Interview with experts: three ways of adjusting medical insurance catalogue to promote innovation

Source: China Medical Insurance 2017-03-07 about the adjustment of the medical insurance catalog, recently, China Medical Insurance (ID: zgylbxzzs) interviewed song Ruilin, President of China pharmaceutical innovation promotion association, and Xuan Jianwei, director of Institute of pharmaceutical economics, Zhongshan University Two experts focused on three moves that have a profound impact on the pharmaceutical industry: first, unprecedented attention to innovative drugs; second, attempts to introduce pharmacoeconomics; third, the launch of dynamic adjustment policies Experts speak in a simple way, from a high position It is not difficult to see that the improvement of the ability of the government departments in dealing with the relationship with the market reflects the transformation of the role of the government from administrative management to social governance In my opinion, this is the highlight of the adjustment of the medical insurance catalogue 1、 Support innovation and release market vitality "policies encourage innovation and release market demand; innovation gets market returns, enterprises pay more attention to innovation; patients get better treatment, and policies get support." President Song Ruilin said it was a virtuous circle Our country didn't have any innovative drugs before, and only after 2008 did it officially launch the major national new drug creation project In the past nine years, the state has invested nearly 12.8 billion in guiding funds 21 class 1.1 innovative drugs have been approved (none of them are listed at home or abroad) The figure is 4.2 times that of the 50 years before the founding of the people's Republic of China (1949-2009) Most of the 21 innovative drugs went on the market during the 12th Five Year Plan (2010-2015), which was behind the health insurance catalog adjustment in 2009 In this medical insurance catalog adjustment, it is clear that innovative drugs are one of the key points of this adjustment The new drugs coming into the market after 2009 will be taken as the key evaluation objects, and the innovative drugs will be further inclined Most of the innovative drugs and biological products approved by China from 2008 to the first half of 2015 have been included in the 2017 version of the drug catalog or the scope of negotiated drugs Only a few varieties have not been included because they do not belong to the scope of medical insurance payment (vaccine) or low clinical recognition This is the first time for innovative drugs to enter the market after eight years For them, it's a big boon It also shows the rapid development of our country in the past ten years Only when the state attaches great importance to innovation can so many innovative drugs be launched and such a situation be created President Song said that innovative drugs meet unmet clinical needs Generally speaking, the disease that cannot be treated before can be treated with medicine or with better curative effect If the new drug meets the clinical needs that have been met, and there is no innovation in essence, it cannot be called innovative drug Therefore, innovative drugs are needed in clinical practice, which is very in line with the interests of patients The purpose of medical insurance is not to save money, but to solve the clinical needs The interests of patients are the ultimate goal of medical insurance But saving money is one of the core interests of patients and the responsibility of medical insurance Therefore, on the one hand, medical insurance should vigorously support innovative drugs During the patent period, it should be included in the medical insurance catalogue as much as possible, so that people can use them as soon as possible; on the other hand, when generic drugs (the efficacy and side effects should be the same as the original research drugs) come out, more attention should be paid to generic drugs, so as to stabilize the market price At this time, innovative drug manufacturers have received market returns, and have the power to carry out the next round of innovation, forming a virtuous circle of innovation So there is a unity of opposites between innovative drugs and generic drugs President Song believed that as a representative of the payer, the attitude towards innovation is an important aspect of the survival environment of innovative drugs Any product is finally tested in the market If the market supports this product, the national policy should guide and release the market demand When the innovative medicine has the market demand, it can show its due value, and ultimately let patients get benefits For the industry, innovative drugs have received good returns, and they are more willing to innovate and join the team of R & D innovative drugs Although the link of medical insurance policy is at the end, it plays a decisive role in the early stage of R & D innovation 2、 "Pharmacoeconomics" is to transform the clinical value of an innovative drug into economic value In other words, although innovative drugs are more expensive than existing drugs, they reduce the cost of other aspects due to their clinical value, such as avoiding patients' stroke, fracture, etc Pharmacoeconomic research is to convert these clinical effects into economic benefits to compare the overall cost It is a unique and most capable research method that demonstrates the overall socio-economic value of innovative drugs " Director Xuan defined pharmacoeconomics "The medical insurance catalog adjustment began to try to introduce pharmacoeconomics into the catalog adjustment, and there is no requirement for enterprises to declare the data of pharmacoeconomics However, experts in pharmacoeconomics were introduced to make a peripheral observation and evaluation through published articles We think it makes sense, it's a good start and a big step forward In fact, the development of this discipline in China requires the medical insurance and drug regulatory authorities to pay attention to pharmacoeconomics when drugs are listed and listed in the medical insurance catalogue In this way, pharmacoeconomics can improve demand and show value This medical insurance has brought unprecedented historical development opportunities for Pharmacoeconomics, lighting a bright light " President Song Ruilin gave a high appraisal When approving new drugs internationally, enterprises are required to provide pharmacoeconomics reports In the past, China was a country dominated by generic drugs, and pharmacoeconomics reported that the original drug manufacturers had done so for a long time Therefore, in the past, domestic enterprises were not required to provide relevant reports, which is consistent with China's social and economic development Now, changes have taken place There are not only innovative drugs in China, but also class 3.1 new drugs (which have been listed abroad but not in China) are constantly on the market, and our comprehensive innovation ability is constantly improving This has also led to an increase in our demand for pharmacoeconomics Not only the quality should pass, but also the economics should be considered scientifically, so as to better reflect the value of drugs Director Xuan introduced three applications of Pharmacoeconomics: first, it can be used as an entry threshold of medical insurance catalogue The social security department can set an evaluation standard, such as how much will be saved or increased for each additional life quality adjustment year after the new drugs are listed, so as to help decision-making Many international reference standards are one to three times of GDP per capita That is to say, if the new drug costs twice the per capita GDP of social security for each additional life quality year of patients, it should be paid Between one and three times of GDP per capita, payment can be considered It is not worth spending more than three times of GDP per capita Second, as a product value-based pricing Third, evaluate the economic risks of the fund 3、 In the early stage, due to various reasons, the period of drug catalog adjustment is indeed long, which we attach great importance to After the release of this catalogue, on the one hand, we will speed up the negotiation of drug access, guide the human resources and social security departments of all provinces (districts and cities) to adjust class B drugs; on the other hand, we will start to study and improve the management methods of drug use, establish a normal and dynamic access mechanism for medical insurance drugs, and make a good organic connection of the access, payment standards, use management and other links of the catalogue, so as to gradually realize the use of medical insurance The whole process management of medicine makes the scope of guarantee adapt to the clinical practice of medicine and the progress of medical technology While providing better guarantee for the majority of insured personnel, medical insurance will further play the role of supporting innovation and promoting development " Chen Jinfu, director of the medical insurance Department of the Ministry of human resources and social security, interprets the dynamic adjustment of the medical insurance catalogue Considering that some of the drugs have high clinical value but are relatively expensive, according to the actual situation that the inclusion of the current price into the catalogue may bring greater pressure to the fund, experts simultaneously reviewed and determined 45 drugs to be negotiated The next step is to control the price reasonably through value-based negotiation In the affordable range of medical insurance, let people use these clinically necessary drugs as early as possible In addition to the dynamic adjustment of negotiation drugs, president Song said he hoped that the shorter the adjustment interval, the better Because the health care catalog should follow the demand, not the demand The closer we adjust our time and demand, the more reasonable it will be According to director Xuan, dynamic adjustment involves not only transfer in, but also transfer out After the new drugs come in, some old drugs will be transferred out when they are not needed For the efficiency of transfer in and transfer out, he believes that the development of information system is far greater than the development of drug research and development, and efficiency is not a problem If we can establish a normal adjustment mechanism and keep our work to a normal level, it will not be a huge project.