Paxlovid health insurance negotiations were unsuccessful and the drugs were reimbursed

On the 8th, after several days of "soul haggling", the negotiation of the 2022 national medical insurance drug catalogue officially ended
.
According to news from the National Health Insurance Administration, the new crown treatment drug Paxlovid that has attracted much attention from the outside world failed to negotiate successfully due to high quotations, and the negotiations for azvudine tablets and lung cleansing detoxification granules were successful
.

 

The offer was too high, and Paxlovid health insurance negotiations were unsuccessful

 

According to the person in charge of the Department of Pharmaceutical Administration of the National Medical Security Administration, this year, a total of three new crown treatment drugs, namely azvudine tablets, nematevir tablets/ritonavir tablets combination packaging (referred to as "Paxlovid"), and lung cleansing and detoxification granules, participated in the negotiations through the
procedures of self-declaration, formal review, and expert review.

 

Among them, the negotiation of azvudine tablets and lung cleansing and detoxification granules was successful, and Paxlovid was unsuccessful
due to the high quotation of the manufacturer Pfizer Investment Co.
, Ltd.

 

The above-mentioned person in charge also said that although Paxlovid failed to be included in the medical insurance catalogue through negotiation, according to the recent "Notice on Optimizing the Medical Security Policy for Patients with Novel Coronavirus Infection after the Implementation of "Class B and B Tube" jointly issued by the National Medical Insurance Administration and relevant departments, all therapeutic drugs in the "Diagnosis and Treatment Plan for Novel Coronavirus Infection (Trial Version 10)", including Paxlovid, azvudine tablets, monogravir capsules, dispersion cold wet granules, etc.
Medicare will make temporary payments until March 31
, 2023.
During this period, insured patients with new coronavirus infection can enjoy medical insurance reimbursement policies for these drugs
.

 

Competitive products approved, domestic drugs on the way, Paxlovid is not the "only option"

 

China's elderly population and people with underlying diseases are huge, so whether new crown treatment drugs such as Paxlovid can be included in medical insurance has always received high attention
.

 

Although Paxlovid was not successfully shortlisted this time, with the approval of the drug regulatory authorities and the acceleration of domestic drug research and development, patients' choices will be more diversified
in the future.

 

Shortly before the negotiations, in December 2022, the State Food and Drug Administration had conditionally approved the import registration
of Merck's new coronavirus treatment monogravir capsules.

 

According to media reports, on March 17, 2022, the Medicines Patent Pool (MPP) in Geneva announced that it had signed agreements with 35 pharmaceutical companies to allow them to produce one of the ingredients of Pfizer's new crown oral drug Paxlovid Nimatevir API or preparation
.
Among them, the five Chinese pharmaceutical companies are Shanghai Disano, Huahai Pharmaceutical, Propharma, Fosun Pharma and Jiuzhou Pharmaceutical
.

 

At the same time, domestic new crown treatment drugs are also accelerating research and development
.
In addition to Real Bio's azvudine tablets that have been approved for marketing in China, Junshi Biologics VV116, Ascletis Pharmaceutical's new crown oral drug polymerase inhibitor ASC10, CSPC Group's new crown oral drug SYH2055, etc.
have entered clinical trials
.

 

Some industry analysts believe that with the increase in the number of approved drugs, it will put pressure on
Paxlovid's future pricing.

 

The National Medical Insurance Administration also introduced that after Azvudine tablets and lung cleansing and detoxification granules were included in the national medical insurance drug list after this negotiation, there are more than 600 kinds
of drugs in the national medical insurance drug list to treat fever, cough and other new crown symptoms.
At the same time, in order to meet the needs of the treatment of patients infected with new coronavirus infection in various places, local medical insurance departments have recently temporarily included a batch of new crown symptomatic treatment drugs into the payment scope
of local medical insurance in combination with the operation of local medical insurance funds.
In general, medical insurance reimburses a wide
range of drugs for the treatment of new coronavirus infection.

 

Official clear reimbursement policy These expenses are reimbursable!

 

In response to the reimbursement of new crown treatment expenses that patients are most concerned about, the policy has also been clarified
.

 

The Notice on Optimizing the Medical Security Policy for Treatment Expenses of Patients with Novel Coronavirus Infection after the Implementation of "Class B and B Management" recently issued by the National Health Insurance Administration and other four departments requires that the inpatient medical expenses incurred by patients with new coronavirus infection in all admitted medical institutions that comply with the diagnosis and treatment plan for new coronavirus infection formulated by the health department shall be implemented as an upfront cost guarantee policy, and shall be paid by basic medical insurance, serious illness insurance, medical assistance, etc.
in accordance with regulations.
The part of the personal burden shall be subsidized by the treasury, the necessary funds shall be paid by the local finance in advance, and the central finance shall provide subsidies
at 60% of the actual expenses incurred.
The policy is calculated based on the time of patient admission and will be implemented until March 31
, 2023.

 

From the local level, Beijing has clarified that the insured patients who occur in designated medical institutions in the city at level 2 and below will implement special protection for outpatient emergency expenses related to new coronavirus infection and 11 types of suspected symptoms (fever, dry cough, fatigue, sore throat, loss of smell/taste, nasal congestion, runny nose, conjunctivitis, myalgia and diarrhea), with no threshold and ceiling line, and the reimbursement rate is 90%, which will be implemented until March 31
, 2023.

 

The Yunnan Provincial Medical Security Bureau and other departments also jointly issued the Circular, clarifying the continued implementation of the policy of full reimbursement of hospitalization expenses and the implementation of special guarantees for outpatient emergency treatment expenses
.

 

In response to the issue of drug pricing, the person in charge of the Department of Drug Administration of the National Medical Security Administration also said that the Office of the National Medical Insurance Administration recently issued the "Guidelines for the Formation of New Crown Treatment Drug Prices (Trial)", which adopts full-cycle and multi-level measures to guide enterprises to open, transparent and reasonable pricing
of newly marketed antiviral treatment drugs required for the prevention and treatment of new coronavirus infection.