The adjustment of the medical insurance catalogue starts!

This year’s National Medical Insurance Catalogue adjustment work officially kicked off.

According to requirements, the public can make comments and suggestions before 17:00 on June 16, 2021 (Wednesday)
.

The drugs in the 2016 forward catalogue are the focus of the call

October-November public distribution end result

Taking into account the functional positioning of basic medical insurance, the clinical needs of drugs, and the affordability of funds, the "Plan" delineates a specific scope for the adjustment of the drug catalog in 2021
.

For western medicines and Chinese patent medicines not listed in the catalog, they can be included in the review scope of the 2021 drug catalog if they meet the provisions of Articles 7 and 8 of the "Interim Measures for the Administration of Drugs for Basic Medical Insurance" and have one of the following four conditions

2.

During the period from January 1, 2016 to June 30, 2021, drugs with major changes in indications or functions and indications approved by the State Drug Administration

3.
Drugs for the treatment of respiratory diseases related to new coronary pneumonia
.

4.
Drugs included in the "National Essential Drug List (2018 Edition)"
.

Continuing the innovative method of last year’s medical insurance catalog adjustment that was first declared by enterprises and then reviewed by experts, the "Plan" clarified that Western medicines and proprietary Chinese medicines outside the catalog that meet the above conditions will also be declared by enterprises in accordance with procedures this year, and after review and approval Included in the scope of review
.

The deadline for exclusive drug identification is June 30, 2021

   In the context of the “vacation of cages for birds” in the medical insurance policy, the drugs already in the medical insurance catalogue are not worry-free
.

For Western medicines and Chinese patent medicines in the catalog, according to the requirements of the "Plan", the drugs in the catalog that meet the requirements of Article 9 and Article 10 of the "Interim Measures for the Administration of Basic Medical Insurance Medications" and have one of the relevant circumstances raised by it will be Be included in the scope of review of the 2021 drug catalog

(1) Drugs that have been revoked, revoked or cancelled by the National Drug Administration
.

(2) Drugs whose clinical value, adverse reactions, drug economy and other factors are considered comprehensively, and the risk is greater than the benefit after evaluation
.

Focus on drugs that have been listed in the catalog before January 1, 2016 and have no purchase records on the national drug procurement platform from January 1, 2016 to June 30, 2021

2.

Adjust the scope of payment standards for drugs

(1) Negotiated drugs that are within the validity period of the agreement and need to re-determine the payment standard in accordance with the agreement
.

(2) According to the company's declaration, it is necessary to adjust the negotiated drugs that limit the scope of payment after expert review
.

(3) Compared with other medicines in the same treatment field, the prices or expenses are obviously higher, and medicines that have taken up a large amount of funds in recent years
.

  

  It is worth noting that in the scope of the drugs that are delineated from the catalog, except for the drugs that have been revoked, revoked or cancelled by the national drug regulatory authority, the National Medical Insurance Bureau has clearly considered the clinical value, adverse reactions, and Drugs whose economics and other factors are assessed to be more risky than benefits
.
For the first time, it is proposed to focus on drugs that have been in the catalog before January 1, 2016, and that there is no purchase record on the national drug procurement platform from January 1, 2016 to June 30, 2021
.
The scope of drugs for adjusting payment standards is basically the same as in previous years
.
  

  According to the arrangement, this year's national drug catalog adjustment is divided into five stages: preparation, declaration, expert review, negotiation, and announcement of results.
Among them, June-July is the preparation stage, July-August is the declaration stage, and August-September is the expert review stage.
, September-October is the negotiation stage, and October-November is the announcement stage
.
In the expert review stage, the drugs declared by pharmaceutical companies will go through three major links: comprehensive group review, professional group review, and comprehensive group demonstration
.
  

  In the comprehensive group review process, the National Medical Insurance Administration will organize review experts to use review indicators to conduct comprehensive reviews of drugs, forming plans to be directly transferred in, to be transferred in through negotiation, to be directly transferred out, to be transferred out, to be adjusted to limit the payment range, etc.
5 Suggested list of related drugs
.
In the comprehensive group demonstration link, the National Medical Insurance Bureau will demonstrate the expert opinions of the professional group, and finally determine the list of drugs in five aspects: direct transfer, negotiation transfer, direct transfer, can transfer, and adjust the limited payment scope
.
    

"Dual channel" policy support

Medicare negotiation drugs are more interesting

  Under the dynamic adjustment mechanism of the medical insurance drug catalog established by the National Medical Insurance Administration, the adjustment of the medical insurance catalog and the accompanying medical insurance negotiations have achieved normalized progress
.
This re-adjustment will give birth to the seventh edition of the medical insurance catalogue since the implementation of the medical insurance system in China.
Looking back at the adjustment results of the 2020 edition of the medical insurance catalogue that has just been implemented for more than three months, it may deepen the industry’s expectations of this new medical insurance catalogue adjustment.

.
  

  The 2020 version of the medical insurance catalogue was officially implemented on March 1 this year.
It contains a total of 2,800 Western medicines and proprietary Chinese medicines, including 1,264 Western medicines, 1,315 Chinese patent medicines, and 221 medicines negotiated during the agreement period
.
In addition, there are 892 kinds of Chinese medicine decoction pieces that the fund can pay
.
From the overall medical insurance adjustment results, according to statistics, a total of 119 varieties have been included in the new version of the medical insurance catalog, of which 23 are directly transferred and 96 are transferred through medical insurance negotiations; 29 varieties are mainly transferred out of the medical insurance catalog.
It is of low clinical value and can be substituted, or the registration number has been revoked by the drug regulatory authority to become a "zombie drug" and other varieties
.
  

  The most concerned by the industry is that the National Medical Insurance Bureau negotiated 162 kinds of drugs.
119 kinds of drugs were successfully negotiated, with a success rate of 73.
46% and an average price reduction of 50.
64%.
The price of individual anticancer drugs even dropped by as much as 80%
.
Insiders pointed out that in recent years, the structural adjustment of the medical insurance catalogue has shown a clear trend.
The medical insurance payment policy is tilted towards more drugs for tumors, rare diseases and chronic diseases.
The results of the medical insurance negotiations last year also reflect this remarkable feature
.
Medical insurance negotiations are obviously the driving force behind the innovation of pharmaceutical companies, because they not only determine the development prospects of innovative drugs for companies, but are also an important catalyst for the increase in volume of innovative drugs
.
  

  With the support of the medical insurance "dual channel" policy, the greater desire of pharmaceutical companies to participate makes this year's medical insurance negotiations more interesting and worthy of the industry's expectations
.
According to incomplete statistics from the reporter of "Pharmaceutical Economic News", only in the first quarter of this year, including Pratini Capsules and Avatinib from CStone Pharmaceuticals, Utidrolone Injection from Chengdu Huahao Zhongtian Pharmaceuticals, and Rongchang 19 new drugs including the new crown vaccine of Beijing Kexing Zhongwei, Sinopharm Zhongsheng, Kangsino, and Zhifeilongkoma have been approved for marketing.
These drugs will eventually be approved for marketing.
What kind of price enters the medical insurance catalogue, wait and see
.

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