Official interpretation of the 12 most important issues in the 2020 health care catalog!

First, what are the general ideas and objectives of the adjustment of the national medical insurance drug catalogue in 2020? In order to implement the decision-making and deployment of the CPC Central Committee and the State Council, in accordance with the relevant provisions of the Interim Measures for the Administration of Drug Use in Basic Medical Insurance, the State Administration of Medical Insurance, together with relevant departments, will earnestly carry out the adjustment of the National Medical Insurance Drug Catalog in 2020.
This adjustment has always adhered to the "basic" functional positioning, in accordance with the "do your best, do your best" requirements, established a "highlight the focus, complement the short board, optimize the structure, encourage innovation" adjustment ideas, play the institutional advantages, policy advantages, market advantages, release Reform dividends, strive to achieve a more optimized structure of the drug catalog, more efficient use of medical insurance funds, basic medical insurance drug security capacity and a higher level of objectives, to better meet the basic drug needs of the vast number of insured people, to help solve the people's worries about medical treatment, improve the general public's sense of access.
After this catalog adjustment, 119 kinds of drugs were transferred to the catalog, 29 kinds of drugs were transferred out of the catalog, the final catalog of a total of 2800 kinds of drugs, of which 1426 kinds of Western medicine, 1374 kinds of Chinese medicine, the proportion of Chinese and Western medicine is basically flat.
, this adjustment, how to ensure that the "basic" functional positioning? For out-of-catalog drugs, in the evaluation, measurement, as well as determine the scope of payment of the medical insurance fund and other links, all take into account the current stage of China's economic and social development level, medical insurance fund and the affordability of insured personnel and other factors, set in line with the "basic" positioning of the technical standards, to ensure that the negotiated payment standards in line with expectations.
to the catalog of drugs, specialized organization of expert review, the original unnegotiated access to the catalog and high prices or high prices of varieties to negotiate price reductions, guide the catalog of drugs to gradually return to reasonable payment standards.
At the same time, through the transfer of clinically low-value drugs and other measures, especially in recent years, the centralized procurement of "quantity for price" to further squeeze the price of water, to achieve "cage for bird", to ensure the safety of the Fund.
, this adjustment, the scope and quantity of drugs included in the scope of adjustment, what changes, what are the considerations? Unlike previous rounds of adjustment, which included "all listed medicines" in the scope of the review, the declaration system was introduced for the first time this year, i.e. out-of-catalog drugs that meet the conditions set out in this year's adjustment programme can only be included in the scope of adjustment.
the scope of adjustment of drugs outside the catalogue has realized the transformation from "sea selection" to "preferably".
According to the 2020 National Health Insurance Drug Catalog Adjustment Work Programme, there are seven main types of drugs adjusted this year: drugs for the treatment of respiratory diseases related to neo-corona pneumonia; Encourage generic drug catalogs or encourage research and development to declare listed medicines for children, include successful drugs in the scope of national centralized procurement, drugs approved for market after January 1, 2015, and drugs with significant changes in adaptive and functional treatment after January 1, 2015.
, taking into account the continuity of drug use in the provinces that originally supplemented their own medicines, this time will also be "included in the list of five or more provincial medical insurance drugs" into the scope of adjustment.
the declaration conditions, a total of 704 kinds of out-of-catalog drugs were successfully declared.
the main consideration of setting the declaration conditions is: First, to better meet the clinical needs.
such as new crown pneumonia treatment drugs, clinically urgent need or encouragement of generic drugs, national basic drugs, the collection of selected drugs.
is to better connect with the new drug approval work, to achieve drug approval and medical insurance evaluation "seamless interface", reflecting the guidance of encouraging the creation of new drugs.
such as newly marketed drugs, newly approved modified functional or adaptive drugs.
third is to take care of the continuity of clinical drug use.
, such as medicines included in the list of five or more provincial health insurance drugs, have also been included in the adjustment.
, the success rate of the negotiations on the adjustment of the national medical insurance drug catalogue? What are the quantities, types, treatment areas and price reductions of successfully negotiated drugs? An important feature of this adjustment compared to previous years is that the largest number of drugs negotiated for price reduction and the widest range of therapeutic areas are benefiting.
We negotiated a total of 162 drugs, with 119 successful (of which 96 were out-of-catalog and 23 in the catalogue), with a success rate of 73.46 per cent and an average price reduction of 50.64 per cent.
A total of 119 new drugs (including 96 exclusive drugs and 23 non-exclusive drugs) have been adjusted to cover 31 clinical groups, accounting for 86% of all clinical groups.
, the catalog has 29 kinds of drugs transferred out, please ask when the drugs will be transferred out, will it have an impact on the relevant disease patients medication? After expert review, a total of 29 drugs were transferred out of the catalog, mainly for clinical value is not high and replaceable, or by the drug regulatory department to revoke the code as "zombie drugs" and other varieties.
the transfer of these drugs, after repeated expert argumentation, strictly in accordance with the procedures.
experts used alternatives as an important indicator during the review process, and the list of drugs available for replacement with comparable or better efficacy.
the same time, the transfer of these drugs to make room for more new drugs, good drugs into the catalog.
, we note that some of the "old varieties" that have been in the catalogue for a long time have been included in the negotiations, what are the considerations? Article 10 of the Interim Measures for the Administration of Drug Use in Basic Medical Insurance clearly stipulates that "drugs with high prices or costs in the same field of treatment with no reasonable justification" and "drugs of insanity of clinical value that can be better replaced" may be transferred out of the List of Drugs after expert review and other prescribed procedures.
In this year's adjustment process, the review experts after repeated argumentation and rigorous review, according to the above requirements of 14 kinds of drugs in the catalog into the scope of negotiations, if successful negotiations will be retained in the catalog, otherwise the directory.
14 drugs were unnegotiated at the time of early access to the catalogue and were assessed to be significantly more expensive or expensive.
, all 14 drugs were successfully negotiated and remained on the catalog, with an average price reduction of 43.46 per cent.
to include the so-called "old varieties" in the catalogue without negotiation, the main consideration is three aspects, one is to enhance the economics of medicines.
also have a life cycle, by the market competition environment changes and other factors, drug payment standards should be adjusted accordingly.
the actual situation, some drugs into the catalog, the payment standards have not been adjusted for a long time, or adjustment is not in place, the economy has decreased significantly.
negotiations are an important means to enhance economic efficiency.
is to promote fairness.
Through the introduction of negotiation mechanism, in recent years, some new access to the catalog of drugs more cost-effective, compared with the original catalog of "old varieties" there has been a price "inverted" phenomenon, in order to maintain the use of health insurance funds and patient rights and interests of fairness, we use the market mechanism, "old varieties" to negotiate, guide its payment standards back to reasonable.
is to reduce the burden on patients and save money on funds.
practice has proved that through negotiation of "old varieties", it can effectively reduce the burden on patients and improve the efficiency of the use of medical insurance funds.
in the future adjustment, we will also organize experts to review, eligible "old varieties" to negotiate, and strive to improve the economics of the drugs in the catalog.
, after this year's adjustment, the field of anti-cancer drugs in the protection of what has changed? The CPC Central Committee and the State Council attach great importance to the protection of anti-cancer drugs.
2018, when our bureau was established, we organized special access negotiations for cancer drugs, and finally 17 drug negotiations were successfully included in the catalogue, and the agreement expired at the end of this year.
of the 17 anti-cancer drugs, three generic drugs were listed in Class B management.
14 exclusive drugs were renewed or renegotied on a rule-by-rule basis, with an average decline of 14.95 per cent, with individual first-line cancer drugs falling by more than 60 per cent.
estimates, 14 anti-cancer drugs reduced prices, is expected to save cancer patients more than 3 billion yuan by 2021.
same time, the adjustment also added 17 new anti-cancer drugs, including PD-1, lenvatinib and other new drugs, the level of protection of cancer drugs in the catalog significantly improved.
, this medical insurance drug catalog adjustment, the impact on the health insurance fund and patient burden? According to preliminary estimates, through negotiations to reduce prices and transfer out of the catalog, can make room for the fund.
Because in the catalog adjustment process, we strictly grasp the economics of drugs, the addition of 119 drugs (exclusive 96, non-exclusive 23), most of which are negotiated to achieve price reductions of the exclusive drugs, the expected increase in fund expenditure in 2021, and the negotiation and transfer of drugs to free up space is basically equivalent.
the same time, the agreement on the drug in this negotiation is valid for two years, and after two years we will adjust its payment criteria again to ensure the smooth operation of the fund.
from the patient burden situation, through negotiations to reduce prices and medical insurance reimbursement, it is expected that 2021 can be accumulated for patients to reduce the burden of about 28 billion yuan.
, in view of the adjustment of the medical insurance drug catalogue, what measures has the State Health Insurance Administration taken to strengthen supervision and ensure the fairness, fairness and integrity of the adjustment of the medical insurance drug catalogue? The State Health Insurance Administration has always attached great importance to strengthening the construction of supervision mechanism in the adjustment of the medical insurance drug catalogue, and its leaders have personally deployed in key links to clarify their tasks, emphasize the requirements of integrity and discipline, and ensure that negotiations are scientific, standardized, clean and orderly.
is to improve the system measures.
for directory adjustment prone risk points, experts, staff and business personnel, have developed clear institutional measures to prevent risks at the source.
is to strengthen the supervision and management of experts.
in determining the list of experts, allocation of measurements, negotiation tasks and other aspects of strict adherence to the principle of interest avoidance and random, all experts are selected at random.
requires that experts be on the job and that each expert participates in only one session.
expert review, measurement and other links to implement a complete closure.
third is to strengthen internal control management.
has formulated special working rules, clarified the responsibilities of jobs and personnel, improved the system of information confidentiality, interest avoidance, accountability and other measures, and strengthened the education, supervision and management of integrity and confidentiality.
fourth is to strengthen the normative constraints.
all staff and experts have signed the Confidentiality and Integrity Commitment Statement.
experts are recommended by the Party organization of their units and truthfully report matters related to the interests of the enterprise.
is to take the initiative to accept the supervision of all parties.
accept complaints from all sectors of the community.
the adjustment of the catalogue invited the media and discipline inspection and supervision to participate in the entire negotiation process audio and video recording, so that all evidence can be traced, the parties can appeal.
in accordance with the above requirements, the work of this negotiation is orderly and steady.
the payment standards for negotiated medicines be implemented? Negotiating drug payment standards are the medical insurance payment standards jointly agreed between pharmaceutical enterprises and the State Health Insurance Administration, which is the sum of the costs paid by the fund and individual patients, and the co-ordination areas pay the drug expenses on the basis of the negotiated medical insurance payment standards.
the new payment standards for drugs this year, which are in sync with the new catalogue, will be implemented from 1 March 2021 until 31 December 2022.
be adjusted in accordance with the relevant provisions of the medical insurance drug payment standard after the end of the agreement.
the validity period of the agreement, the price of the drug to the fixed-point medical institutions and fixed-point retail pharmacies of the national medical insurance shall not exceed the standard of payment for medical insurance.
If a generic-named drug (generic) from another manufacturing enterprise is listed within the scope of the catalogue, the medical insurance department shall have the right to adjust the payment standard for medical insurance according to the price of generic drugs, and shall also have the right to include the generic-name drug in the scope of centralized procurement.
in the event of a major adjustment in national policy or if the actual market price has been significantly lower than the agreed payment standard, the medical insurance department may, in consultation with the enterprise, re-establish the payment standard.
exceeds the validity period, the medical insurance department shall adjust the payment standard in accordance with the relevant provisions of the medical insurance drug payment standard.
, after the completion of negotiations, the new version of the National Health Insurance Drug Catalog when to start implementation, how to implement? This year's adjustment was not completed until December because of the outbreak.
in order to set aside time for system adjustment, policy convergence and personnel training for local health insurance departments and agencies, we have decided to formally implement the new catalogue from March 1, 2021.
The State Health Insurance Administration will issue documents with relevant departments, strengthen guidance, promote the implementation of the new version of the catalogue, and strengthen monitoring and dispatch, strengthen post-access management, to ensure that the new version of the directory can benefit the masses as soon as possible.
, the new version of the catalogue issued, the National Bureau is prepared to take what measures to promote landing? After the publication of the catalogue, we will guide all regions to strengthen the transformation of information systems, adjust and refine payment management measures, do a good job of policy convergence.
is to implement measures such as the direct networking of negotiated drugs to ensure that the negotiated drugs adjust the payment standards in accordance with the agreement on schedule.
is to guide the establishment of fixed-point medical institutions, timely optimization and upgrading of the institution equipped with, use of drugs, improve the level of clinical drug use.
3 is to guide innovative ways to promote the landing of drugs in the new version of the catalog by improving the policy of outpatient protection, opening the channel of fixed-point pharmacies for medical insurance, and rationally adjusting the total amount control.
fourth is to strengthen monitoring and scheduling.
mechanisms to strengthen the monitoring of the use and payment of drugs in the catalogue, especially negotiated medicines, and to solve problems in the process of landing in a timely manner.
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