Is "life-saving medicine" landing only relying on "medical insurance"?

Medical network, October 29 -- on October 10, the State Medical Security Bureau issued the notice on including 17 kinds of drugs into the category B scope of the national basic medical insurance, work injury insurance and maternity insurance drugs catalogue (hereinafter referred to as the notice) After more than three months of negotiation, 17 kinds of anticancer drugs were included in the medical insurance reimbursement catalog, including 12 solid tumor drugs and 5 blood tumor drugs After being included in the medical insurance reimbursement catalogue, compared with the average retail price, the average decrease is 56.7% The payment standard of most imported drugs after negotiation is lower than the market price of surrounding countries or regions, which is 36% lower on average, which will greatly reduce the drug burden of cancer patients in China The negotiation fully demonstrates the urgency and timeliness of the entry of anti-tumor drugs into the medical insurance, and also reflects the importance and support of the state for pharmaceutical innovation, which plays a positive role in encouraging the research and development of innovative drugs as soon as possible For pharmaceutical companies, the increasingly frequent national negotiations are both opportunities and challenges The change and unchangeability of three groups of national drug negotiations In order to reduce the burden of drug use by the people and make the achievements of reform and development more equitable for the benefit of all the people, the relevant departments of the state once held two national drug price negotiations in May 2016 and July 2017, which were led by the state health and Family Planning Commission and the Ministry of human resources and social security respectively The first batch of negotiations achieved three varieties, with a price reduction rate of more than half The second batch of negotiations succeeded in 36 varieties, with an average price reduction The range is 44% In this year's negotiation, a total of 17 varieties were included in the list of medical insurance reimbursement, and the payment standard of most imported drugs after negotiation was lower than the market price of surrounding countries or regions, with an average price reduction of 56.7% Liu Mingrui, a senior expert in the pharmaceutical industry, is optimistic about the national drug price negotiation "If the policy can be implemented without discount, we believe that more products of enterprises will participate in price negotiation," he said "Small profits and quick sales" is a simple arithmetic problem for enterprises As long as the quantity is up, I believe they will make greater concessions in price " It is undeniable that the price negotiations of the three batches of drugs have been greatly reduced, which has greatly reduced the burden on the people According to the three groups, Wang Zhenlin, CEO of Shenyang Huawei Group, gave his own analysis: "there are three main factors for such a strong price reduction: first, the original price of tumor drugs is very high, and the market prospect is not optimistic; second, the huge Chinese market brings significant chips to the negotiation; third, the newly established medical insurance bureau has a high enthusiasm to carry out work, and the method is successful When, and focus on the use of tumor drug negotiation strategies in place " It is worth noting that compared with the previous two negotiation varieties involving hepatitis B treatment drugs and cardiovascular and cerebrovascular drugs, the 17 varieties included in the medical insurance catalogue are all clinically necessary anti-cancer drugs, including 12 solid tumor drugs and 5 blood tumor drugs, which is also closely related to Premier Li Keqiang's efforts to push down the price of anti-cancer drugs Wang Zhenlin pointed out that the main reasons for the selection of anticancer drugs in the national negotiations were that the proportion of cancer mortality was the highest, the serious lack of anticancer drugs, especially the fewer varieties entering the medical insurance, which deeply reflected the urgency and timeliness of the entry of anticancer drugs into the medical insurance He further added that in my opinion, this is closely related to the emphasis of the State Council in recent years on strengthening the research and development innovation of anti-cancer drugs and solving the difficulties and high costs of medical treatment Premier Li Keqiang asked relevant departments to speed up the implementation of relevant measures such as price reduction and supply guarantee of anticancer drugs, and pointed out in the instructions: "the demands of patients with serious diseases such as cancer on importing 'life-saving drugs' that can't afford, can't afford, and can't afford, highlight the urgency of promoting the solution to the problem of price reduction and supply guarantee of drugs Relevant measures determined by the Standing Committee of the State Council should be implemented as soon as possible, and those that can be accelerated should be accelerated as soon as possible " Liu Mingrui also agreed: "anticancer drugs are life-saving drugs Malignant tumors do great harm to patients' lives and health, and the social burden is also quite heavy It is imperative to speed up the negotiation of anticancer drugs." In addition to the price reduction range and variety changes, the 17 varieties included in the medical insurance catalog also involve 12 enterprises including Pfizer, AstraZeneca, Takeda, Novartis, Hengrui medicine, Bayer, etc After the price reduction, the market structure of these enterprises is bound to change "I believe that the market will give a good feedback to the first crab eater, and these large enterprises will take this opportunity to expand their market share." Liu Mingrui said so Wang Zhenlin put forward different views He believes that the market pattern will change to some extent, but the initial change will not be too big The reason is that 10 of these 17 varieties are new varieties that were only launched in 2017, and the market needs an experience process In addition, the price determines the market size, sales receipts and profits of the enterprise The number of anti-cancer drugs entering the medical insurance audience will definitely increase, and the market scale will certainly expand Due to the large price reduction in negotiation, the common people and patients benefit a lot At the enterprise level, the profit is lower when the scale goes up and the payment is collected Implementation on the ground - the time is tight, and the notice requires that the centralized procurement of drugs in all provinces (regions and cities) should be implemented by the end of November However, according to the implementation of the first two batches of negotiated varieties, there is still a situation that patients can't buy drugs, which inevitably causes people to worry about the same problems in this implementation In this regard, Wang Zhenlin gave his own views He said: "this time, the 17 varieties landed on time should be relatively smooth The reason is that 10 of these 17 varieties are new varieties that were only listed in 2017, and as manufacturers, they will actively occupy the market In addition, the tumor varieties involved in this time, the competition will be more intense, once the opportunity is taken, the market is huge Even if there are difficulties, they will only appear in medical units, not reflected in the supply of pharmaceutical enterprises " Liu Mingrui doesn't think so He pointed out that it is a systematic project to solve the problem of the landing of negotiation varieties, which can not be solved only by one "negotiation", but also by the close combination of local governments and the state and the matching of local policies If the enterprise just talks about an "identity" and "price" at the national level, but goes back to the local level, there is no corresponding inclination in the policies of "drug payment", "drug bidding procurement" and "proportion of clinical drugs", the situation of patients "unable to buy drugs" will certainly occur According to the notice, the payment standard stipulated in the column of "medical insurance payment standard" includes all expenses jointly paid by the basic medical insurance fund and the insured The sharing proportion of the basic medical insurance and the insured is determined by each overall planning area, so it can be said that the degree of freedom is very high In response, Wang Zhenlin said that the regulation definitely considered the imbalance of economic development and the problem of payment capacity in various regions, and gave full autonomy to all provinces and cities   As to whether there will be more problems in the proportion of insured personnel, Wang Zhenlin thinks that we should look at and analyze from three aspects: first, the economic development of various provinces in the country is very uneven; the proportion of individuals in developed areas may be lower; two, the incidence rate of cancer patients is also unbalanced, and some regions have relatively high incidence rate The proportion of regional individual payment may be higher; third, there is a bottom line problem between the proportion of reimbursement and the proportion of individual commitment Once people's psychological threshold is broken, it is difficult to implement So, on the whole, there will be differences in the proportion of individual commitment among regions, but not too much In view of the deficit of medical insurance in some places in recent years, Liu Mingrui said that once anti-cancer drugs are added to the big pool of local medical insurance to share the cost of medical insurance, it is not ruled out that the proportion of the insured is more In addition, the notice also requires the provincial (District, city) drug centralized procurement agencies to publicly hang the negotiated drugs on the provincial drug centralized procurement platform according to the payment standard before the end of October 2018, and ensure the implementation before the end of November, which can be described as a tight time and heavy task Some in the industry doubt whether the task can be completed within the specified time In response, Wang Zhenlin said that with the experience of landing three varieties in 2016 and 36 varieties in 2017, I think there should be no problem in landing 17 varieties on time, which is feasible in theory and can be guaranteed in time In addition to some hospitals to medical insurance fund pressure is too large, the hospital advance funds are seriously insufficient and other reasons, as well as a small number of hospitals loss serious objective reasons Liu Mingrui also said that it would not be too difficult to negotiate the purchase of drugs in the bidding and online link But there are still some problems to be considered in hospital implementation According to the requirements of guiding principles for clinical application of new anti-tumor drugs (2018 version) published by the health administration of the state health and Health Commission on September 21, negotiation drugs are classified as "common use level" Medical institutions need to control and monitor the whole process of clinical application of anti-tumor drugs, both hospital and department levels, including use rate, adverse reactions, proportion of total drug cost Evaluation of the rationality of the use of clinicians Obviously, there are still many things that need to be done by the hospital in the negotiation of drug implementation, which can be described as a tight time and heavy task Innovative pharmaceutical enterprises usher in the spring of development It is worth noting that the state health insurance bureau mentioned in the document that, within the validity period, if a generic drug (generic drug) is listed, the payment standard of the drug will be adjusted according to the price level of generic drug and further notice will be given And in this negotiation, two domestic enterprises have successfully negotiated varieties, which can be successfully included in the medical insurance catalogue of each province and city Wang Zhenlin said that the regulation mentioned by the health insurance bureau is likely to mean that generic drugs will be liberalized, not limited by the validity period, and may follow India's path of strong imitation In addition, the 17 anticancer drugs include two domestic varieties of Jiangsu Hengrui and China biopharmaceutical, which will play a positive role in mobilizing the R & D innovation of Chinese pharmaceutical enterprises and fully reflect the national attention and support for pharmaceutical innovation   For the announcement of the negotiation results of the National Health Insurance Bureau, Wang Zhenlin thinks that there are two obvious advantages: first, the patients who could not afford the above-mentioned anticancer drugs, most of the payment standards after the negotiation of imported drugs will be lower than the market prices of the surrounding countries or regions, which greatly reduces the drug burden on cancer patients; second, the innovative drug enterprises with core R & D capabilities, Approval procedures, simplification of clinical trials and reduction of R & D cost of new drugs are just around the corner And the increasingly frequent national negotiations have opened a convenient door for Chinese pharmaceutical R & D enterprises to actively innovate and go to the world Wang Zhenlin pointed out that as the country will continue to give green light to the urgently needed, short and difficult innovative drugs according to the actual needs of the medical industry, those enterprises that are good at R & D and pay attention to scientific research will usher in a huge business opportunity and development spring "Whether it's price adjustment for generic drug listing or direct entry of domestic negotiated products into the medical insurance catalogue of various provinces and cities, it's a policy guidance for the state to encourage domestic enterprises to increase the independent research and development of drugs and strive to realize the transformation from a big pharmaceutical country to a powerful pharmaceutical country." Liu Mingrui concluded He entered