of patient reimbursement, there is no reason.
I need to be prompted here, will there be similar rules next year? If next year's range is no longer within five years and five provinces are added, only for the previous year's new drugs, then this year is undoubtedly the last chance for some products;
There are actually some gambling implications here, after all, the directory management measures set out in the scope of the annual program, the objective situation faced by the health insurance side each year is not the same, the scope or wide or narrow are unknown.
In addition, from a corporate point of view, in addition to considering the issue of provincial-level replacement transition period, there may be other reasons for the failure of negotiations, such as some foreign companies will be wary of the global price system (and even the problem of domestic smuggling abroad), there is the scarcity of products.
if a product does not have any competing products in its field, it is more likely in a sense to lead to the failure of negotiations."
Because these scarce products, whether medicare or non-medicated, patients face a life-or-death moment to buy, or that negotiating price cuts does not lead to much sales increase, and it is understandable that companies have chosen profits between morality and profit.
can also raise the question of the limits of a health-care negotiation.
There is no doubt that the health care negotiations is a very good policy, the specific rules are also in line with the international very advanced thinking, but from the point of view of enterprises and patients, should not expect the health care negotiations to solve all the problems, the future of our country will be built into a multi-level health care system, and we commonly known as health insurance, but only the basic medical insurance part of the future, I believe there will be many innovative access channels, such as commercial insurance, or charity crowdfunding, can work together with basic health insurance to solve many problems.
On this issue, enterprises should show more sincerity and expand their thinking, instead of holding patients hostage and coercing the government, it appears that a small problem has been solved in a matter of time or a matter, which in fact will lead to a deeper problem of fairness.
For these reasons, there are some predictions and reasons for the probability of a successful negotiation below, but some of these bets on companies and products may not be accurate.
is like playing poker, the health insurance bureau has developed rules, I try to help you look at the card face and possible card ideas, but the specific can not play well, that is still the enterprise's own business.
Generally speaking, the forecast for large foreign enterprises will be more accurate, because large foreign enterprises generally do not play cards indiscriminately, and small foreign enterprises and some domestic enterprises in previous years in the process and results, a good hand playing a rare situation is not uncommon.
individuals estimate that the negotiations and access to bidding products should be about 200, limited to space, the following only for some products to make predictions, of which 2015 to date the new drug part will be relatively complete, and 5 provinces of health insurance part combined with the enterprise's independent declaration mechanism, there are relatively large variables, only selected some of the more popular products to make predictions.
diabetic drug GLP-1 subjectors glucosine peptide, Essena peptide microsphere, polyglycol locena peptide three GLP-1 weekly preparations have different long-term principles, given the success of the 2019 renewal of liraglutide, Lisnapeptide and Essena peptide negotiations, the probability of these three weeks of preparation is still quite large.
some regrets about the Essena peptide microchipe, which would have had the opportunity to capture more health insurance markets a year earlier, but was put into competition this year with two more weeks of preparation, and the price is a big challenge.
weeks of preparations improve patient compliance, theoretically the price will be higher than the price of seven-day preparations, but this year, given the competition and negotiation cycle, perhaps the price of these three weeks of preparations will eventually be lower.
-made Benaglutide did not talk about success last year, but this year there is last year's GLP-1 as a price scale, theoretically as long as it does not play cards indiscriminately, the probability of success will be greater than last year.
but with weeks of preparations entering the catalog, it is difficult to compete in the market for the product's three-time-a-day approach.
Insulin Degumen winter double insulin should be the only long-lasting 3 generations and short-acting 3 generations, this product from its own properties is very good, the probability of successful negotiations mainly depends on the price, the longer challenge is that the future door winter insulin may face a volume of procurement, but considering that Degu insulin prices last year set more reasonable, so without negotiations can be directly into the regular catalog, it can be seen that the price strategy of enterprises is more pragmatic, so I personally am optimistic about the success of this product can be negotiated.
SGLT-2 inhibitor Engli net metformin is currently the only compound metformin SGLT-2 variety in China.
In view of metformin in the volume of procurement down to less than a dime, so if this product is close to last year's successful negotiations of the Ngli net price, the high probability can still be negotiated successfully.
was only approved last month and caught the last bus at the last minute, given that several SGLT-2s had already produced a rough idea last year.