The national collection variety payment standard has come.

On September 28th, Sichuan Medical Insurance Bureau issued a public consultation on the issuance of a notice (draft for comments) on the issuance of the national organization's centralized procurement and use of drugs to expand the relevant drug medical insurance payment standards.
In the annex section, Sichuan Province announced the national organization of drug centralized procurement and use of the pilot expansion of the relevant drug payment standards, around 25 drugs, Sichuan for different pharmaceutical companies, different product regulations of 503 drugs, one by one set the payment standards.
, Sichuan stated in the circular that the payment criteria applied to the centralized procurement and use of the pilot expansion of 25 drugs by national organizations, including selected and non-selected drugs.
, whether it is a selected or non-selected variety, you need to refer to this standard for medical insurance reimbursement.
addition, patients use drugs that cost more than the payment standard, the portion that exceeds the payment standard is paid by the patient, and the portion within the payment standard is shared between the patient and the health insurance according to the regulations.
patients with drugs that are priced below the payment standard and are paid at the actual price.
addition to Sichuan Province, Zhejiang has also issued a relevant notice on the payment standards of the national collection of varieties.
, Seberlan's contributing author, Wan Yu, told Seberan that the impact of health care payment standards is expected to be systemic and more widespread.
There are industry insiders to Cypress Blue said that the collection of varieties to pay the standard according to the common name, and reference to the purchase price of the selected varieties, the greatest impact may be the relatively high price of the original research drugs, with the implementation of payment standards, the alternative effect of generic drugs may be strengthened.
the draft opinion, the above notice will be implemented from 15 November 2020, i.e. by that time, 25 collection varieties will have adopted the new payment standard. After the normalization of
collection, the establishment of payment standards is key as early as September 30, 2019, the State Health Insurance Administration and other nine departments issued "on the national organization of drug centralized procurement and use of pilot expansion of regional implementation opinions" clearly pointed out that the exploration of centralized procurement of pharmaceutical medical insurance payment standards and procurement price synergy.
" For centralizedly procured drugs, the medical insurance fund shall, in principle, settle the original research drugs under the same generic name, the evaluation of generic drugs, and generic drugs evaluated by consistency, with the centralized purchase price as the standard of payment for medical insurance within the scope of the medical insurance catalogue.
Patients use drugs higher than the payment standard, the part of the payment standard is paid by the patient, such as the patient's use of the drug price and the selected drug centralized procurement price difference is large, can gradually adjust the payment standard, in 2-3 years to adjust in place."
According to Seber blue inquiry, the National Health Insurance Administration in the response to the relevant recommendations, said that according to the central institutional reform program, the health care sector officially became the competent department of drug prices, after which the State Health Insurance Administration began to actively carry out the national organization of drug belt procurement.
January 1, 2019, the General Office of the State Council issued the Notice on the Piloting of the Central Procurement and Use of Drugs by State Organizations, and organized 11 cities, including Beijing, Tianjin, Shanghai and Chongqing, to carry out volume procurement for 25 varieties.
, the collection of medicines by state organizations has been carried out in the third batch, involving a total of 113 varieties.
Follow-up, on the one hand, is the normalization of the collection of national organizations to carry out - collection of products and collection of the main body continue to expand;
more far-reaching impact of drug payment standards, industry authorities told Seberan that the exploration and development of payment standards is one of the important purposes of the national organization of drug collection.
once the payment standards are formally introduced, this will have an impact on the use of drugs in selected varieties, non-selected varieties, hospitals and retail pharmacies.
Shi Lichen, founder of the Beijing Dingchen Medical Management Consulting Center, told SaibaiLan today that according to the policy orientation of the National Health Insurance Administration, the national health insurance directory and medical insurance payment standards will gradually be unified, but considering the different capacity of the provinces to pay for medical insurance funds, the determination of payment standards will also take into account the situation of the provinces comprehensive formulation.
return to the national collection of varieties, according to the relevant policy requirements, medical insurance payment standards should be set in accordance with the winning price, but at present, the same generic name under the different drugs, in the provinces of the tender price difference is still relatively large.
with the harmonization of payment standards, this could push down the tender prices for these drugs further, arguably at least in the policy market, and the prices of these varieties will face a downward decline.
as the price of the winning variety spreads to the level of payment standards, non-selected drugs will be affected, and in some ways, payment standards will be developed to expand the impact of volume procurement.
further, as the standard of payment for varieties collected and even more is reduced, as long as they are included in the National Health Insurance Directory, they will be affected by the standard of payment for health insurance.
for affected drug companies, entering retail pharmacies at their own expense may become an option for non-selectable varieties.
yards wanyu further said to Cypress Blue, with the establishment of payment standards, non-selecting enterprises are basically left with the following few options: First, Mo fist rub, waiting for the next collection in the full fight for the election.
drug companies that have not yet been selected have suffered a new blow on the unseeded circuit, and the mentality is likely to change further;
drug companies could retain their existing market share by lowering the price of the internet in the affected areas, or consider overseas markets with relatively calm policies.
relatively intuitive price, the system of medical insurance payment standards has far-reaching implications and cannot be ignored.
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