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    Home > Active Ingredient News > Drugs Articles > National Health Insurance Directory adjustments are published through a formal review! How to avoid misunderstandings in the enterprise sprint stage

    National Health Insurance Directory adjustments are published through a formal review! How to avoid misunderstandings in the enterprise sprint stage

    • Last Update: 2020-10-31
    • Source: Internet
    • Author: User
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    On Friday, the National Health Insurance Administration flatly zoomed in, issued "on the 2020 National Health Insurance Drug Catalog adjustment form review results query announcement", announced that the new version of the health insurance catalog work into a sprint stage, enterprises can query the form of the declaration of drugs review results, the next step will be to carry out expert review and negotiation work, is the enterprise's fist rub, show their hands at the moment.
    the announcement has two messages: 1. All shortlists have been finalized, and the final results are known only to the participating companies.
    2. The real health care review enters the sprint phase, which is mainly for expert review and negotiation.
    why do companies expect lower expectations of access to health insurance? The results of the review of the National Health Insurance Directory were published through a formal review, although the list of drugs reviewed through the form of review was not made public, and only pharmaceutical companies were open to inquire about their own varieties.
    but it also means that the 2020 version of the health care catalog adjustment has taken another step forward, through the review of the drug access to the new version of the national health insurance directory, will also open a performance "growth door" for related enterprises.
    But in recent years, due to the major reform of pharmaceutical policy, enterprises' expectations of medical insurance have been far lower than the 17th and 19th editions, there are several main factors: 1 health care negotiations in the variety of large-priced medical insurance evaluation of the variety of sharp price reduction, this year in addition to exclusive products, learn from the successful experience of collecting price reduction, non-exclusive varieties also opened the price reduction channel, that is, bargaining.
    70 of the 119 new varieties in the 2019 health care negotiations were successful, with an average drop of 60.7 percent.
    of three hepatitis C treatment drugs decreased by more than 85%, tumor diabetes decreased by more than 65%.
    27 of the 31 renewal drugs successfully, a decline of 26.4 per cent.
    no surprise, companies still need to be prepared to slash prices this year.
    health insurance fund was put on the agenda after the new health insurance fund was established in 2018.
    also in the hospital assessment of the use of medical insurance funds as an important assessment indicators, hospital control, management, department restrictions, doctor ranking and other means, resulting in the use of medical insurance products tend to rational.
    China Hospital Association Health Insurance Commission in 2013 organized the formulation of the National Hospital Medical Insurance Service Code (hereinafter referred to as the Code).
    Commission in March 2016 launched the implementation of the Code research work, so far, has been carried out for three consecutive years of research, released in 2019, the results show that 95% of hospitals have set up a health care management committee, 95% of hospitals can be staffed in accordance with the requirements of the Code, health care practitioners in the hospital management position significantly improved.
    3 health insurance review once a year health insurance review frequency increased, some business leaders said, this year's sprint, not next year to continue.
    this also reflects the mentality of some pharmaceutical companies, for the health care review is no longer a company-wide force must choose, but become a priority option.
    Nevertheless, important varieties of enterprises, such as access to health insurance, doctors priority to issue medical insurance drugs, patients preferred medical insurance drugs, can effectively protect drug sales;
    and enterprise drugs can successfully enter health insurance is still worth fighting for and efforts.
    drug companies face three major misconceptions about health insurance reviews in line with the previous catalog adjustment process, the 2017 edition of the "Drug Catalog" of Western medicine 1297 varieties, an increase of 133, an increase of about 11.4%.
    taking into account the safe operation of the health insurance fund, the medical insurance authorities to the health insurance fund estimates that the proportion of increase in varieties will not be too high, unless the price of drugs more, but too much, too fast into the health insurance varieties there is still a certain risk.
    is relatively reasonable to include 100-150 varieties in accordance with the past, and the annual catalog adjustment will not have much impact on pharmaceutical companies.
    consider limited health-care funds, the 2020 version of the health-care catalog is even more valuable.
    This is a huge pressure on enterprises, competition is more intense, due to the cause of the epidemic, this year's medical insurance is particularly special, enterprises in the special circumstances do not fall into a misunderstanding: 1 pharmaceutical enterprises medical insurance strategy misjudgment this year's new version of the medical insurance catalog review background is different, in the "Basic Medical Insurance Drug Administration Interim Measures" and "2020 National Health Insurance Drug Catalog Adjustment Work Programme" in the background adjustment, and "Basic Medical Insurance Drug Administration Interim Measures" as the guiding principles of health insurance work.
    the 2020 National Health Insurance Drug Catalog Adjustment Work Programme is also different from the past, enterprises independently declare, cancel the selection of varieties, increase the bargaining link, drug economics expert status prominent, which will form a new challenge to enterprises.
    is important to study the rules, not just the rules.
    2 After the establishment of the new health insurance bureau, the medical insurance material is not prepared enough, relying more on expert review to highlight the clinical value and scientific nature of the health insurance catalog, and in 2020, in addition to the past clinical experts, more prominent expert value in drug economics.
    The economic value assessment of drugs in the health care negotiation and bargaining process will become a top priority, and most domestic enterprises or products have not yet been studied, so it will be difficult to form effective convincing evidence in the product pricing process.
    And there are a small number of enterprises temporarily asked the relevant drug economics experts through modeling research, in a hurry can also get a certain theoretical basis, but based on time, group of patients, research design and other factors assessment, the scientific nature of this kind of evidence is worth considering.
    , the author boldly predicted that this year's exclusive product price reduction or bargaining will be comparable to the past, or between 60% and 80%.
    3 expert visits to lag expert review is an important part of the health insurance catalog evaluation process.
    And expert visits "inside and outside" are different, foreign pharmaceutical companies based on a wealth of medical insurance experience, expert visits started earlier, and most of the domestic pharmaceutical companies there is a lag, especially in the material preparation delay led to expert visit delays.
    health care review experts are already signing non-disclosure agreements, and can no longer accept corporate invitations to visit, which can also lead to companies losing contact with experts at important levels.
    drug companies how to circumvent the three major mistakes of medical insurance evaluation soldiers to block, water to cover, for the identification and avoidance of the three major misunderstandings is particularly important.
    1 read through the rules, standing in the rules of health insurance is like an examination, rules are like a test outline, how to be invincible in the medical insurance examination, probably can only be familiar with the examination outline, and not only in the examination outline.
    under the guidance of the basic rules of the Interim Measures for the Administration of Drug Use of Basic Medical Insurance, the work of medical insurance will reflect stability and system, which will help enterprises to formulate the general direction of medical insurance work in accordance with the rules of the Measures.
    , for each year's National Health Insurance Drug Catalog Adjustment Work Programme, according to the work programme to develop the current year's health care strategy.
    is important after the rules have been made.
    According to the results of health insurance for health insurance personnel reward and punishment is also particularly important, such as a large variety of health insurance, foreign enterprises, annual health insurance leaders to develop health insurance indicators, usually according to the number of varieties, such as 3 or 5, and after the end of health insurance, if the completion of the target will be given a high reward, if not completed, it is possible to imagine, may also face classes, so health insurance personnel in the evaluation stage is often in a schizophrenic state.
    2 material preparation based on evidence-based material preparation based on evidence-based evidence has become a trend, with the widespread approval of innovative drugs and the elimination of low-value drugs after "cage-for-bird", the level of health insurance evaluation varieties is also rising.
    this is different from the past, in the assessment of many varieties of evidence-based evidence is insufficient scenario.
    Evidence classification criteria, which are widely accepted and used internationally, are mainly based on the evidence classification standards developed by the Evidence-Based Medicine Centre at Oxford University and theGRADE standards developed by the Working Group on "Recommended Grading Assessment, Development and Evaluation", which combines the various classification criteria.
    , in the preparation of medical insurance materials, it is necessary to achieve "high standards, strict requirements", scientific demonstration.
    3 Expert visit in peacetime expert management non-one-day work, especially experts on the product advantages of the existence of awareness, cognition, understanding of the process, this process is long and difficult, requires a lot of investment, which is why foreign products can be invincible in the medical insurance review reasons.
    Many foreign companies attributed the health care performance to the business unit also stems from this, the management and information transmission of large experts, in addition to the marketing department daily visits and meetings of the "brainwashing", more cases are sales of daily visits and services are not related.
    this to give the vast number of domestic pharmaceutical companies in expert management and medical insurance visits enlightening.
    addition, health care experts to visit "early", to "frequently", if the academic basis of the product is not good, but also should develop a systematic expert management plan, otherwise it will be in the "door-to-door" when the loss of the opportunity.
    Always mentioned, year after year to say health insurance, annual health insurance, annual assessment of health insurance, from the author, enterprises and experts will be different, we in the medical insurance review to learn the rules, make materials, visit experts, all for a goal, is to provide the vast number of patients with trustworthy good medicine, good medicine for health insurance will be a trend in the future.
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