The 2020 Health Care Catalog is back! Domestic PD-1 all-in, 29 kinds of drugs transferred out, the average decline in national talks 50%, is expected to reduce the negative 28 billion yuan!

The largest number of negotiations! The widest range of benefits! Exclusive medicine and then reduce the price! ...... How much of this year's health insurance drug catalog adjustment results come out of life-saving drugs talk about? How much benefits do ordinary people get? All you care about is here! A total of 162 drugs were negotiated, 119 were successful and the success rate was 73.46 per cent.
prices for drugs negotiated in the united States have been reduced by an average of 50.64 per cent.
through this catalogue adjustment, the total number of drugs in the National List of Basic Medical Insurance, Industrial Injury Insurance and Maternity Insurance Drugs (2020) is 2,800, of which 1426 are Western medicines and 1,374 are Chinese medicines.
chinese medicine tablets in the catalogue were not adjusted and remained at 892.
the characteristics of the catalog adjustment, the first is to adhere to the "basic" functional positioning, to ensure that the expenditure of the health insurance fund can be controlled.
In the process of catalog adjustment, adhere to the basic principle of "doing everything possible to protect the basic, always adhere to sustainability", do your best, do your best, firmly grasp the functional positioning of "keep the basic", through the transfer of clinically low-value drugs, negotiate to reduce the cost of drugs in the catalog significantly higher, special negotiations on the price of expired drugs, especially in recent years, the centralized procurement of "quantity-for-price" to further squeeze the price of medicine, to achieve "cage for birds", to ensure the basic balance of funds.
is the largest number of negotiated drugs and the widest range of therapeutic areas.
the 96 exclusive drugs eventually negotiated, plus 23 non-exclusive drugs transferred directly, involved 31 clinical groups, accounting for 86% of all clinical groups, with a broader range of patient benefits.
is the first attempt to reduce the price of drugs in the catalog negotiations, significantly improve the economy.
review experts selected 14 exclusive drugs with high prices or high costs and more funds to negotiate price reductions, all of which sold for more than 1 billion yuan a year.
the negotiations, all 14 drugs were successfully negotiated and kept in the catalogue, with an average price reduction of 43.46 per cent, setting a clear direction for the need for the original catalogue of drugs to continue to improve their economy.
fourth is to support the prevention and control of the new crown outbreak.
This adjustment, attaches great importance to the protection of the treatment of new crown pneumonia-related drugs, libawelin injections, Abidor particles and other drugs into the catalog, the latest version of the national new crown pneumonia diagnosis and treatment program listed drugs have been all included in the national medical insurance directory, with practical action to help the prevention and control of the epidemic.
is to include this year's new drugs in the scope of adjustment.
to better meet patients' demand for new drugs, the company has included drugs on the market before August 17 this year in the scope of adjustment, and finally 16 drugs have been included in the catalog, reflecting the direction of supporting new drugs.
as a whole, through the current national medical insurance drug catalog access negotiations, the medical insurance fund and insured patients have not significantly increased drug expenditure, under the premise that the overall safety of the fund can be controlled, the ability and level of medical insurance drug security has been improved.
More importantly, it can further guide pharmaceutical enterprises to form a reasonable and healthy value trend, and finally, by supporting innovation and value purchase, we can vigorously promote the high-quality development of China's pharmaceutical industry from the perspective of strategic purchase, and promote the pharmaceutical industry to deepen supply-side reform.
. Policy Interpretation: In order to let the community know more about the adjustment of the National Health Insurance Drug Catalog in 2020, the State Health Insurance Administration has interpreted the Notice on the Release of the National Basic Medical Insurance, Industrial Injury Insurance and Maternity Insurance Drug Catalog for 2020 (Medical Insurance Issue No. 53, hereinafter referred to as the Notice).
1. 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, the State Health Insurance Administration, in accordance with the relevant provisions of the Interim Measures for the Administration of Basic Medical Insurance Drug Use, will work with relevant departments to carry out the adjustment of the national medical insurance drug catalogue 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.
2. How to ensure the functional positioning of "guarantee basic" in this adjustment? For out-of-catalog drugs, in the evaluation, measurement, and determination of the scope of payment of the medical insurance fund, all take into account the current level of China's economic and social development, the affordability of the medical insurance fund and insured personnel and other factors, set a technical standard in line with the "guarantee basic" positioning, 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 payment standards gradually return to reasonable.
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.
3. What changes and considerations have been given to the scope and quantity of drugs listed in this adjustment, which are included in the scope of the adjustment? Unlike previous rounds of adjustment, which included "all listed drugs" in the scope of the review, this year for the first time, the declaration system was introduced, that is, 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 those included in the list of five or more provincial health insurance drugs, are also 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.
5, the catalog has 29 kinds of drugs transferred out, please ask when the drug will be transferred out, will it have an impact on the use of drugs in patients with related diseases? After expert review, a total of 29 drugs were transferred out of the catalog, mainly for low clinical value and replaceable, or by the drug regulatory department revoked the code as "zombie drugs" and other varieties.
the transfer of these drugs, after repeated expert argumentation, strictly in accordance with the procedures to determine.
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.
6. We note that some of the "old varieties" that have been in the catalogue for a long time have been included in the scope of negotiations, what are the considerations? Article 10 of the Interim Measures for the Administration of Essential Medical Insurance Drugs clearly stipulates that "in the same field of treatment, drugs with high prices or costs and no reasonable reason" "clinical value is not accurate, can be better replaced by drugs", etc., after expert review and other prescribed procedures, can be transferred out of the Drug Catalog.
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 catalog.
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.
the so-called "old varieties" in the catalogue into the negotiations, mainly considering 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.
from 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 protection situation in the field of anti-cancer drugs 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, it 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 decrease 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.
8. What is the impact of this adjustment of the medical insurance drug catalogue on the burden of health insurance funds and patients? 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.
9. 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 standard 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 the supervision mechanism in the adjustment of the medical insurance drug catalogue.
is to improve the system measures.
for directory adjustment prone risk points, experts, staff and business personnel, have developed a clear system of 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